A. Dougall

The value of education in special care dentistry as a means of reducing inequalities in oral health

People with disability are subject to inequality in oral health both in terms of prevalence of disease and unmet healthcare needs. Over 18% of the global population is living with moderate to severe functional problems related to disability, and a large proportion of these persons will require Special Care Dentistry at some point in their lifetime. It is estimated that 90% of people requiring Special Care Dentistry should be able to access treatment in a local, primary care setting. Provision of such primary care is only possible through the education and training of dentists. The literature suggests that it is vital for the dental team to develop the necessary skills and gain experience treating people with special needs in order to ensure access to the provision of oral health care. Education in Special Care Dentistry worldwide might be improved by the development of a recognised academic and clinical discipline and by providing international curricula guidelines based on the International Classification of Functioning, Disability and Health (ICF, WHO). This article aims to discuss the role and value of promoting and harmonising education in Special Care Dentistry as a means of reducing inequalities in oral health.

Access to special care dentistry, part 8. Special care dentistry services: seamless care for people in their middle years – part 2

This article about special care dentistry in the middle years considers people who have Downs syndrome and cerebral palsy and those who have cardiac and respiratory disease. The increased life expectancy of people with Downs syndrome, currently 50-60 years, is reflected in the changing population profile and needs of these individuals. The preventive and dental treatment of most people with Downs syndrome and cerebral palsy can be met in general dental practice. However, those people with profound disability, anxiety or learning disability may require either a shared approach to care or referral for specialist care. Cardiac and respiratory disease occur commonly in the general population both in middle and older age groups and the dental team will meet increasing numbers of people with these conditions. The procedures and drugs used in dentistry can aggravate heart disease and it is important that the dental team are aware of the common cardiac conditions and their management, as well as how to best manage the oral care of this group. Also, they have a role to play in the provision of oral health advice, smoking cessation and dietary advice. This is particularly important as poor oral hygiene has been linked to respiratory pathogen colonisation and dental plaque may act as a reservoir for aspiration pneumonia in susceptible individuals.

Guidance for the core content of a Curriculum in Special Care Dentistry at the undergraduate level

Given the rapidly changing demography of populations worldwide, dental professionals of the future need to be able to meet the challenge posed by the evolving landscape in health care needs. Leading institutions are now embedding teaching and learning in special care dentistry (SCD) within their curricula, to provide students with the knowledge, skills and attitudes to meet the oral health needs of vulnerable groups within their communities. The International Association for Disability and Oral Health (iADH) has initiated the development of undergraduate curriculum guidance in SCD through a consensus process. The curriculum in SCD is defined in statements of learning outcomes with many of the skills being transferable across the undergraduate course. This curriculum includes examples of teaching and assessment, designed to enhance critical thinking in relation to SCD and to promote positive attitudes towards disability and diversity. The learning outcomes are designed to be readily adapted to conform to the generic profiles and competencies, already identified in undergraduate frameworks by global educational associations, as well as meeting the requirements of professional regulatory bodies worldwide. Suggestions for teaching and learning are not intended to be prescriptive; rather, they act as a signpost to possible routes to student learning. Ideally, this will require that students have a sufficiently diverse patient case mix during their undergraduate studies, to achieve the required levels of confidence and competence by the time they graduate. Clinical care competencies in SCD emphasise the need for learners to broaden their theoretical knowledge and understanding through practical experience in providing care for people with special health care needs. It is crucial to the development of equitable dental services for all members of a community, that these learning outcomes are embedded into evolving curricula but most importantly, that they are evaluated and refined in a dynamic way with shared learning for all teachers.

What should dental services for people with disabilities be like? Results of an Irish Delphi panel survey.

Background This study aimed to generate prioritised goals for oral health services for people with disabilities as a first step in meeting the need for evidence based oral health services for people with disabilities in Ireland. Methods The study used a three round modified e-Delphi method, involving dental service professionals and people with disabilities or their representatives, in Ireland. Three rounds were completed online using SurveyMonkey. Round 1 asked: “List what you think dental services for people with disabilities in Ireland should be like.” Items for subsequent rounds were generated from responses to Round 1. Round 2 and Round 3 used 5 point Likert scales to rank these items by priority: from No Priority (1) to Top Priority (5). Consensus was achieved on each item where at least 80% of respondents considered an item either High or Top Priority. A consensus meeting concluded the process. Results Sixty-one panelists started and 48 completed the survey. The Delphi panel agreed on level of priority for 69 items and generated 16 consensus statements. These statements covered a range of topics such as access to care, availability of information and training, quality of care, dental treatment and cost. A recurrent theme relating to the appropriateness of care to individual need arose across topics suggesting a need to match service delivery according to the individuals needs, wants and expectations rather than the disability type/diagnosis based service which predominates today. Conclusions This process produced a list of prioritised goals for dental services for people with disabilities. This creates a foundation for building evidence-based service models for people with disabilities in Ireland.

A Global Oral Health Survey of professional opinion using the International Classification of Functioning, Disability and Health.

OBJECTIVES The concept of oral health is frequently reduced to the absence of disease, despite existing conceptual models exploring the wider determinants of oral health and quality of life. The International Classification of Functioning, Disability and Health (ICF) (WHO) is designed to qualify functional, social and environmental aspects of health. This survey aimed to reach a consensual description of adult oral health, derived from the ICF using international professional opinion. METHODS The Global Oral Health Survey involved a two-round, online survey concerning factors related to oral health including functioning, participation and social environment. Four hundred eighty-six oral health professionals from 74 countries registered online. Professionals were pooled into 18 groups of six WHO world regions and three professional groups. In a randomised stratification process, eight professionals from each pool (n=144) completed the survey. The first round consisted of eight open-ended questions. Open expression replies were analysed for meaningful concepts and linked using established rules to the ICF. In Round 2, items were rated for their relevance to oral health (88% response rate). RESULTS Eighty-nine ICF items and 30 other factors were considered relevant by at least 80% of participants. International professionals reached consensus on a holistic description of oral health, which could be qualified and quantified using the ICF. CONCLUSIONS These results represent the first step towards developing an ICF Core Set in Oral Health, which would provide a practical tool for reporting outcome measures in clinical practice, for research and epidemiology, and for the improvement of interdisciplinary communication regarding oral health. CLINICAL SIGNIFICANCE Professional consensus reached in this survey is the foundation stone for developing an ICF Core Set in Oral Health, allowing the holistic aspects of oral health to be qualified and quantified. This tool is necessary to widen our approach to clinical decision making, measurement of clinical outcomes, research and epidemiology.

Child oral health from the professional perspective – a global ICF-CY survey

BACKGROUND The International Classification of Functioning, Disability and Health Children and Youth version (ICF-CY) (WHO) may serve as a tool for the application of holistic models of oral health. AIM The ICF-CY Global Oral Health Survey explored international professional opinion regarding factors relating to child oral health, including social environment, functioning, activity, and participation. METHODS Networking resulted in 514 professionals from 81 countries registering for a two-round Delphi survey online. Participants were pooled into 18 groups according to six WHO world regions and three professional groups. In a randomized stratification process, eight from each pool (n = 144) completed the survey. The first round consisted of eight open-ended questions. Open-expression replies were analysed for meaningful concepts and linked using established rules to the ICF-CY. In the second round, items were rated for their relevance to oral health (86% response rate). RESULTS A total of 86 ICF-CY items and 31 other factors were considered relevant to child oral health and function by at least 80% of professionals. CONCLUSIONS The ICF-CY can describe the holistic experience of oral health in children from the professional perspective. The data from this study will contribute to the development of an ICF-CY Core Set in Oral Health.

Guidance on the core content of an undergraduate curriculum in special care dentistry.

This paper has been previously published in the Journal of Disability and Oral Health and provides guidance on the core content of an undergraduate curriculum in special care dentistry by featuring three abstracts, published over the last year in the European Journal of Dental Education, on the context and methodological approach to the curriculum process.

Identifying common factors of functioning, participation and environment amongst adults requiring specialist oral health care using the International Classification of Functioning, disability and health

Introduction Persons unable to access oral health care in the conventional primary health care setting suffer from inequalities in oral health, particularly in terms of unmet dental need. The International Classification of Functioning, disability and health (ICF) is designed to look beyond medical diagnosis and to describe individuals or populations in terms of their ability to function and participate in a social environment. The objective of the study was to describe an adult population requiring specialist oral health care using the ICF and to identify common factors of functioning, participation and environmental context. Method The ICF Checklist for Oral Health was completed for 246 participants from five specialist dental services in five countries (mean age 36 ±16.44 years; 16–92). ‘Developmental disability’ and ‘Medically compromised’ groups were identified (72% and 28%). Results Participants presented with oral disease (92%) and dysfunction (66% impaired chewing). 33 ICF items were affected in over 50% of participants in both groups. Impaired body functions included ‘ingestion functions’, ‘energy and drive functions’ and ‘emotional functions’. Participation was restricted for “Acquiring, keeping and terminating a job”, “Intimate relationships”, “Handling stress and psychological demands”, “Economic self-sufficiency”, “Carrying out a daily routine”, “Recreation and leisure”, “Community life” and “Looking after one’s health”. In the environment domain, “Support and relationships” and “Attitudes” were rated as facilitators. Environmental barriers reported for over 25% of the whole group were related to “Services, systems and policies” including, health, social security, general support, transportation, and labour and employment. Discussion and perspectives Common aspects of functioning, participation and environment were found amongst a heterogeneous population of adults attending specialist dental services, alongside poor oral health and function. The ICF may be used to describe populations that suffer inequality in oral health in order to develop services that effectively target those in need of additional means.

Development of a battery of tests to measure attitudes and intended behaviours of dental students towards people with disability or those in marginalised groups

INTRODUCTION Recommended curricula in Special Care Dentistry (SCD) outline learning objectives that include the domain of attitudes and behaviours, but these are notoriously difficult to measure. The aims of this study were (i) to develop a test battery comprising adapted and new scales to evaluate values, attitudes and intentions of dental students towards people with disability and people in marginalised groups and (ii) to determine reliability (interitem consistency) and validity of the scales within the test battery. MATERIALS AND METHODS A literature search identified pre-existing measures and models for the assessment of attitudes in healthcare students. Adaptation of three pre-existing scales was undertaken, and a new scale was developed based upon the Theory of Planned Behaviour (TPB) using an elicitation survey. These scales underwent a process of content validation. The three adapted scales and the TPB scale were piloted by 130 students at 5 different professional stages, from 4 different countries. RESULTS The scales were adjusted to ensure good internal reliability, variance, distribution, and face and content validity. In addition, the different scales showed good divergent validity. DISCUSSION These results are positive, and the scales now need to be validated in the field. CONCLUSIONS It is hoped that these tools will be useful to educators in SCD to evaluate the impact of teaching and clinical exposure on their students.