Oral Health Professional Alert on Special Care Dentistry

Abstract

Special needs dentistry, also known as special care dentistry, is a specialty of dentistry concerned with the oral health of
people who have intellectual disability, or who are affected by other medical, physical, or psychiatric issues. Their additional
needs may be due directly to their impairment or disability, or to some aspect of their medical history that affects their
oral health, or because their social, environmental or cultural context disables them with reference to their oral health.
1
According to data from the Indonesian Medical Council, there was an increasing number of Indonesians experiencing chronic
diseases including cancer, stroke, heart disease, renal disease, and diabetes mellitus from 2013 to 2018.2
Unfortunately, there
was no data describing other special needs condition aside from medically challenged. This absence of data might make
dentists and authorities complacent about this need. Even in the developed country, we found that people with disabilities
were rarely identified as a priority population group in the public health policy and practice.3
Along with increasing awareness of parents and careers, supporting facilities and education such as physiotherapy, speech
therapy, management behavior are much in demand. Though, dental treatment is still not popular. They are prioritizing
general health instead of dental and oral health to support short term impact.4
Meanwhile, special need persons are prone
to poor oral health. People with developmental disabilities have higher rates of cavities, gum disease and tooth loss and the
cause is often heartbreakingly simple.5
Many of these persons are physically unable to brush their teeth, and many won’t allow
someone else do it for them.6
Others are hampered by medical conditions, or by the side effects of medications they take,
which is why regular dental checkups and cleanings are so important.
General dentists are reluctant of taking care of special need patients
We recognized that there are only a few oral health professions that work to improve the oral health of people with
special needs.7
Not only is their access to care almost non-existent in comparison to the general population, but also the
facilities are inadequate and staff lack awareness of oral health matters that may impact those with special needs.8
Moreover,
parents and careers are confronted with different problems such as, dentists who lack skills and competency in managing
people with disabilities. Dentists reported having difficulty treating such patients. The complexity in treating patients with
special needs, the variety of medical conditions or disabilities that require more time or altered delivery methods than the
routine delivery of dental care for the general population,9
and sometimes patients required special methods and techniques
to treat their oral health conditions has led to low preparedness and willingness of oral health professionals to treat patients
with special needs.10 It requires a holistic approach that is dentist led in order to meet the complex requirements of people
with impairments. It may impact access and thus their oral health, while other complications include inconvenient locations
of dental clinics, transport issues, and cost of dental treatment.11All patients with special needs should have equal access and
high-quality treatment that focuses on patient safety, patient-centered care, and treatment of all dental needs. Thus, oral health
professional needs to have training or special education to handle patients with special needs in an effort to increase oral and
dental health of this population.
Dental student training improvement is needed
It is written in standard competency of Indonesian dental doctor released by Indonesian Medical Council that
undergraduate dental student must be able to ascertain congenital and hereditary abnormalities in oral cavity, and maintaining
oral soft tissue health in patients with compromised medical condition. In fact, there are limitation of opportunity for
them to meet those special patients. Dentists who treat patients with special needs are dental pediatrics; there are no dental
specialists who specifically manage patients who are adults with special needs.12 Furthermore, for the undergraduate basis,
dental school are not well equipped with staff and tools to support that competency. Of the 11 dental schools that have been
accredited ”A” in Indonesia, there are only 4 dental schools who have structured dental courses on taking care of oral and dental
health for person with special needs. This program is restricted to postgraduate student only. There is no syllabus or program
for undergraduate dental students. Lack of training and experience of undergraduate dental students in dealing with patients
with special needs was one of the most reported issues that inhibits the treatment of these patients. Therefore, the access of
dental student to gain knowledge and experience in this major should be improved.
Indeed, it is well known that good oral health is conducive to overall well-being. Due to increasing demand of treating
special care persons with their complexities, oral health professionals need to improve their skill and knowledge.

Tania Saskianti, DDS, PhD, Ped Dent
Chairperson, Joint Scientific Meeting in Special Care Dentistry
Lecturer, Department of Pediatric Dentistry
Faculty of Dental Medicine, Universitas Airlangga

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