SPECIAL PATIENT CARE EDUCATION AN EDUCATIONAL EXPERIENCE AT

LEARNING OBJECTIVES The importance of special needs patient education in the dental curriculum Improving

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

CHALLENGE: Recognition that people with special needs have poor oral health and high levels

DENTAL PROVIDER Difficulty in communication Time Finances Lack of experience and insufficient undergraduate experience/clinical

CURRICULUM In 2007, the American Dental Association, Commission on Dental Accreditation (CODA) recommended that

The higher a dental student’s perceived value is of their pre-doctoral special needs

BEFORE: �Lecture series on different disorders, conditions, management techniques �Assessment was done using multiple

NOW: Started in 2010 1 day and 1 hour rotation Junior year of dental

CASE PRESENTATION Given by fellow junior dental students that attended the rotation the week

HOSPITAL DENTISTRY CLINIC GPR Conscious sedation patients � Practice starting IVs HN cancer patients

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

INPATIENT EXPERIENCE AT THE RRUCLA MEDICAL CENTER Visiting inpatients during consultation/exam/treatment Discussion of dental

METHODS Survey was administered to the dental students at the conclusion of 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

RESULTS – TYPES OF PATIENTS SEEN 90 80 70 60 50 40 30 20

RESULTS – TREATMENT TECHNIQUES 70 60 50 40 30 20 10 0 orrinttn short/freq

RESULTS – COMFORT LEVELS IN PATIENT TREATMENT 120 100 80 not 60 somewhat comfortable

RESULTS – BARRIERS TO CARE 133 128 123 118 113 108 finances transportation finding

COMMENTS Strengths: � opportunity to observe patient treatment in an inpatient setting, dental treatment

DISCUSSION Well received by the students Students reported good comfort levels in treatment of

FUTURE GOALS Improve assessment of rotation Consider a longer rotation Possible simulation model Offer

THANK YOU FOR YOUR ATTENTION. QUESTIONS? Special thanks to Dr. Kelly Pierson and Dr.

REFERENCES Cumella S, Ransford N, Lyons J, Burnham H. Needs for oral care among

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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 The importance of special needs patient education in the dental curriculum Improving access to dental care for special needs patients Evaluation of the teaching model to improve students’ educational experience Share our educational experience at the UCLA School of Dentistry

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 care � Finances � Transportation � Architectural challenges � Anxiety Patient Dental provider

DENTAL PROVIDER Difficulty in communication Time Finances Lack 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

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 setting Clinic 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 90 80 70 60 50 40 30 20 10 0 hearing vision speech nuromusc physic psycho dev dlay dementia sev med comp other none

RESULTS – TREATMENT TECHNIQUES 70 60 50 40 30 20 10 0 orrinttn short/freq sch time caregvr mod comm consult MD refer

RESULTS – COMFORT LEVELS IN PATIENT TREATMENT 120 100 80 not 60 somewhat comfortable 40 20 0 hearing vision speech psycho dementia dev dlay nuromusc physic sev med comp

RESULTS – BARRIERS TO CARE 133 128 123 118 113 108 finances transportation finding a dds sed/GA Dent offc dsgn oral home care

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 students Students 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

THANK YOU FOR YOUR ATTENTION. 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

REFERENCES 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. 1.