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
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
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
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
130
125
120
115
110
105
finances
transportation
finding a dds
sed/GA
Dent offc dsgn
oral home care
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
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
1.
2.
3.
4.
5.
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.