SYMPOSIUMS

Symposium 1: Abstracts, Biological approaches to disease management throughout the lifecourse of people with disabilities

Symposium 1: Abstracts

Biological approaches to disease management throughout the lifecourse of people with disabilities

Chair- Denise Faulks1

1Université Clermont Auvergne, CROC (Centre for Clinical Research in Dentistry) and CHU Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
Session Outline:

In the last 30 years, dental treatment has moved away from the purely mechanical replacement of diseased tooth tissue towards a more biological approach. This evolution has been supported by a conservative and functional philosophy of care that can be applied throughout the life course. To set the scene for this philosophy, Professor Sophie Doméjean will describe the tenets of Minimal Intervention Dentistry (MID) and their importance for our special care patients. Professor Gustavo Molina will lead on from this to describe MID resources such as remineralising and infiltrating agents as well the use of Atraumatic Restorative Treatment (ART) in populations with special needs, including the three year results of a clinical trial. In the second half of the seminar, approaches to deeper dentinal caries will be presented by Doctor Pierre-Yves Cousson. His research on pulpotomy in the adult dentition shows promising results and may be an alternative to extraction for some patients. Finally, Dr Graeme Ting will present the applications of MID, ART and silver diamine fluoride techniques in ageing adults, allowing a conservative approach in challenging conditions.

Abstracts

S1:1 Sophie Doméjean1

1Université Clermont Auvergne, CROC (Centre for Clinical Research in Dentistry) and CHU Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France

The concept of minimal intervention dentistry (MID) encompasses all preventive and therapeutic measures used to prevent the onset and progression of diseases affecting soft and hard tissues. Most often, however, the term MID is applied to the prevention and management of dental caries. MID not only concerns the symptoms of a disease but mostly the causes. In cariology, its scope is broad: it includes the detection of the earliest possible lesions, the identification and management of risk factors (caries risk assessment) and the implementation of targeted prevention strategies, including patient/caregiver education (depending on the patient autonomy) and monitoring. When the effects of the disease are present (carious lesions), other therapeutic strategies are required through the preferential use of less invasive solutions: remineralisation, therapeutic sealants, resin infiltration or, in cases of cavitated carious lesion, restorative care that aims to retain the maximum amount of sound tooth tissue. MID applies to all patients, at all ages, whatever the health condition and disability. A MID orientated treatment plan is decided, case by case, patient by patient, according to individual needs and particularities of each patient. The aim of the presentation is to present the global philosophy of MID based on the latest scientific evidences.

S1:2 Gustavo Molina1

1Facultad de Ciencias de la Salud—Universidad Católica de Córdoba and The Dental Faculty—Universidad Nacional de Córdoba, Argentina

Prevalence of caries among people with disability is equal to lower compared to people without disability. However, there is a higher number of untreated cavities in the first group. Barriers such as the inability to cope with ordinary restorative procedures may compromise the provision of dental care to this population and can be improved by shifting to a more conservative, less invasive approach by means of several resources proposed in the scope of MID. Caries risk assessment, the use of strategies and products for chemical control of demineralization processes as well as preventive-restorative concept like the ART approach have been clinically tested with promising results. Enhanced formulations of restorative glass-ionomers have largely contributed to this success. Quality of the restorations compared to conventional treatment still remains as a matter of discussion.

S1:3 Pierre-Yves Cousson1: co-authors- Zanini M, Munoz ML, Hennequin M

1Université Clermont Auvergne, CROC (Centre for Clinical Research in Dentistry) and CHU Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France

Pulpotomy is traditionally indicated for the treatment of immature permanent teeth with deep carious lesions or trauma but a healthy pulp or reversible pulpitis. However, with the development of bioactive materials, pulpotomy could become an alternative to root canal treatment in vital, mature permanent teeth. Numerous studies have demonstrated a good success rate for vital pulp therapy on 
permanent teeth. Pulpotomy is defined as a procedure in which part of an exposed vital pulp is
removed, allowing the preservation of the vitality and function of the
remaining pulp. The
portion of the degenerative pulp tissue is removed leaving behind healthy and vital tissue. The healthy radicular pulp is capped with a bioactive material which enables the formation of tertiary dentine or a mineralized barrier against aggression. The objective of such procedure is to preserve all the functions of the pulp. Moreover, pulpotomy is technically less complicated, less time-consuming, and less expensive than root canal treatment and could be indicated in difficult endodontic cases.

S1:4 Graeme Ting1

1Faculty of Dentistry, Department of Oral Diagnostic and Surgical Sciences, University of Otago, New Zealand

Advances in medical and dental science, are allowing people in many parts of the world to live into older age with more of their own teeth than ever before. Medical, physiological and psychosocial factors can combine to increase the risks of caries and periodontal disease in older people. In particular; vulnerable, institutionalised, frail older people, have a higher caries incidence than their peers living independently in the community. Sometimes a combination of medical, behavioural, physical, psychological and or financial factors make treatment planning choices and provision of care perplexing. Biofilm modulation, the use of MID, ART and silver diamine fluoride techniques in ageing adults, can sometimes allow a conservative approach to caring for frail people in demanding conditions.

Symposium 2: Abstracts, Orthodontics for people with disabilities

Symposium 2: Abstracts

Orthodontics for people with disabilities

Chair- Reena Kumar

Stefan Axelsson1

María Teresa Abeleira2

1Tako Centre, Oslo, Norway
2University of Santiago de Compostela, Santiago de Compostela, Spain
Session Outline:

To ensure that orthodontic treatment becomes more available to persons with disabilities, knowledge about the possibilities and limitations of orthodontic treatment must be included in the curriculum in the orthodontic speciality. The orthodontist should have a pragmatic view of orthodontic treatment and aims should be modified from the “ideal”, but still be an aesthetically acceptable and functional result. This session will address some off the challenges influencing treatment goals and outcomes and two speakers will illustrate their talks with clinical cases which outline necessary modifications to achieve good outcomes and also present lessons learned.

The complete knowledge about the prevalence of malocclusions in groups of persons with disabilities are not fully known, but reports suggest that the prevalence is much higher than in the general population. In addition, the severity of the malocclusions is higher and more complex. Thereby the orthodontic treatment needs are large. In addition to the normal spectrum of malocclusions, there are syndrome-specific craniofacial deviations and malocclusions. The most frequent aetiological factor is deviant orofacial function (breathing pattern, chewing, lip seal, tongue posture, and speech). These aetiological factors also influence the treatment goals, results and stability. It is therefore sensible for the orthodontist to seek collaboration with an oral motor function treatment team.

One of the greatest challenges is patients with cognitive or learning disabilities alongside treatment of patients with physical/functional deviations, such as CLP, craniofacial syndromes and multiple hypodontia. Refusal of delivery of orthodontic treatment to persons with disabilities are made on different grounds, such as poor oral hygiene, inadequate cooperation, and insufficient degree of manual dexterity but use of different behaviour modification techniques, adjustments in the treatment setting, and sedation techniques can be included in the orthodontic treatment toolbox to address many of these issues.

Symposium 3: Abstracts, “It’s too late to say I’m sorry” - exploring outcomes and possibilities under general anaesthesia and sedation for people with disabilities

Symposium 3 Abstracts

“It’s too late to say I’m sorry” - exploring outcomes and possibilities under general anaesthesia and sedation for people with disabilities

Chair- Alison Dougall

Session Outline:

The literature describes inequality regarding the number of missing teeth in older people with disabilities. Alongside the social determainant of Health, over their lifecourse cumulative effects of toothloss may be generated in part by attitudes and cultural norms of the profession, poor access to a full scope of dental care and/or rationing of care under general anaesthesia or sedation. This is underpinned by a poor evidence base to inform decision making around long term outcomes. Paying attention to the requirement for equivalence of care for peeple with disabilities according to the Convention for the Rights of People with disabilities, this session will look at what influences the decision making processes that may favour toothloss over rehabilitation of the dentition. It also aims to look at strategies to reduce inevitable tooth loss for people with disablities over the life course. Four experienced speakers will outline their clinical perspectives and research in this area with time for a lively interactive discussion and questions from the floor.

Abstracts

S3:1 ‘It’s too late to say I’m sorry1

Caoimhin Mac Giolla Phadraig1 (presenting author), Danielle McGeown1, June Nunn1

1Trinity College Dublin, The University of Dublin, Ireland

Total tooth loss is an accumulative disabling condition that reflects the burden of oral disease and the effectiveness of disease management over the life course. It is seen commonly with both age and intellectual disability. Considering edentulism, therefore, as a barometer of both the experience of and the outcomes from oral disease, oral health outcomes for people with ID can be seen as poor, despite regular use of dental care. This presentation aims to identify edentulism as oral disability and relate this to oral health service use by considering recent and relevant research in this area in Ireland.

By the end of this presentation attendees should be able to identify international trends in edentulism and describe the impact of edentulism on adults with ID Recognise international dental service use trends among adults with ID and consider a life-course approach to minimally invasive oral healthcare for people with ID to avoid edentulism and oral disability.

S3:2 Assuring equitable outcomes under General Anaesthesia for people with disabilities

Denise Faulks1 (presenting author), Pierre-Yves Cousson1, Nicolas Decerle1, Martine Hennequin1

1CHU Clermont-Ferrand, Service d’Odontologie, Clermont Universite´, Universite´ d’Auvergne, EA3847, Centre de Recherche en Odontologie Clinique, Clermont-Ferrand, France

General anaesthesia (GA) is a permissive procedure which allows access to high quality oral rehabilitation for patients who may have difficulty cooperating in a conventional setting or who present an accumulation of treatment need. The essential aim of dental treatment under GA is to provide equivalent care in terms of treatment options and equivalent quality of care as for all other patients. This presentation will describe the procedural protocols that can be put in place to ensure equitable treatment options, even when time constraints are limiting, including the provision of molar endodontics. It will describe the equipment that is necessary to perform successful restorative and endodontic procedures under GA. The GA/ sedation continuum will be discussed as a useful tool in treatment planning for the provision of fixed dental and implant retained prostheses. A highly conservative approach is particularly important for those patients for whom removable dentures cannot be envisaged. The discussion will be based on published research, illustrated with presentations of patients treated at the Unit of Special Care Dentistry in Clermont Ferrand.

S3:3 Treatment under general anaesthesia and sedation for children, adolescents and young adults with Cerebral Palsy

Juan Pablo Loyola-Rodriguez1

1Universidad Autónoma de Guerrero, Mexico

This presentation describes the use of different options for facilitating dental treatment for patients affected by cerebral palsy (CP) in a dental school setting. 38 patients (20 female and 18 male) with diagnostics of CP were included. The mean age was 7.14+/-2.2 years for children's group and 18.5+/-3.06 years for adolescent and young adult group. Risks and benefits of conscious sedation and general anaesthesia were written into a consent form and these were discussed with parents or guardians of each patient. Most children (77.3%) were classified as ASA II with a level of behaviour I-II according to Frankl's scale and they were treated under general anaesthesia (GA). For patients that were classified with positive behaviour and little necessity of dental procedures, independent of the medically compromised level, dental treatment was provided with conscious sedation. Dental procedures were completed as follows: in children: composites, dental prophylaxis/sealants and dental extractions; in adolescents and adults, importantly the requirement for restoration of anterior teeth and molar endodontic treatment alongside surgical procedures was more common than in younger children. The mixture of sevoflurane-propofol worked effectively during pre-, peri-, and post-operative procedures. During the discharge process, most patients needed a recovery of 20-40 minutes after which they were awake and oriented, breathing comfortably with stable vital signs. It was concluded that both GA with sevoflurane-propofol and conscious sedation are an excellent tool to provide a full scope of required dental treatment in CP patients in a dental school setting without most of the major reported postoperative complications, such as nausea and vomiting.

S3:4 The use of the WHO Surgical Safety Checklist to address risk under General Anaesthesia in SCD

Fatimah Alsayer1

1Special Care Dentistry Department, Eastman Dental Hospital, University College London Hospitals, UK

Background: The World Health Organisation (WHO) surgical safety checklist (SSC) was introduced in 2008 as part of “Safe Surgery Saves Lives” campaign to reduce wrong site surgery, improve surgical outcome by ensuring patient’s safety and improving team’s communication. Aims: To review completed SSC forms to gain insight about team’s perception of SSC as a service improvement exercise. Design/ Methods: Inclusion criteria: All adult patients undergoing dental treatment under General anaesthesia (GA) as day case in 2017 were included in this review. All staff members involved in Special Care Dentistry GA list were invited to participate. Results: 95 patients were selected for this review. Consent was confirmed in 100%. 92 had all parts of SSC completed. 3 had some parts of SSC not completed. These include 2 sign-outs and 1 pre-op section incomplete. Team survey had favourable outcome with most team members perceived the SSC as a valuable tool in improving patient safety and communication among the team. Conclusion: The WHO SSC is an essential tool to avoid irreversible mistakes. All team members must be involved in SSC to ensure patient’s safety.When asked to comment, team members felt that SSC has improved communication between team members. Risks were identified earlier; this includes highlighting challenging behaviour in some patients with severe learning disability. Plans were discussed during team briefing which increased team members awareness and participation in the planned actions.
Keywords: WHO, surgical safety checklist, General anaesthesia

Symposium 4: Concepts of Dysphagia throughout the Life Course

Symposium 4

Concepts of Dysphagia throughout the Life Course

Masahiro Watanabe1

Shouji Hironaka2, President of iADH

Koichiro Matsuo3

1 Department of Oral Biological Science, Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences
2 Department of Special Needs Dentistry, Division of Hygiene and Oral Health School of Dentistry, Showa University
3 Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University
Session Outline:

Dysphagia is often an invisible problem - but has been described as a silent epidemic.....Firm statistics on the prevalence of swallowing disorders are also sparse, but a recent survey in the Netherlands estimated that they affect as many as 1 in 8 adults. People who struggle to swallow can easily choke, are more likely to develop aspiration pneumonia and they can often become dehydrated and malnourished, at best have to significantly amend their diet and may need to become tube fed to maintain a viable body weight.

In recent years, due to the progress of medical care, children with severe disease now survive through adolescence into adulthood, however on the other hand many remain deprived of the function to taste or swallow delicious food due to various influences. Moreover, alongside children with chromosomal abnormalities and/or severe disease which are previously said been said to have be short-lived, many have extended life expectancy so it becomes necessary to consider ageing superimposed on the influence of the condition itself. In Japan, the field of swallowing disorder (Dysphagia) develops differently from the rest of the world, with dentists and dental hygienists contributing greatly to diagnosis and treatment of dysphagia.

Dental intervention includes development and use of devices that support various swallowing functions alongside oral healthcare. Video fluoroscopic examination of swallowing and Video endoscopic examination of swallowing have spread to dentists in Japan, and various foods for dysphagic and disability people are appearing on the market and readily available. In our country, the problem of dysphagia throughout the life course has been evident from early 1980’ through its inclusion in the medical insurance.

In this seminar, we would like to introduce the efforts of the life course approach in our country divided into three themes: physiology of eating and swallowing, eating and swallowing disorder of childhood, and eating and swallowing disorder of the elderly.

Symposium 5: The Advocacy Toolkit: Skills and Strategies for effective action

Symposium 5

The Advocacy Toolkit: Skills and Strategies for effective action

Chair- Dimitris Emmanouil

Dimitris Emmanouil 1DDS, MS, PhD

Sue Greening2 MBE, BDS, DCDP, FDSRCS

Brian O’Mahony, President of the European Haemophilia Consortium

1 Assistant Professor, Dept of Pediatric Dentistry, Faculty of Dentistry, University of Athens, Greece
Visiting Assistant Professor, Kings Dental Institute, London, UK
2 Retired Consultant in Special Care Dentistry, Gwent, Wales
Despite the adoption of the Convention of the Rights for people with disabilities inequalities exist regarding the oral health of people with disabilities and also for the education and professional opportunities for the teams that treat them.

In 2016, IADH council and partners across health and social care crafted a series of statements regarding the Oral Health and Dental Care of People with Disabilities. These were later adopted as a joint FDI/IADH policy statement as a valuable tool to inform and encourage the direction of national or local strategies to achieve change. But to achieve real and sustained change requires advocacy skills working nationally and internationally at a top level with political leaders, governments and professional structures but also on behalf of and alongside those patient groups who are unable to manage their own oral health

Advocacy is a skill which is rarely taught despite its important and frequent need in Special Care Dentistry. To be effective before advocacy action comes planning, and before planning comes an understanding of what needs to be put in the plan. Collaborative working between partners is key.

This session aims to equip participants with an understanding of the principles of advocacy as illustrated with case studies and examples from the perspectives of a distinguished panel which includes a renowned advocacy expert and President of a large International Patient Organisation, a recent past-president of the International Association for Disability and Oral Health and this year’s life-member of IADH honoured for her role in successfully advocating for and achieving change in health services for people with disabilities and the teams that treat them during her long and successful career.

Symposium 6: Multi-professional strategies to manage oro-motor function

Symposium 6

Multi-professional strategies to manage oro-motor function

Lorena Sepúlveda1

Daniel Carreño2,3

Asa Mogren4

Pamela Åsten5

Colman McGrath6

1 Faculty of Dentistry, University of Chile, Chile
2 Pedro Aguirre Cerda National Rehabilitation Institute, Chile
3 Special Care Dentistry education, Dental School, Pontificia Universidad Católica de Chile, Chile
4 Mun-H-Centre, Public Dental Service, Region Västra Götaland, Sweden
5 TAKO-centre, Lovisenberg Diakonale Sykehus, Norway
6 Faculty of Dentistry, University of Hong Kong, Hong Kong
Session Outline

Orofacial dysfunctions are present in all ages and relate to several diagnoses, both congenital and acquired. Any dysfunction in the area of the face and mouth can have great impact on important body functions and may negatively affect quality of life. In case of orofacial dysfunction, oral health is also at risk. Thus, all professionals in the dental team should have sufficient knowledge about orofacial function and strategies on how to best care for this group of patients, throughout the whole life span. Young children with eating disorders, adolescents with myofunctional disorders and geriatric patients with reduced oral clearance - they all need care from a multi-professional team.
In this seminar, we will cover a spectrum of disorders and conditions with emphasis on questions related to orofacial function. The presenters come from different parts of the world and together they represent a multi-professional team which includes dental specialists alongside speech pathologists from Latin America, Hong Kong and Scandinavia.

Symposium 7: Abstracts, Facilitating Oral Health for People with Autistic Spectrum Disorders (ASD)

Symposium 7: Abstracts

Facilitating Oral Health for People with Autistic Spectrum Disorders (ASD)

Egle Tuckiene1

Heather Jackson2

Jacobo Limeres-Posse3

1 Dr.Rose and Associates Dental Clinic, Pediatric Dentistry Department, Dubai, UAE
2 Innovation Myofunctional Therapy @Paediatric Oral Health and Dentistry, London, Ontario, Canada.
3 University of Santiago de Compostela, Spain
Session Outline

It has been demonstrated that some patients with ASD can be “trained” to tolerate dental procedures. There is no one system applicable to all patients diagnosed with ASD. Visual pedagogy and desensitisation to structure the time and space and to anticipate are well-known techniques that have shown reasonable good results. Nevertheless, in addition to the characteristics of each patient, success is determined by constraints of family support, time, money, and human resources.

This presentation will look at the different strategies utilised by three dental professionals from different backgrounds and cultures. A specialist paediatric dentist working in practice based environment in Dubai will describe her behavioural approaches. A dental hygienist and myofuntional practitioner from Canada will present an integrated sensory programme designed to maximise tolerance to dental interventions. The final speaker will how It is important to design individualised strategies to facilitate adaptation to the dental environment for people with ASD, but also recognise that some patients will require the use of GA or sedation and will discuss the decision making process around this choice.

Abstracts

S7:1 Dental Health and Behavior Guidance in Dental Treatment of Patients with Autism Spectrum Disorder (ASD)

Egle Vitaite Tuckiene1
1Dr.Rose and Associates Dental Clinic, Pediatric Dentistry Department, Dubai, UAE

In recent years dental practitioners are seeing patients with ASD diagnosis more frequently and the symptoms of disorder can have a detrimental influence on the ability of dental practitioners to provide necessary care. Understanding the environmental factors in the dental office that can influence the behaviour and cooperation ability of patients with autism helps dental professionals to be able to successfully treat these individuals. The aim of this presentation is to identify the most frequent problems among patients diagnosed with ASD, explain the key factors influencing behavioural issues of patients with ASD and share clinical practice provide recommendations to professionals treating to make dental treatment more comfortable for both dentist and patients alike.

Keywords: Autism, dental problems, behavioral problems, recommendations

S7:2 Patient guided sensory integration in ASD

Heather Jackson RDH OMT1
1Innovation Myofunctional Therapy @Paediatric Oral Health and Dentistry, London, Ontario, Canada.

Patient guided sensory integration (PGSI) combines many different approaches to sensory issues and the ability of a child to tolerate dental care. This often includes; music therapy, counting, positive reinforcement, choices, repetitive language/tasking, deep pressure as well as any other technique that have been found to be successful at home. The goal of the PGSI programme depends on the needs of the individual but is most often a comprehensive dental examination. By using the reaction of the child to these different techniques, the child guides the appointment. Although, most often used with children on the Autism spectrum, it can be useful for any child with sensory issues and is best implemented in the young. This creates a tolerance that can be continued through into adulthood. This session will explore the implementation of the PGSI as well as the long-term affect in the young adult.

Keywords: ASD, Sensory Integration, music therapy

S7:3 Individualised strategies for people with ASD – what happens when it’s not working?

Jacobo Limeres Posse1
1University of Santiago de Compostela, Spain

Dental care in people with Autism Spectrum Disorders (ASD) can be difficult due to the presence of disrupted behavioural patterns. Attitudes that have been described vary from total permissiveness and collaboration, even surgical procedures, to the impossibility in conducting an oral examination. So, it is hard to anticipate capability and capacity for tolerating a dental visit. The main challenges for people with ASD in the dental clinic are due to their difficulties with social interaction, sensory processing and communication which impacts on their ability to co-operate. Moreover, cognitive dysfunction, challenging behaviours, convulsions and resistance to changes in routines can be present which also reduce the possibility of being treated successfully in the dental chair. There is no effective universal behavioural management technique for all ASD patients. Gathering information via a preliminary interview with the parents/guardians of the patient is recommended to design an individualized behavioural control strategy. However, sometimes, the patient does not respond to communicative techniques or the progress is too slow. In these cases, or in an emergency situation, the need to perform dental treatment under General Anaesthesia (GA) should be considered. Factors associated with need for GA include previous behaviours shown in the clinic, the need to carry out extensive (4 quadrants of the oral cavity) and/or the need for complex (prosthetic rehabilitation) treatment. GA is also sometimes necessary to “update” the oral condition of the patient previous to starting with time-consuming techniques like behaviour modification techniques.

Keywords: autism spectrum disorders, challenging behaviour, general anaesthesia

Symposium 8: Abstracts, Dental management for people living with Epidermolysis Bullosa -DEBRA International Guidance

Symposium 8: Abstracts

Dental management for people living with Epidermolysis Bullosa - DEBRA International Guidance

Chair- Miguel Peñarrocha

Susanne Krämer1

James Lucas2

David Peñarrocha3

Sanchit Paul4

1 University of Chile, Santiago, Chile
2 Melbourne
3 Universidad Católica De Murcia, Spain
4 Department of Dentistry, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Session Outline

DEBRA International is a worldwide network of national groups working on behalf of those affected by the rare but lifelong skin condition, epidermolysis bullosa (EB). EB encompasses a clinically and genetically heterogeneous group of rare inherited disorders characterized by marked mechanical fragility of epithelial tissues with blistering and erosions following minor trauma. It has great significance for the dental professions with multiple oral manifestations, requiring a special approach from the dental point of view. The scientific literature regarding oral health care of people living with EB is relatively scarce and historically this has made it difficult for dentists with no experience in treating people with EB to know how best to address the challenges throughout the life course. In 2012 a team of international experts in this field published guidelines on dental care for people living with EB in partnership with DEBRA International, using a standard methodology based on a systematic review of the currently available scientific evidence and series of practice statements. In this seminar, key members of the Debra International panel of dental experts will present the principal oral features of this condition along with updates to further inform best practice in the areas of prevention and oral care, dental implants and anaesthetic management.

Abstracts

S8:1 Management of Odontogenic Facial Cellulitis under general anesthesia in Severe Dystrophic Epidermolysis Bullosa

Sanchit Paul1, Jessica Ebrahimi
1 Department of Dentistry, The Hospital for Sick Children, University of Toronto, Toronto, Canada

Introduction: Epidermolysis bullosa (EB)comprises a group of uncommon skin-related diseases, characterized by the formation of blisters on mucocutaneous regions occurring spontaneously, following a trauma, exposure to heat, or as result of minimal mechanical trauma.Due to the continuous scar formation and tissue shrinkage seriously involving the mouth opening and contracture of the lips and cheeks, children with EB have profound caries susceptibility, associated with difficulties in oral hygiene because of the brushing traumas. Facial cellulitis is an emergency seen in the pediatric population and if not treated well, can lead to serious concerns including death. Case Report: A 14 year-old boy with known diagnosis of EB presented in emergency department of the tertiary children’s hospital with left side facial cellulitis involving submandibular and buccal spaces. Intraoral examination revealed dental abscess in relation to 36 along with generalized enamel hypoplasia and other advanced multisurface dental caries. Oral manifestations also included microstomia, scarring on buccal mucosa and tongue leading to reduced mobility,desquamatitive gingivitis and chronic periodontitis. Based on clinical presentation of cellulitis and patient’s medical condition, he was put on intravenous clindamycin in Alternative Care Environment ( A.C.E.) protocol.On the third day, when the facial cellulitis subsided considerably, based on risk-benefit analysis by medical staff, it was decided to perform comprehensive dental care under general anesthesia.  Comments: This manuscript reviews the clinical features and guidelines for general anaesthesia management of dystrophic EB patients requiring complex advanced oral rehabilitation including facial cellulitis. Collaboration with others on the medical team is imperative for optimal care.

Symposium 9: Abstracts, Education and Training in Special Care Dentistry

Symposium 9: Abstracts

Education and Training in Special Care Dentistry

Chair: Shelagh Thompson

Session Outline:

The session will provide delegates with information on how other educators have introduced and embedded education and training in Special Care Dentistry (SCD) in their Schools and Institutions. The emphasis of the session will be based on the congress theme A Lifecourse approach to Disability and Oral Health and how teaching can be applied using this approach. In his welcome letter, Professor Shouji Hironaka, iADH President stated ‘the chains of risk can be broken and other interventions may be especially effective during the key life transitions, e.g. late adolescence to early adulthood and dependency in older age. It is an optimistic approach, but one which raises questions for policy, training and research’. This is true within education in Special Care Dentistry and what we learn from each other. Short presentations will be followed by an interactive discussion to share experiences and suggest solutions to develop a Lifecourse approach to SCD, inter-professional education and networking.

Abstracts

S9:1 An Overview of the life course approach to teaching and training in Special Care Dentistry

Shelagh Anne Thompson1

1School of Dentistry, University of Liverpool, England, UK

The Education session will focus on the iADH Congress theme- A Lifecourse approach to Disability and Oral Health and how teaching and training in Special Care Dentistry (SCD) could be applied using this approach. The need for a broad range of knowledge acquisition, development of transferable skills and enhanced attitudes and behaviours will be highlighted by five presenters, at different stages of development of Special Care Dentistry education, within their programmes. The emphasis will be on under- and postgraduate student education, and how this can be effective during key life transitions such as late adolescence to early adulthood and to dependency in older age.  The session will be led by an experienced educator who will facilitate interactive discussion between the presenters and delegates to share experiences, understand barriers and suggest potential solutions to developing a Lifecourse approach to SCD, through inter-professional education and networking in this field. The benefits of a commonality of educational approach, through embedding contemporary curricula in SCD will be highlighted, in the context of globalisation and movement of educators. Strategies and drivers such as SCD teacher’s groups could aid in advocacy for educational inclusion of Special Care Dentistry within Schools, Institutions and training programmes.

Keywords: Education, Special Care Dentistry, undergraduate and postgraduate curricula, training, inter-professional education

S9:2 Teaching undergraduate dental students in the only department for Special Care Dentistry in Germany, focusing on patients with different kinds of intellectual disabilities in all age groups: comparisons with the IADH curriculum.

Andreas G. Schulte1

1Dental School, Department of Special Care Dentistry, Witten/Herdecke University, Witten, Germany

In Germany, a minimum of 5 years is required for the education of undergraduate dental students. In Witten/Herdecke University undergraduate dental students of each year are offered lectures and/or practical courses in special care dentistry. In our department children, adolescents and adults with disability are cared for and it is mandatory for the students to assist in treatment sessions where patients with disability are examined, receive preventive care or dental treatment. Students also have to be present in treatment sessions carried out in general anaesthesia. On special occasions advanced undergraduate dental students have the opportunity to treat patients with disability under supervision. In the lectures the topics of all 6 domains listed in the IADH curriculum for undergraduate dental students are addressed.

S9:3 Empowering multidisciplinary care for people with disabilities via interprofessional oral health education involving medical, nursing and allied health students

Mas Suryalis Ahmad1

1Universiti Teknologi MARA Malaysia

Effective oral health management of patients with special needs requires multiple disciplinary intervention of various members of the healthcare team. Therefore, educational preparation is integral to prepare future members of the multidisciplinary team, including medical, nursing and allied health professionals for collaborative role in oral health care of these patients. This presentation will discuss efforts in a Malaysian institution to introduce interprofessional education in management of individuals with disabilities that incorporated involvement of dental, medical, nursing and allied health faculties, as well as non-healthcare personnel involved in this area.

Keywords: interprofessional education, special needs, disability

S9:4 Cem Dogan1

1Cukurova University, Turkey

In developing countries like Turkey, Special Care Dentistry is a relatively new working area and usually hosted within Pediatric Dentistry Departments despite their age because often there is nowhere for them to transition after they hit adolescence. The cross-cultural adaptation of the iADH undergraduate curriculum learning outcomes in Special Care Dentistry was published recently. However, there remain very few faculties in Turkey where Special Care Dentistry has a dedicated place in the curriculum during undergraduate education. Cukurova University, Faculty of Dentistry is one these faculties and the curriculum is designed to be multi-disciplinary. At the beginning of the academic year, the definition and meaning of special care is addressed and in order to increase the awareness of the students, the head of a non-governmental organization, related with the parents of patients who would need special care dentistry were invited to give conferences. At the end of the year the students were asked to fill a questionnaire to evaluate whether the program had met the student expectations. In my presentation I will discuss the results of this questionnaire and the future direction of Special Care Dentistry Education in Turkey.

S9:5 Process of establishing the Academic and Clinical Aspect of SCD in the Arab World, particularly in Lebanon: A promising challenge

Mohamad Ossama Saad El Masri1

1MSc student in Special Care Dentistry, University College London, London, United Kingdom; Beirut Arab University, Beirut, Lebanon

The Arab region of the world is rapidly changing and advancing. There are striking differences from the developed world in terms of prevalence and type of diseases leading to various forms of disability. Moreover, political challenges, financial constraints, limited healthcare systems, and negative attitudes and beliefs towards individuals with disability are all factors that can influence the provision of healthcare services for these individuals. These factors can additionally impact on access to oral healthcare, which is often not considered a priority. Approximately 15% of the people in the Arab region are estimated to be living with disability. Attitudes toward disability in this region have been found to be negative. There are few studies in the region reflecting the dental needs of individuals with disabilities. Dental education and training to provide oral health care for patients with disability in the Arab world are remarkably limited. Countries in the region should take advantage from the available evidence provided by the International Association for Disability and Oral Health (iADH) and the British Society for Disability and Oral Health (BSDH) and consider establishing SCD within the undergraduate and postgraduate curriculum. The aims of the presentation are to review the impact of disability across the region, identify factors that may influence access to healthcare, review barriers in order to enable the imminent approach to address the provision of SCD, and outline the pathway that will enable the establishment of the Academic and Clinical Aspect of SCD in the Arab world, and particularly in Lebanon.

Keywords: Arab World, Special Care Dentistry, Academic, Clinical, Pathway

S9:6 Special Care Dentistry in Oman: Steady steps towards the future

Nadiya Ali Alkindi1

1Ministry of Health, Muscat, Oman

Special Care Dentistry in Oman is a relatively new speciality. Most of the dental care provided for people with disabilities in Oman is within Muscat region and limited to a few hospitals. With an increase in the country's population and an evident increase in people with disabilities, crucial measures are needed to be taken to ensure accessible dental care services are available. Investing in education is one of many factors needed to expand and improve care for people with disabilities. Promising steps have been taken in dental education in Oman to include Special Care Dentistry in both the undergraduate and postgraduate curricula.

Keywords: Education, Special Care Dentistry, Oman

S9:7 Meeting the needs of patients with disabilities - How can we better prepare the new dental graduate?

Kathy Wilson1

Richard Holmes1

Kate Bird1

Laura Delgaty2

1School of Dental Science, University of Newcastle upon Tyne, United Kingdom
2School of Medical Education, University of Newcastle upon Tyne, United Kingdom

Background: The dental profession has a social responsibility to provide equitable oral health care for all. This is recognised in the UK, General Dental Council document ‘Preparing for Practice’, which states “ registrants must be able to recognise the needs of all patients, including those with special care requirements”. This raises the question, are we adequately preparing future dental professionals to fulfil their obligations? Aim: To explore final year dental students’ insight into issues of disability.

Research Questions:

1. What are students’ perceptions of their preparedness to meet the needs of patients with disabilities?

2. What has influenced this sense of preparedness?

Method: Two focus groups were employed to address the research questions. Sixteen final year dental students, attending Newcastle School of Dental Sciences participated. The transcribes were analysed using thematic analysis. Results: Four themes were identified; ‘perceptions of disability’, ‘experience of disability’, ‘patient management’ and ‘teaching and learning’. Exploring the themes further, it became apparent that levels of preparedness and self-efficacy varied among students. This variation could be attributed to, knowledge of disability issues, previous experience with people with disabilities and how education in Special Care Dentistry was delivered. Students identified the need for more structure to their teaching and increased exposure to the disabled community. Conclusion: The issues identified reflect current literature and highlight the importance of addressing disability within the wider undergraduate curriculum. Responding to the ‘student voice’ has the potential to tailor elements of the Special Care Dentistry programme, to address their educational needs.

Keywords: Dental Students, Special Care Dentistry, Preparedness

S9:8 Dental Students’ Understanding of Geriatric Dental Care: a University of Malaya Experience

Jacob John1

Nurfatiha Izati Omar

Zharifah Mohd Yusof

 

1Dept of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia

Background: Geriatric dentistry curriculum is taught in most dental schools at the undergraduate level to equip students with knowledge and clinical skills to manage ageing-dental health issues.

Aims:

• To assess the dental students' knowledge, attitude and practice towards geriatric dental care

• To determine the factors influencing dental students in providing dental care towards elderly patients.

Methodology: This is a cross-sectional survey, targeting 173 clinical based undergraduate dental students using convenience sampling. The questionnaires were designed and validated using content and face validity. It comprised of 4 sections on students’ social demographics, knowledge on aging, clinical practice and attitude towards elderly patient. The data were collected and analysed using the Statistical Package for the Social Sciences (SPSS) software version 22.0 for Windows. Results: The response rate was 70.5%. Senior students performed better regarding knowledge on aging-related issues, but there was no significant difference between gender and year of study. Majority of the respondents demonstrated moderately good sense of practice skills; however there seemed to be a negative attitude towards the care. Patient compliance was the main issue students considered as a barrier in providing good dental care for their geriatric patients. Conclusion:The dental students seem to have appropriate knowledge and clinical skills about aging but lack the awareness of the “biopsychosocial” concerns of the elderly. There needs to be educational interventions in the teaching of geriatric dentistry emphasising on dental students' awareness of mental health, independence, and social concerns when dealing with elderly patient in different settings.

Keywords: Geriatric dental care, dental students, attitude, biopsychosocial model, educational intervention

Symposium 10: Abstracts, Reaching out-multiplying the workforce for people with disabilities

Symposium 10: Abstracts

Reaching out-multiplying the workforce for people with disabilities

Session Outlines:

Part 1 - Traditional versus digital methods of multiplying the SCD workforce

Sharat Chandra Pani1

Zikra A Alkhayal2

1Department of Preventive Dentistry, Riyadh Elm University
2Department of Dentistry, King Faisal Specialist Hospital and Research Center

The advent of mobile phone based internet platforms has revolutionised multimedia communication. The use of platforms for group messaging offers the dentist an ability to consult with colleagues and specialists across the globe. There is however, a need to understand the emerging relationship between existing models of outreach and the newer digital models of communication. This workshop will illustrate using data collected in Saud Arabia, how mobile phone teledentistry can be integrated into existing outreach networks. The workshop will also show the success and limitations of such a hybrid model and demonstrate how teledentistry can be used as a workforce multiplier for special care dentistry.

S10:1 Reaching out – Traditional vs digital models for multiplying the Special Care Dentistry workforce

Sharat Chandra Pani1
Zikra A Alkhayal2

1Department of Preventive Dentistry, Riyadh Elm University
2Department of Dentistry, King Faisal Specialist Hospital and Research Center

Background: The use of platforms for group messaging offer the dentist to consult with colleagues and specialists across the globe. The aim of this study was to analyze the reliability of diagnosis made using mobile phone based pictures and compare them to those made in the dental clinic with the aid of radiographs. Methodology: Six examiners each with at least three years of experience in the field of special care dentistry were calibrated on the WHO oral health method questionnaire using 20 test patients. Examiners used the dentition status and treatment needs index as well as the community periodontal index to chart the oral health status. Clinical oral photographs of 50 patients with special health care needs were taken and forwarded to the examiners using a cloud based store and forward network. Examiners were asked to fill in the WHO questionnaire and their observations were compared to those of the control examiner who examined these patients clinically with the aid of radiographs. The cohen’s Kappa and Intraclass correlation coefficient were used to assess reliability. Results: The overall reliability for dental caries ranged from Kappa=0.795 to Kappa=0.875, with the highest reliability statistics for dental caries (Kappa=0.891) and the lowest for secondary caries. Sending the dentists radiographs significantly improved the accuracy of the diagnosis. Conclusion: While the use of mobile-phone based teledentistry platforms remains in its infancy, the results show promising reliability. It can serve as a consultation platform in countries with a lack of a trained special care dentistry workforce

Keywords: Dental Workforce, Store and Forward, Teledentistry

Part 2 - Creating a dental network for people with Fibrodysplasia Ossificans Progressiva (FOP) – A Call for Action

Clive Friedman1

Gabriela Scagnet2

1Schulich School of Medicine and Dentistry, London. Ontario, Canada
2Quinquela Martin Hospital, Government of Buenos Aires City & National University of Buenos Aires,  Argentina

Fibrodysplasia Ossificans Progressiva (FOP) is a rare genetic disease characterized by skeletal malformations and heterotopic ossifications in skeletal muscles, tendons, ligaments and aponeurosis. Dental Treatment can be a trigger that initiates this ossification or can exacerbate existing conditions- resulting in further disease progression. Up to now there is no known effective treatment for this disease, so all therapeutic treatment must be conservative to avoid any condition that may cause heterotopic ossification. Specific Guidelines have been created for treating people with FOP and the goal of this session is to provide a brief overview of the life course of the disease, how it manifests in children and into adulthood, and triggers that we in the oral profession need to be particular aware of. There will be a particular emphasis on current risk management strategies to be employed by oral health professionals to limit any impact of an oral intervention- from evaluation through to treatment under general anesthesia.

A long-term goal and hope is that iADH will help facilitate a body of professionals familiar with and sensitive to the needs of these families who can be called on by the International Fibrodysplasia Ossificans Progressiva Association (IFOPA) to provide appropriate treatment as needed. The International Fibrodysplasia Ossificans Progressiva Association is a non-profit organisation supporting medical research, education and communication for those affected with FOP.

Symposium 11: Abstracts, Ageing and end of life care - Caring for frail older adults-Part 1 and 2

Symposium 11: Abstracts

Ageing and end of life care

Caring for frail older adults-Part 1 and 2

Session Outlines:

Part 1
Models of Care: Working with carers of dependent older adults in urban, rural and remote areas

Kerrie Punshon1,

Archana Pradhan2

1Universities of Melbourne and La Trobe
2The University of Queensland

Working with carers of dependent older adults is challenging not only in rural and remote areas but also in urban facilities, due to inadequate training of carers in oral care, high turnover of carers and/or carer burnout.  At this seminar, we will share and discuss models of care and oral care training in Aged Care (online and practical) for dental practitioners, students and carers in Australia at state and national levels.

Part 2
The role of the dental team in Palliative Care

Almir Oliva Filho1,
1Geriatric Dentistry Specialist, Department of Community Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil

In order for palliative care to be effective, the focus of attention must not be an illness to be cured or controlled, but rather the individual, understood as a biographical, active being, with a right to information and full autonomy to make decisions about his or her treatment. The oral cavity is vitally important to well-being, and in short, palliative care in dentistry has a wide scope of practice. In addition to controlling oral symptoms, dentists can direct therapy as appropriate to prioritise pain control, proper hydration, and preservation of oral feeding for those with serious incurable diseases, as well as for patients with reduced autonomy or high dependence as a result of prolonged illness, as in some neurodegenerative diseases.
This presentation will explore the philosophies around palliative care and will outline the crucial role of the dentist, not only in detecting abnormal finding in the mouth which may cause pain and suffering, but also in assuring and prioritising one of the main goals in palliative care and that is the ability to still experience the pleasure of savouring one’s favourite foods.