Documente Academic
Documente Profesional
Documente Cultură
a range of disabilities
complex additional needs
long stay residential care
people in secure units
people who are homeless.
Extracting teeth.
5.
6.
8.
10.
Current training:
On the whole, individuals who have undertaken training
in SCD have been responsible for their own training,
formal and informal.
It should not be left to the individual dentist to fund their
training in SCD.
Philosophy of care
A philosophy of care is a framework of care goals and values
to help you make the best choices for your child and family.
Special Care Dentistry has a broad based philosophy which
takes a holistic view of oral health and requires specialists to
liaise and work with all those members of an individual's care
team. This is particularly important in the case of people at
the more severe end of the spectrum of disability, where a
greater range of issues needs to be considered.
HUH???
HOW???
The ethos of Special Care Dentistry (SCD) has always echoed this
philosophy. It is concerned with the improvement of oral health of
individuals and groups in society who have a physical, sensory, intellectual,
Reducing Inequalities
Reducing Inequalities
1. Lack of Education:
Lack of education has been cited as one of the barriers for the
poor awareness of the importance of oral health for people
with disabilities and, subsequently, one of the factors that
impacts in the provision of oral health care for a significant
number of individuals within society.
Education as a possible solution to improve access to oral
health care for the people who needs special health care.
Reducing Inequalities
Undergraduate education:
Include Special Care Dentistry in undergraduate teaching.
Centered on demonstrating positive attitudes towards
diversity and included disability awareness, public health
aspects of Special Care Dentistry and relevant ethics and
legislation.
In 2006, the American Dental Education Association
(ADEA) adopted a resolution to ensure that education
programs include both didactic instruction and clinical
experiences involving treatment of people with special
needs.
Reducing Inequalities
Postgraduate and specialist education:
- Currently, Special Care Dentistry is recognized as a
registered specialty in four countries: Brazil, Australia,
New Zealand and the UK.
Reducing Inequalities
2. Awareness among the public:
Impact of
Health and Social Policy
Services &
protection
The Department of
Social Welfare
Ministry of Women, Family,
and Community Development
What is disability?
What is disability?
A disability is a condition or function judged to
be significantly impaired relative to the usual
standard of an individual or group. The term is
used to refer to individual functioning,
including physical impairment, sensory
impairment, cognitive impairment, intellectual
impairment, mental illness, and various types
of chronic disease.
Vision disability
Hearing disability
Mouthbreathing
Sign Languages
Learning disability
Attention deficit/Hyperactivity disorder
(Atomoxetine)
Psychological disorders
Schizophrenia
(high DMFT)
Brain injuries/disability
Autism
Aspergers
syndrome
Pervasive
developmental
disorder
Rett syndrome
Childhood
disintegrative
disorder
Interlectual disability
Down syndrome
Metabolic Diseases
Genetic conditions that result in metabolism
problems
defective gene that results in an enzyme
deficiency
Metabolic Diseases
Hurler syndrome (abnormal bone structure and
developmental delay)
Niemann-Pick disease (difficulty feeding, and nerve
damage)
Tay-Sachs disease (progressive weakness, progressing
to severe nerve damage; the child usually lives only
until age 4 or 5)
Fabry disease (pain in the extremities in childhood,
with kidney and heart disease and strokes in
adulthood; only males are affected)
Krabbe disease (progressive nerve damage,
developmental delay in young children)
2012
27636
39303
180
106252
117699
2130
12713
305,640
Current workforce
Most dentists working in the field of SCD are based in the salaried Community
Dental Service.
There is a smaller constituent of SCD based in general and teaching hospitals who
are either salaried NHS or university staff.
General dental practitioners contribute to the overall picture of SCD, but only a
small number of practitioners have a specialist interest in this field.
QP
Voluntary Organisations
Collectively and individually, they are a primary source of knowledge and expertise on all aspects of
learning disability.
Based on British society of disability and oral health guideline of 2012, the range of organisations
involved includes:
-Self-advocacy groups, in which people with learning disabilities come together to find strength in
unity, explore common problems and share solutions.
-Citizen advocacy groups working in partnership with people with learning disabilities to inform them
of their rights, help them assert those rights.
-Parent and carer groups in which members learn from each others experiences, and work together
for greater success and a diminished sense of isolation.
-Policy-shifting organisations, which advise, campaign, inform and co-operate with others to change
national and local policies and practices.
-Service providing organisations, which provide services, usually under contract from the statutory
agencies, and sometimes with added value from voluntary input.
QP
Voluntary Organisation
Many of the larger organisation produce specific information on oral care.
-Mencap has an oral care leaflet in a number of ethnic minority languages;
it also produces training material dealing with oral care and diet for use
with parents of people with profound and multiple disabilities.
-PAMIS (Profound and Multiple Impairment Service) provides training
programmes on dental care and oral health specifically for people with
profound and multiple learning disabilities.
QP
In Malaysia , there are 49 Kiwanis clubs across the country, with more than 1300
members. The first club, the Kiwanis Club of Kuala Lumpur was chartered in 1976
by the then returning Ambassador to the US, "Bapak Kiwanis" Tan Sri Khir Johari.
QP
The National Autism Society of Malaysia (NASOM) is a non-profit, non-governmental welfare organisation which was formed in
1986 by a group of parents and professionals. It was registered on 3rd March 1987, as a national voluntary charitable organisation
and aims at providing education, help, care and protection for people with autism and their family members. Currently, NASOM
has established 14 Early Intervention Programmes and 3 Vocational Programmes for people inflicted with autism in Malaysia.
QP
PSDNJ started as a small support group of parents who sent their children to Kiwaniss
Early Intervention Centre. With guidance and support from the Kiwanis members and
teachers, we started to form our society, Down Syndrome Society of Johor. We are
the first association created specifically to support the cause of individuals with Down
syndrome established at the state level. Following from the success of this
organization, there are now currently 8 such State-level associations in Malaysia.
QP
Speech Therapy
Speechlanguage pathologists assess and treat individuals from children to
adults with communication difficulties. These include understanding, expressing,
pronunciation difficulties, voice difficulties, fluency and nasalized speech.
They may also work with people who have feeding and swallowing difficulties.
Speechlanguage pathologists work collaboratively with patients, families
and related professionals to ensure patients needs are been addressed holistically.
QP
Specialists work need not, and indeed should not, be restricted to working in
hospitals. Local studies demonstrate that general and community dental services
provide the majority of the currently supplied care for people living in community
settings who are on disability registers.
QP
Whereas consultants and a large proportion of specialists have until recently had a strong
hospital focus, there is recognition that not all of them need to be based in hospitals or, if
they are, they may only provide certain aspects of care in a hospital setting. SCD should be
predominantly community based. This would have the effect of reducing inequality in two
ways:
Directly by improving physical access to a specialist service that is not solely hospital based
Indirectly by improving access through support for interested generalists in primary dental
care.
Hospital services should be closely aligned with specialists in a community setting so that
people who require hospital-based treatment because of medical complications,
multidisciplinary care, and/or care under general anaesthesia, may do so seamlessly.
Ideally, the dental team will include dental care professionals (DCPs) such as dental therapists
and dental hygienists, and may involve liaison with health promotion services to ensure that
a preventive approach is taken locally to support health care for people with disability. Such
an approach allows a proactive move to reduce and prevent dental disease rather than the
currently common reactive approach of treatment of disease.
QP
QP
Malaysia
Special Needs Dentistry (Snd) In Malaysia: A Way Forward
Siti Zaleha Hamzah - Special Needs Dentistry, Hospital Serdang
INTRODUCTION
Ministry of Health Malaysia (MOH) recently recognised SND as a dental specialty to provide better oral
health needs of the population with disabilities who, due to advances in medicine and improved general
healthcare are surviving much longer into old age.
In Malaysia, it is predicted that, with an increased number of elderly in the community due to an
improvement in health care delivery and health awareness, the population with disability/ies may also
expand as older people are more likely to develop coincident or consequent disability with ageing. Apart
from that, it has been reported that the number of Malaysian population suffering from various types of
disability had significantly increased from 132, 655 in 2003 to 197, 519 in 2006. Therefore, the demand in
oral health care for these special needs groups is expected to outstrip the service currently provided. The
same situation is also reported in United Kingdom, Australia and New Zealand.
Many studies have confirmed that people with disabilities are more likely to have a poorer oral health
condition than those in general population, mainly due to barriers such as limited access to dental service,
financial problems and the complexity of medical conditions from which they suffer.
QP
DEFINITION
QP
SND includes the delivery of oral health care, focusing on individuals with special
needs above 16 years, and it is a hospital-based dental specialty due to the
complexity of the problems that the patients are often presented with.
For the time being, patients with special needs can be referred to Hospital Kuala
Lumpur and Hospital Serdang for further management whereby care provided
includes various types of treatment in general dentistry.
QP
REFERRAL PROCESS
During the referral process, it is crucial for referring clinician to state clearly in the referral letter the reason
for referral, such as for consultation and examination regarding a specific condition or a particular area in
patients care, for urgent treatment in managing a specific complaint or condition or for further
management when the overall medical conditions or oral health problems requires care from specialists.
The patients have to be reminded to bring their valid PWD/ OKU card authorized by the Social Welfare
Department if they have one, or guarantee letter as well as the referral letter.
It is the responsibility of the referring clinician to complete a referral letter or form which contains details
information about the patient which include patients full name, address details and phone number,
copies of relevant radiographs if available, access and consent issues as well as special requirements, any
diagnostic test result, a brief medical history including current medications and allergies and indication of
disability and state clearly the contact details (including phone no and/or email) of the patients general
practitioners/ specialist medical practitioners if applicable. The last but not least is the contact details of
the referring clinician including phone no and/or email address.
All of this information would facilitate and reduce the time spent by patient in the specialist facilities.
QP
QP
With the aim to reduce the gap and burden for patients to access oral health
care facilities, the community component in SND would enhance and
encourage knowledge and competence of the community based dental
officers in managing and providing care for patients with special needs
through various strategies and planning.
The set-up of the SND service in the community is to facilitate the delivery and
provision of oral health management and care for those patients who are
considered having mild to moderate disabilities/medical problems.
QP
CONCLUSION
More dental practitioners are expected to develop their interest in SND field as the
training pathway becomes clearer, as well as the initiative of the Ministry of Health
to support the career development of the specialist in SND in line with other
existing dental specialties in the near future. To ensure a continuing development
in this rewarding field of dentistry, research in SND should be encouraged and
incorporated in planning, development, and monitoring of the specialty.
Thus, future studies should investigate the oral health status of adults with
disabilities in Malaysia in various aspects, such as caries experience and
periodontal status which is currently lacking.
There are many ethical issues related to this area of health care and few questions
or problems can be addressed in a yes/no, black or white manner.
Thus, details investigation and attention are required to explore these areas of
concern in the future development of SND service in Malaysia.
QP
THANK
YOU!
QP
References
http://www.hraljournal.com/Page/7%20Kamarulzaman.pdf
http://www.cbrglobal.org/Downloads/PS2a.pdf
http://www.ijssh.org/papers/447-H10019.pdf
http://www.pdknet.com.my/web/index.php?module=view_pdk&pdk_id=
6
http://www.ncbi.nlm.nih.gov/pubmed/24417495
http://www.ndss.org/Resources/Health-Care/AssociatedConditions/Dental-Issues-Down-Syndrome/
http://www.mdj.org.my/index.php?option=com_content&view=article&id
=141&catid=53&Itemid=133
http://www.disabilitymalaysia.com/about.html
http://ohd.moh.gov.my/v3/index.php/en/contact-us
https://www.mah.se/.../Malaysia/.../oral_healthcare_in_malaysia_05.pdf