2. Oral Maxillofacial Surgery Orthodontic Periodontic Oral
Medicine and Pathology Dental Paediatric Restorative Dentistry
Special Needs Dentistry (2008)
3. SND What?
4. That part of Dentistry concerned with the oral health of
people adversely affected by intellectual disability, medical,
physical or psychiatric issues. (RACDS)
5. That part of dental practice which deals with patients where
intellectual disability, medical, physical or psychiatric
conditions require special methods or techniques to prevent or
treat oral health problems, or where such conditions necessitate
special dental treatment plans. (ADA)
6. The oral health management of patients adversely affected
orally by intellectual or physical disability and medical or
psychiatric issues or, more often, a combination of a number of
these factors, where such conditions necessitate a modified
delivery of oral health care for patients total health
well-being
7. SND as a specialty: 2003-New Zealand and Australia (SND)
(Hospital Dentistry and Paediatric Dentistry) 2008- United Kingdom
(SCD) (Dentist with special interest in SCD) 2008- Malaysia
(SND)
8. Dr Jane Chalmers: Passed away on 7th Dec 2008 after a battle
of cancer. Key organizer instrumental of ASSCID. First Australian
who received PhD and became an associate professor in that
field
9. Dr Peter King BDS MDS FICD Working at Hunter New England
Health Service as a specialist providing oral health services to
people with special needs. Peter was the first President of the
Australian Society of Special Care in Dentistry and is on the
editorial board of the International Journal of Disability and Oral
Health.
10. Impairment as any loss or abnormality of physiology or
anatomical structure or function Disability any restriction or lack
(resulting from an impairment) of ability to perform an activity in
a manner or within the range considered normal for a human being
International Classification of Functioning, Disability and
Health
11. Handicap seen as the disadvantage for a given individual,
resulting from an impairment or a disability, which limits or
prevents the fulfillment of a role that is normal (depending on
age, sex, social and cultural factors) for that individual
International Classification of Functioning, Disability and
Health
12. Intellectual disability A disability characterized by
significant limitations both in intellectual functioning and in
adaptive behavior, which covers many everyday social and practical
skills. This disability originates before the age of 18 (AAIDD
website, 2011) Examples: Down syndrome Global developmental
delay
13. Physical disability Either loss or missing body parts
and/or functions including hemiplegia, paraplegia, tetraplegia
which affecting activities of daily living such as personal care,
movement and body posture (JKM website,2011) Examples of etiology:
Spinal Cord Injury Stroke Traumatic brain injury Cerebral
Palsy
14. Medical complex Receiving treatment or medication for any
other long-term conditions or ailments and still restricted in
everyday activities Any other long-term conditions resulting in a
restriction in everyday activities
15. Psychiatric/psychological disorders a broad range of
problems, with different symptoms. However, they are generally
characterized by some combination of abnormal thoughts, emotions,
behaviour and relationships with others (WHO website, 2011)
Examples: Schizophrenia Depression
16. Geriatric dentistry Focuses on the diagnosis, prevention
and treatment of oral diseases in adults who, because of their
medical condition or old age, are handicapped or institutionalised
and require special management during their dental treatment
21. Unmet treatment needs due to barriers to dental care
Increase in numbers of the elderly population and people with
disabilities with multiple medical conditions leading to impairment
Absence of follow up and maintenance care
22. Individual barriers: Lack of perceived needs Anxiety or
fear Financial considerations Lack of access Dental profession:
Inappropriate manpower resources Uneven geographical distribution
Training inappropriate to changing needs and demands Insufficient
sensitivity to patient attitudes and needs
23. Society: Insufficient public support of attitudes conducive
to health Inadequate oral health care facilities Inadequate oral
health manpower planning Insufficient support for research
Government: Lack of political will Inadequate resources Low
priority Unattractive problems * KEY - EDUCATION
24. The majority of problems for all could be addressed by an
ideal public health system. Unfortunately, the situation in many
countries is far from ideal, and the demand for secondary and
tertiary care continues to grow. This is particularly true of the
population with special needs where an accumulation of unmet need
continues to be discovered (Faulks & Hennequin, 2006)
25. Akta Orang Kurang Upaya 2008:- 'Orang Kurang Upaya'
termasuklah mereka yang mempunyai kekurangan jangka panjang
fizikal, mental, intelektual, atau deria yang apabila berinteraksi
dengan pelbagai halangan, boleh menyekat penyertaan penuh dan
berkesan mereka dalam masyarakat.
26. 1. Orang kurang upaya hendaklah mempunyai hak untuk
menikmati kesihatan atas asas kesetaraan dengan orang upaya 2.
Majlis, sektor swasta dan pertubuhan bukan kerajaan hendaklah
mengambil langkah yang sesuai untuk memastikan orang kurang upaya
mendapat akses kepada perkhidmatan kesihatan, termasuk rehabilitasi
berkaitan kesihatan,yang peka gender
27. Hospital-based specialty Focusing on individual 16 year old
and above Providing clinical support at the local community health
centers-visiting and consultation, combined clinic with other
dental disciplines Referral to specialist in SND patients with
complex problems (ASA III/ASA IV) or issues with multiple
co-morbidities and polypharmacy Demonstrate appropriate clinical
skills in relation to behavioural management strategies,
understanding legislation and ethics, positive attitude towards
PWD
28. Hospital Kuala Lumpur Hospital Serdang Current SND service
provision (2011 and 2012) General dentistry services with
modification in accordance with patients condition For examples:
Comprehensive dental treatment (restorative works, RCT, routine
periodontal therapy, simple extraction /MOS, biopsy ) under GA,
sedation or with behavioral modifications strategies. Preventive
strategies including close monitoring of oral hygiene care
performed by carer at home. Treatment/ procedures Physical
disabilites Psychologic/psychiatric issues Complex medical
conditions Intellectual/behavioural issues Patient who requires
conscious sedation/GA Type of patients
29. Treatment modifications Hearing and visual impairment
Wheelchair users Managing the challenging behaviour Ensuring airway
patency Referral for treatment and consultation by specialists
Inter-collaboration with other health care providers Physical
interventions
30. All patients in ASA III and IV category requiring oral
health care, including geriatric patients Patients with
intellectual impairments/disabilities requiring dental treatment
under sedation or general anaesthesia or unable to receive
treatment at the community dental setting
31. Patients with physical disabilities with significant
co-morbidities and mortality conditions All in-patients requiring
oral health assessment prior to organ transplant procedure All
in-patients requiring an assessment or oral health care prior to
cardiac surgery
32. All in-patients undergoing head and neck radiotherapy/
chemotherapy, during and after the therapy Patients with
psychiatric and psychological conditions with associated medical
conditions which compromising the oral health status
33. Patients referred by the community dental centers or
rehabilitation centers because they cannot be managed at the
community dental setting due to the complex medical issues or
behavioural problems.
34. ASA DEFINITION DENTAL TX MODIFICATIONS I Normal , healthy
patient None II A patient with mild systemic disease, e.g. well
controlled diabetes, anticoagulation, mild asthma, hypertension,
epilepsy, pregnancy, anxiety. Medical advice may be helpful. Often
few treatment modifications needed, unless GA or major surgery is
needed.
35. ASA DEFINITION DENTAL TX MODIFICATIONS III A patient with
severe systemic disease limiting activity but not incapacitating,
e.g. chronic renal failure, epilepsy with frequent seizures,
uncontrolled hypertension, uncontrolled diabetes, severe asthma,
stroke. Medical advice is helpful. Dental care should focus on
elimination of acute infection and chronic disease, prior to
medical/surgical procedure (e.g. haemodialysis patients). Patients
are often best treated in a hospital- based clinic where medical
expert is available.
36. ASA DEFINITION DENTAL TX MODIFICATIONS IV A patient with
incapacitating disease that is a constant threat to life, e.g.
cancer, unstable angina or recent myocardial infarct, arrhythmia,
recent cerebrovascular accident, end- stage renal disease, liver
failure. Medical advice is indicated. All potential dental problems
should be corrected prior to medical/ surgical procedure to deal
with basic problems (e.g. radiotherapy to head and neck, or organ
transplant). Patients are often best treated in a hospital- based
clinic where medical expert is available. Emergency dental care
indicated.
37. ASA DEFINITION DENTAL TX MODIFICATIONS V Moribund patient
not expected to live more than 24 hours with or without treatment.
Medical advice is essential. Patients are often best treated in a
hospital-based clinic where expert medical support is available.
Emergency dental care indicated.
38. Generalized marginal gingivitis Chronic Periodontitis and
Dental caries
39. Poor oral hygiene Chronic periodontitis
40. Manual dexterity issues Microstomia
41. Frail and functionally dependent (relying on the carers for
activities of daily living (ADL) such as bathing, eating and tooth-
brushing) Neurologic and cognitive impairments Communication and
behavioural problems Increased chronic medical conditions including
polypharmacy Chronic psychiatric/psychological conditions
42. Nutritional/swallowing problems Poor motivation towards
oral health care Elderly who is categorized as ASA III or ASA IV
Patients require dental management under conscious sedation or
general anaesthesia
43. Clinical presentation of patient (either one or more):
-Intellectual/ cognitive/ developmental problem -Physical/
mobility/ manual dexterity issues Emotional/ mental issues -Chronic
medical problem history and current problems -Polypharmacy Impact
of the above conditions on oral health Impact on coping with dental
treatment at a normal setting Appropriate to refer to SND Impact on
performing and maintaining oral hygiene Appropriate to refer to SND
Impact of communication or behavioural challenge Appropriate to
refer to SND Impact on provision of treatment Risk of medications
esp. Bisphospho-nate therapy Appropriate to refer to SND Risk of
bleeding and/or healing problems Appropriate to refer to SND
Require sedation or GA Appropriate to refer to SND
44. Consultation Urgent treatment Further management Reason for
referral Referral letters with complete patients details and
relevant documents including valid OKU card/photocopy or guarantee
letter The responsibilities of the referring clinicians
Prioritizing the patients Review the referrals in accordance to
referral guidelines Advice for referred patients The
responsibilities of the referral centers
