SPECIAL PATIENT CARE EDUCATION: AN EDUCATIONAL EXPERIENCE AT THE

UNIVERSITY OF CALIFORNIA, LOS ANGELES SCHOOL OF DENTISTRY

Evelyn M. Chung DDS

UCLA School of Dentistry

Division of Advanced Prosthodontics

LEARNING OBJECTIVES

Improving access to

dental care for special

needs patients

The importance of special needs patient

education in the dental curriculum

Share our educational

experience at the UCLA School of

Dentistry

Evaluation of the teaching model to improve students’

educational experience

LEARNING OBJECTIVES

Improving access to

dental care for special

needs patients

The importance of special needs patient

education in the dental curriculum

Share our educational

experience at the UCLA School of

Dentistry

Evaluation of the teaching model to improve students’

educational experience

32 million non-institutionalized people have a chronic disabling condition.

Will require a change in their dental treatment.

http://www.raconline.org/maps/#disability

CHALLENGE:

Recognition that people with special needs have poor oral health and high levels of unmet need in terms of prevention of periodontal disease, restorative and functional treatment. 1,2

Barriers to careFinancesTransportationArchitectural challengesAnxiety

Patient

Dental provider

DENTAL PROVIDER Difficulty in communication Time FinancesLack of experience and insufficient

undergraduate experience/clinical exposure 3

CURRICULUM In 2007, the American Dental

Association, Commission on Dental Accreditation (CODA) recommended that Graduates must be competent in addressing the treatment needs of patients with special needs.

2009, Int J Oral Sci, Holder M, Walsman HB, Hood H Majority of students felt inadequate in their

competency to treat SNP Directors of medical/dental residencies indicated

that residents need additional training

The higher a dental student’s perceived value is of their pre-doctoral special needs patient (SNP) experiences, the more likely they are to treat them in private practice. 4,5

LEARNING OBJECTIVES

Improving

access to

dental care for

special

needs patien

ts

BEFORE:

Lecture series on different disorders, conditions, management techniques

Assessment was done using multiple choice/short answer/essay questions

No formal clinical experiences for students in a special needs settingClinic exposure

NOW: Started in 2010 1 day and 1 hour rotation Junior year of dental school Presentation with Q&A Hospital Dentistry Clinic Operating room RRUCLA Medical Center – inpatient visit

CASE PRESENTATION Given by fellow junior dental students that

attended the rotation the week before Powerpoint format Present the case, review medical history,

physical examination, medical and dental implications, considerations and treatment planning as it relates to medical condition(s) of the patient

Q&A session 60 minutes

HOSPITAL DENTISTRY CLINIC GPR Conscious sedation patients

Practice starting IVs HN cancer patients H&P exam with a SNP and a physician Wheelchair transfers and general

management techniques Choose a patient that they observed this day

to do the case presentation the following week

OPERATING ROOM SETTING OPSC and RRUCLA Medical Center Patient management Discuss anesthesia, airway management,

dental challenges in this setting Access to care in a hospital setting Finances, recall frequency, conservatorship, etc.

Observe treatment of patient under general anesthesia

INPATIENT EXPERIENCE AT THE RRUCLA MEDICAL CENTER Visiting inpatients during

consultation/exam/treatment Discussion of dental treatment as it relates to

the patient’s medical condition Involvement in the overall health care of the

patient

METHODS Survey was administered to the dental

students at the conclusion of the rotation Anonymous Multiple choice questions about their

impressions, experiences and comfort levels in treating SNP

Comments section – strengths of the rotation, and improvements for the rotation

RESULTS 2010-2013 306 students attended the rotation 135 surveys were returned

SURVEY Student experiences with patients with a

disability/special need Different modifications in routine dental care Student comfort levels in treating patients

with special needs Barriers to care Comments section

What they liked What needs change/improvement

RESULTS – TYPES OF PATIENTS SEEN

hear

ing

vision

spee

ch

nuro

mus

c

phys

ic

psyc

ho

dev

dlay

dem

entia

sev

med

com

p

othe

r

none

0

10

20

30

40

50

60

70

80

90

RESULTS – TREATMENT TECHNIQUES

orrinttn short/freq sch time caregvr mod comm consult MD refer0

10

20

30

40

50

60

70

RESULTS – COMFORT LEVELS IN PATIENT TREATMENT

hearing vision speech psycho dementia dev dlay nuromusc physic sev med comp

0

20

40

60

80

100

120

not somewhat comfortable

RESULTS – BARRIERS TO CARE

finances transportation finding a dds sed/GA Dent offc dsgn oral home care105

110

115

120

125

130

LEARNING OBJECTIVES

Improving

access to

dental care for

special

needs patien

ts

COMMENTS

Strengths: opportunity to observe patient treatment in an

inpatient setting, dental treatment in the operating room and sedations

high faculty to student ratio clear integration of medicine and dentistry

Improvements: students wanted more direct involvement in

patient care longer rotation

DISCUSSION

Well received by the studentsStudents reported good comfort

levels in treatment of SNP following the rotation

4-6 students that attend the case presentations regularly, even though they are not on the rotation

FUTURE GOALS Improve assessment of rotation Consider a longer rotation Possible simulation model Offer opportunities for dental students to

participate more in the care of SNP Practice management

How to incorporate the care of SNP into a private practice

TH

AN

K Y

OU

FO

R Y

OU

R A

TTEN

TIO

N.

QUESTIONS?

Special thanks to Dr. Kelly Pierson and Dr. Mita Jethwani for leading the students during this rotation. Their leadership and dedication have and will be instrumental in the success of this rotation

REFERENCES1. Cumella S, Ransford N, Lyons J, Burnham H. Needs for oral

care among people with intellectual disability not in contact with Community Dental Services. J Intellect Disabil Res 2000: 44(Suppl 1): 45-52.

2. Pezzementi ML, Fisher MA. Oral health status of people with intellectual disabilities in the southeastern United States. J Am Dent Assoc 2005:136:903-912.

3. Holder M, Waldman HB, Hood H, Preparing health professionals to provide care to individuals with disabilities. Int J Oral Sci 2009 Jun;1(2):66-71

4. Chavez EM, Subar PE, Miles J, Wong A, Labarre EE, Glassman P. Perceptions of predoctoral dental education and practice patterns in special care dentistry. J Dent Educ. 2011 Jun: 75(6):726-732.

5. Vainio L, Krause M, Inglehart MR, Habil P. Patients with special needs: Dental students educational experiences, attitudes, and behavior. J Dent Educ 2011; 75 (1): 713-722.