FINAL_SPECIAL CARE DENTISTRY -harathi edit 23.11 12pm

TABLE OF CONTENTS

Foreword 1
Special Care Dentistry (SCD) in Malaysia 2-6
Competencies of a Specialist in SCD 7-19
Referral Guidelines for SCD Service 20-30
Requirements for SCD Clinic Settings 31-38
Recommended List of Specialised Equipments for SCD Clinic 39-40
Conclusion 41

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SPECIAL CARE
DENTISTRY

IN MALAYSIA

Special Care Dentistry (SCD
) is a branch of dentistry
concerned with the oral he
alth of patients adversely
affected orally, by intellec
tual, physical, medical or
psychiatric issues or, more often, a combination of a
number of these factors, where such conditions
necessitate a modified delivery of oral health care for
patients’ total health well-being.

definition

2

Malaysia is the first country in South East Asia to recognise Special Care Dentistry as a dental
specialty. SCD service, previously known as Special Needs Dentistry (SND) in the Ministry of
Health (MoH) was established in year 2011 with two trained specialists. Since then, the number
of trained specialists in SCD have gradually increased. Recognising the need for relevant
documents for reference in SCD, the first e-book was published by the Oral Health Programme
in year 2015. The e-book encompassed clinical core competencies of the specialty, referral
guidelines, requirement for SCD service and the list of equipment to deliver the service.

Although all the basic information contained in the previous version of the e-book is still
relevant, the need for a revised version of the e-book is deemed necessary. The updated
version of the e-book may assist any interested parties to establish the SCD service in their
practice anywhere in the world. However, this must comply with the rules and regulations of
the local authorities.

SPECIAL CARE DENTISTRY IN MALAYSIA 3



Nature of In the Ministry of Health Malaysia, SCD is a hospital-based
Service dental specialty. However, the management of patients
with special needs can occur at different levels,
Delivery i.e. primary care or specialist care.

Multidisciplinary/ interdisciplinary approach in the provision of comprehensive treatment plan:

The specialist in SCD is responsible in managing patients with special health care needs
The specialist in SCD is also responsible in providing clinical support at the local/ primary/
community health centres. Services include consultation on patient care and assistance to
the general dental practitioners who need help and guidance in managing such patients

SPECIAL CARE DENTISTRY IN MALAYSIA 5









b) Patients with physical disabilities with significant co-morbidities which may include:

Cerebral palsy Quadriplegia, hemiplegia, paraplegia due to
stroke, spinal cord injury or traumatic brain injury

COMPETENCIES OF A SPECIALIST IN SPECIAL CARE DENTISTRY



clinical

d) Geriatric patients with significant co-morbidity and mortality conditions which may include:

Parkinson's disease

Dementia

Alzheimer’s disease

Significant medical
conditions



COMPETENCIES OF A SPECIALIST IN SPECIAL CARE DENTISTRY 1 2





Provision of treatment and maintenance of key DCS ni stsilaiceps yb
dentition to facilitate long-term care and improve dedivorp serudecorp latneD
quality of life


Modification of routine restorative dentistry to

prevent tooth loss


Provision of preventive and routine periodontal
therapy

Provision of routine endodontic care


P r o v i s i o n o f d e n t a l p r o s t h e s i s




COMPETENCIES OF A SPECIALIST IN SPECIAL CARE DENTISTRY 1 5

Management of oral adverse effects of medications/
polypharmacy


M a n a g e m e n t o f o r a l m a n i f e s t a t i o n s o f s y s t e m i c d i s e a s e

and medical therapy in conjunction with Oral Pathology
and Oral Medicine specialist


P r o v i s i o n o f r o u t i n e d e n t a l e x t r a c t i o n s

Provision of minor oral surgery
(e.g. surgical extraction of impacted teeth)

Provision of treatment for simple dentoalveolar
trauma




COMPETENCIES OF A SPECIALIST IN SPECIAL CARE DENTISTRY 1 6

BEHAVIOUR GUIDANCE FOR PATIENTS WITH
BEHAVIOURAL ISSUES

o Communication strategies
o Behaviour guidance techniques
o Clinical holding
o General anaesthesia (GA)




COMPETENCIES OF A SPECIALIST IN SPECIAL CARE DENTISTRY 1 7

BEHAVIOUR GUIDANCE FOR PATIENTS WITH
BEHAVIOURAL ISSUES

o Conscious sedation
(Oral/Inhalation sedation)

o Intravenous sedation
(requires further training)




COMPETENCIES OF A SPECIALIST IN SPECIAL CARE DENTISTRY 1 8



REFERRAL GUIDELINES FOR SCD SERVICE




20

Referrals to the Hospital-based SCD clinic



( )Criteria for adult patients 16 years and above who present with

conditions as below:


Physical disabilities with
Intellectual significant co-morbidities
impairments
or mortality
• Requiring sedation or
general anaesthesia • Wheelchair user/bedridden
• Unable to be • Present with complex
managed at the medical problems
community setting

21

Complex medical problems which pose a significant
morbidity/mortality for dental treatment

Haematological disorders implication
(high risk of bleeding from invasive dental procedures)
Pre-cardiac surgery
Patients with pre/post organ or bone-marrow transplantation
Prior, during and after radiotherapy/chemotherapy due to
malignancies


22
REFERRAL GUIDELINES FOR SCD SERVICE

Geriatric
Unable to be
Psychiatric/ dental patients Requiring managed at the
psychological (please refer to multidisciplinary/ community level due
conditions with referral criteria interdisciplinary to the complexity of
underlying care from the medical problems
of geriatric medical and/or disabilities
systemic patients professionals or associated with
diseases that below) other dental behavioural issues
disciplines
requiring

specialist care


23
REFERRAL GUIDELINES FOR SCD SERVICE

Frail and functionally dependent Neurologic and Communication
cognitive and behavioural
(relying on the caregiver for activities
of daily living (ADL) such as bathing, impairments problems

eating and tooth-brushing)

24

Chronic medical Chronic psychiatric/ Nutritional/
conditions including psychological conditions swallowing problems

polypharmacy

25



Prerequisites for Referral




As a general rule, every attempt should be made by the referring dentist to manage
the oral health care of the patients with special needs at their level of capacity prior
referring to the specialist in SCD. However, in cases where there is any concern
regarding the appropriateness of the referral, the specialist should be consulted and
will assess any such case on an individual basis.

It should be noted that not all holders of the People with Disabilities (PWD) card of
the Social Welfare Department are eligible to receive SCD service. Patients who are
less than 16 years old should be referred to Paediatric Dental specialists.


27
REFERRAL GUIDELINES FOR SCD SERVICE















Dental Surgery Rooms

The dental surgery should have:
Double opening doors. Doorways need to be wide enough to accommodate the manoeuvre of a
wheelchair, large patient, equipment handling and transfer of trolleys
Enough space on each side of the dental chair to accommodate the manoeuvre of wheelchair, large
patient, equipment handling and transfer of trolleys
Proper wall colour and lighting to minimise anxiety
Worktop which is seamless, heat resistant, scratch resistant and chemical resistant for placement of
equipment and preparation of dental materials
Work station for telephone; computer and networking (online) for viewing digital radiograph, patient
information system and teledentistry
One deep stainless steel sink to be used by the dental surgery
assistant to wash selected dental instruments e.g. mixing slab,
for mixing alginate for dental impressions etc
One clinical sink (preferably ceramic) with elbow tap for use by
operator to wash hands
Space for an emergency trolley
Isolated dental surgery rooms with proper ventilation system

3 5REQUIREMENTS FOR SPECIAL CARE DENTISTRY CLINIC SETTINGS

Specialist surgery room (18-24 m²):

Closed surgery room with additional requirements as below:
Thick-brick wall (6 inches) and lead-lined door for safety and installation of intraoral x-ray
machine (intra-oral radiograph to be performed in the surgery for patients)
Operating table system or a dental chair with specialist specification for SCD (Refer standard
equipment list)
An intraoral radiograph unit (digital) – a wall mounted or mobile
A hoist for transferring patient from wheelchair to dental chair
A storage area for nitrous oxide sedation machine

3 6REQUIREMENTS FOR SPECIAL CARE DENTISTRY CLINIC SETTINGS

Other facilities may be required:

a. A dental record room
b. A consultation room
c. Donning and doffing area
d. Instrument reprocessing and sterilisation area
e. Dental laboratory
f. Store room or cabinet for storage
g. A seminar room
h. Staff pantry room and staff lockers
i. Disposal area
j. Recovery bay
k. Disabled-friendly toilet

3 7REQUIREMENTS FOR SPECIAL CARE DENTISTRY CLINIC SETTINGS



RECOMMENDED LIST OF
SPECIALISED EQUIPMENT

FOR SPECIAL CARE
DENTISTRY CLINIC




39

OTHER STANDARD EQUIPMENT




RECOMMENDED LIST OF Examination set
SPECIALISED EQUIPMENT
Minor oral surgery set

FOR SPECIAL CARE
DENTISTRY CLINIC Conservative set





Endodontic set

Periodontal set

Prosthetic set


Microstomia set



40

CONCLUSIONS






It is anticipated that the information in this e-book will provide some guidance to start and develop
SCD service, as it addresses issues such as clinical competencies, referral guidelines, facility and
equipment. Teamwork between the various specialties and primary oral health care practitioners
would allow successful delivery of the service. It certainly would benefit the target groups and meet
the World Health Organisation (WHO) aspiration that healthcare personnel support and protect the
rights and dignity of patients with disabilities in tandem with Ministry of Health (MOH) vision,
“A Nation Working Together for Better Health”.

41

ADVISO R REVIEWERS

Dr. Noormi binti Othman Dr. Fauziah binti Ahmad Dr. Rapeah binti Mohd Yassin
Principal Director of Oral Health Director of Oral Healthcare Division
Deputy Director of Specialist Oral
Ministry of Health Malaysia Oral Health Programme Healthcare Section
Ministry of Health Malaysia
Oral Health Programme
Ministry of Health Malaysia

Dr. Dasera Raj Vedha Raj Dr. Harathi a/p Dorairaja
Specialist in SCD Principal Assistant Director
Specialist Oral Healthcare Section
SCD Unit, Hospital Seberang Jaya
Oral Health Programme
Penang Ministry of Health Malaysia

Dr. Siti Zaleha Hamzah
Head of Specialty and Consultant Specialist in SCD

SCD Unit, Hospital Kajang
Selangor

Dr. Wong Yii Chyng
Dental Officer

SCD Unit, Hospital Queen Elizabeth
Sabah

Dr. Norjehan Yahaya Dr. Eileen Yap Ai Ling Dr. Wan Syasliza Mohamed Thani
Specialist in SCD Specialist in SCD Specialist in SCD

SCD Unit, Hospital Kuala Lumpur SCD Unit, Hospital Queen Elizabeth SCD Unit, Hospital Rehabilitasi Cheras
Sabah Federal Territory of Kuala Lumpur