Evelyn M. Chung DDS UCLA School of Dentistry Division of Advanced Prosthodontics

1. 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

2. Learning Objectives

3. Learning Objectives

4. 32 million non-institutionalized people have a chronic disabling condition. Will require a change in their dental treatment. http://www.raconline.org/maps/#disability

5. 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

6. Dental provider • Difficulty in communication • Time • Finances • Lack of experience and insufficient undergraduate experience/clinical exposure 3

7. 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

8. 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

9. Learning Objectives

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. Results • 2010-2013 • 306 students attended the rotation • 135 surveys were returned

18. 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

19. Results – types of patients seen

20. Results – treatment techniques

21. Results – comfort levels in patient treatment

22. Results – barriers to care

23. Learning Objectives

24. 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

25. 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

26. 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

27. 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 Thank you for your Attention.

28. 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. • 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. • 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 • 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. • 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.