Erasmus+ 2019-1-RO01-KA202-063820 Project

Oral Special Care Academic Resources (OSCAR)

IO3. Proposal to upgrade the current curriculum for residency in Pedodontics –  section ”Complex treatment of patients with special needs”

In Romania, Pediatric Dentistry (Pedodontics) has been recognized as a self-standing dental specialty since 2016, with a 3-years residency program (Order of Ministry of Health no.  1109/6.10.2016, published in the Official Gazette no. 786 of October 6, 2016). During the third year of residency, the current postgraduate curriculum comprises 12 hours of courses and 28 hours of clinical stages dedicated to oral care for patients with special needs.

 

In its current version, this curriculum includes:

Complex treatment in patients with special needs  (40 hours)

  I. Courses – 12 hours:

• Terminology and classification of patients with special needs according to the type of disability (physical, mental, sensory, medical)
• Comprehensive and interdisciplinary therapeutic management of disabled children
• Specific aspects of the pedodontic treatment in special needs patients

  II. Clinical stages – 28 hours:

– Performing specific therapeutic maneuvers in patients with disabilities

– Reviews of the literature, reports submission.

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According to the current recommendations of iADH (International Association of Disability and Oral Health), pediatric dentistry specialists can be regarded as having a ”high level of competence” in providing oral care to patients with special needs because in the residency program they have up to 12 weeks of theoretical and practical training in this field. In addition, pediatric dentists are the only ones who receive training in behavioural management during their residency, which makes them a first-choice profesional category for the therapeutic approach of the disabled patient.

Therefore, an improved and detailed curriculum is needed in order to obtain the best possible training for pedodontists in dental management of patients with special health care needs.

 

The OSCAR team project performed a thorough study of the undergraduate and postgraduate curricula in the field of dental care for patients with special needs in the project countries (France, Italy, Romania and Turkey). The of this research were published in Romanian Journal of Dental Medicine, no 3-4/ 2021; available online at: https://rjd.ro/volume-xxiv/no-3-4-2021/special-oral-care-in-educational-systems-from-four-european-countries/

A pilot study on the perception and attitudes of pediatric dentistry residents from the project countries with regard to providing oral care for children with special healthcare needs was conducted within the project. The results of this study were presented at the Congress of the Association for Dental Education in Europe (ADEE), 2021 edition (Didilescu A, Vinereanu A, Tănase M, Vacaru RP, Ilinca R, Munteanu A. Romanian paediatric dentistry residents’ self-perceived training needs towards treating patients with special oral care needs. ADEE Strasbourg on-line  annual meeting 2021. https://adee.org/tour-poster-showcase-session-1).

The corroboration of the results of these researches led us to the conclusion that the section dedicated to special oral care in the current residency program in Romania could be improved, even in the conditions of maintaining the current number of allocated hours.

 

Therefore, we present the following

 

Proposal to improve the current

Special Oral Care curriculum

for the PD Residency Program

 

  A. Theoretical courses – subjects:

• Terminology and classification of patients with special needs according to the type of disability (physical, mental, sensory, medical)
• Epidemiological issues related to patients with special health care needs
• Ethical issues; informed consent for disabled patients
• General clinical aspects of the most common disabilities/pathologies with impact on oral health:
  • Down Syndrome
  • Autism spectrum disorders
  • ADHD
  • Diabetes mellitus
  • Congenital cardiovascular diseases
  • Bleeding disorders
  • Renal disorders
  • Cerebral palsy
  • Epilepsy
  • Clefts lip and/or palate
  • Sensory disabilities
  • Primary failure of eruption
• Oral manifestations of different types of disabilities and oral health related quality of life for children with disabilities
• Specific aspects of the pedodontic treatment in special needs patients
• Comprehensive and interdisciplinary therapeutic dental management of children requiring special health care needs
• Pharmacological and non-pharmacological behaviour techniques for special needs patients; indications, contraindications, limits
• Dental treatment with conscious sedation:
  • Sedation with Midazolam
  • Inhalation sedation with nitrous oxide/oxygen
• Dental treatment in hospital setting:
  • Bedside dentistry
  • Dental treatment under general anesthesia
• Side effects of medication used for treatment of certain general conditions with implications for oral health and dental treatment techniques
• Prophylaxis for bacterial endocarditis in patients with heart diseases
• The ”Dental Home” concept
• Preventive methods for caries lesions, periodontal diseases and dental injuries in special needs patients.

  B. Practical activities:

• Performing specific therapeutic maneuvers in patients with disabilities, both cooperative and partially cooperative or uncooperative. Residents
  • can perform dental treatment of special needs patients in dental office conditions, with or without help (but under the supervision) of a teacher;
  • they will attend the treatment with conscious sedation or under general anesthesia of partially cooperative or uncooperative patients.
• Reviews of the literature in order to submit reports on a rare disability/disease and its implications on oral health
• Preparing a paper/presentation on the clinical course of the examined and treated patients, starting from their first visit in the dental office.

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  C. Expected results

As a result of this training, pediatric dentistry residents will be able to:

• Understand the biological basis of different impairments
• Recognize different types of disabilities
• Describe the frequently encountered types of disabilities and their impact on oral health status and oral functions
• Know the pharmacological principles, the main interactions and side effects, both general and on oral cavity, of medicines frequently used by patients with special needs
• Know the prophylactic and curative treatment methods used in management of special needs patients
• Understand legal and ethical aspects of dental dental treatment of disabled patients
• Respect the autonomy of the patients and to adapt the pharmacological and non-pharmacological technique of behavioral management to the specific needs of each patient.
• Understand the role of family and caregivers in taking decisions about caring of these patients
• Have experience in risk assessment, tratment planning and dental care under sedation or general anesthesia
• Have knowledge of safe transfer techniques and correct positioning, using assistive devices when needed, for patients with physical disabilities.
• Understand the importance of continuing medical education and improving skills in care of patients with special needs throughout their careers.

 

The aim  of training of pediatric dentistry residents in the dental care of patients with special needs is:

• to raise the awareness of dental practitioners,
• to increase the level of kowledge of dental practitioners,
• to improve the practical skills of dental practitioners,

 

pursuing, as a consequence,   

 

• to improve access for patients with special needs to quality dental care
• to improve the level of quality of medical services provided to this category of patients
• to improve the quality of life of these patients.

 

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            In order to support the teachers from the Pedodontics Department in the university centers that organize Pediatric Dentistry residency, it is important to mention that  Erasmus+ 2019-1-RO01-KA202-063820 Oral Special Care Academic Resources (OSCAR)  project platform can be used as course support, both for the theoretical part and for the practical part of the training of pediatric dentistry residents in the field of Special Oral Care.  

The platform is open-access, available at https://oscarpd.ro/. All materials on the platform are the result of the team work of the OSCAR project team, the clinical cases presented are part of the personal work of the team members, and the use of these materials is allowed free of charge exclusively for non-commercial purposes, with proper mentioning of the source. The content of the platform is protected by copyright law and any reproduction not in accordance with the above specifications is punishable under the applicable law.