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During COVID-19 pandemic, health cannot be put on hold – and oral health makes no exception. A 3 days Learning-Teaching-Training event on Special Oral Care with hands-on experience was hosted last September by the Pedodontics Department of the Faculty of Dentistry, Carol Davila University. Part of the Erasmus+ 2019-1-RO01-KA202-063820 Oral Special Care Academic Resources (OSCAR) Project, an unconventional encounter between young dentists and children with special healthcare needs, beneficial for all involved: children got free dental check-ups and treatment, while dentists got a boost of self-confidence and hopefully the will to continue providing treatment to this underprivileged category of population.
Key words: special needs, dental care, hands-on, international
Patients with special healthcare needs (SHCN) from many countries have limited access to quality oral care and their parents and caregivers often do not realize the importance of efficient primary prevention for the overall wellbeing of these kids. Families and caregivers do not get enough information, practitioners are reluctant towards dealing with this category of patients, dedicated facilities are scarce -if any- and therefore patients with SHCN develop complex oral pathologies, with important consequences upon their quality of life. Erasmus+ 2019-1-RO01-KA202-063820 Oral Special Care Academic Resources (OSCAR), initiated in 2019 by the Romanian National Association of Paediatric Dentistry (ANSPR), emerged from this reality.
OSCAR is an international educational project reuniting partners from 4 countries (Romania, Italy, France, Turkey) and aiming to raise awareness regarding the above-mentioned aspects by addressing young dentists (especially residents in paediatric dentistry) alongside with SHCN children, their families and caregivers.
Besides the use of digital means – as the https://oscarpd.eu/open-access platform that offers useful practical readily-applicable information for both dental practitioners and parents on providing treatment to this category of patients, webinars and virtual meetings – OSCAR is also about facilitating direct real-life encounters between SHCN children and young dentists, about building confidence and mutual trust in order to encourage a wider opening of dental professionals towards these children.
Covid-19 pandemic has impacted all our activities and quality of life, and there was no exception regarding social and educational events. Although eager to organise on-site events, due to restrictions, the OSCAR team has faced the impossibility to gather people around in real-life events for a long period of time, therefore most of the activities were held in a virtual manner. But this autumn, between 29th of September- 1st of October, we had the chance to organise a hands-on learning-teaching-training event (LTT) in Bucharest, at the Paediatric Dentistry Clinic, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy – an occasion to reconfirm that many SHCN patients have a lot of unmet treatment needs and that oral pathologies, as progressive diseases, cannot be put on hold by an unfavourable situation.
The event brought together more than 20 young dental practitioners from partner countries – Romania, Turkey and Italy. Romanian dentists (PD residents) were selected upon completion of an online form where they described their reasons and motivation for taking part in this event, while foreign guests were sent by their respective institutions – Marmara University, Istanbul and Ospedale Pediatrico Bambino Gesu, Roma. Special Olympics Romania, partner in the OSCAR project, invited 50 children with special care needs (and their parents) to benefit from free dental examinations and treatment.
All participants were welcomed by George, Dani, Andreea and Bogdan, our special friends from Special Olympics Romania who brought their mobile “Coffee Bicycle”, part of their project “Athlete leadership” (financed by Special Olympics International, through Bank of America). Very enthusiastic and happy to be part of this event, the four youngsters demonstrated their abilities in preparing hot beverages that they offered to everybody, along with a special smile and a boost of energy that managed to completely set aside their disabilities (Figure 1).
Organized in a non-conventional manner, across 3 full days, the LTT started with an “immersion in disability” experience, meant to encourage dental professionals see reality through a different perspective – that of people with various pathologies that impact not only the way they see things, but also the way they are seen by other people.
Ioan Batinaș, a well-known Romanian actor, volunteered to contribute to that with a short original act meant to help participants see the world through the eyes of a person with an autism spectrum disorder (Figure 2). The performance triggered empathy and an amalgam of emotions.
An unexpected questionnaire-test followed and brought both smiles and concern among the respondents who thus understood that conventionally accepted truth is not necessarily the only truth in life and that the same reality can be regarded from different angles (Figure 3).
Vlad, a young university graduate and Master student for whom cerebral palsy is an everyday challenge that can’t stop him from pursuing his ambitious goals, explained how being accepted and treated like everybody else means a lot to him, as it does to every person with or without disability (Figure 4). Vlad’s mother, a professional psychologist, brought forward both the parent’s and the therapist’s point of view, explaining how a dental appointment can be stressful for both dentist and SHCN child, yet this kind of reluctance can be overcome with a little bit of understanding and good will.
“Photovoices” (Figure 5) in the hallway told, in pictures and few words, the stories of some more remarkable children with disabilities that learnt to fight their way towards integration. Ana is one of them. 19 years old, Ana is a 12th grade student at Queen Elizabeth Technological School, she can swim like a fish – won gold and bronze medals in Special Olympics World Games in Los Angeles in 2015 – and is also good at karate, athletics and bocce. The extra 21 chromosome she’s got does not prevent her from loving to help people: Ana has been a volunteer for Special Olympics Romania for many years now and also has a part-time job. By being part of the Project “Employed, NOT assisted” and of a Youth Leader Activation Project, Ana hopes to inspire other youngsters like her in finding their own place in society.
Alexandra, from Special Olympics Romania, gave a short presentation about the foundation’s activities, goals and achievements. SO athletes are an inspiration to many people with disabilities, as they manage to constantly improve themselves and develop through sports. Organised all year round, SOR events help intellectually challenged people integrate and bring their own contribution to society’s life.
A Colgate representative presented the benefits of recommending fluoride-containing oral care products to our SHCN patients, especially as this category is often more likely to develop dental caries as a result of a number of factors, such as chronic administration of sugar-containing medication, lesser abilities to understand and perform proper oral hygiene, less concern for oral health within the greater picture of the child’s general condition.
Participants shared information on how oral care for children with special healthcare needs is organised and provided in their respective countries and institutions. Differences were identified between the various medical systems, yet the main common point was that access of SHCN patients to quality dental treatment is limited as compared to regular healthy patients. Presentations on providing special oral care (SOC) in office and under general anaesthesia followed and opened the way for further debate. The fact that an international team brought together members with different educational backgrounds and approaches gave the participants a chance to exchange facts and thoughts and to learn from each other. Waiting time for dental general anaesthesia, behavioural management and ways to develop and improve the current status of SOC in the participating countries were discussed. Opportunities to implement the Italian model of “Bedside Dentistry” in Romania were explained and discussed.
The second part of the event was dedicated to hands-on clinical experience. Mixed dental teams were organised and participants took turns in playing dentists’ and dental nurse’s roles for the children patients invited by SOR.
In order to prevent the spread of COVID-19, special measures were observed. All patients had to show proof of vaccination. Non-vaccinated participants were tested on-site for COVID-19 contamination. Protection equipment and disinfectants were provided for all participants. A strict schedule was set, limiting the number of patients per treatment room and per time unit in order to avoid unnecessary crowding. Treatment rooms were disinfected with UV lamps at the end of each session and good air ventilation was ensured constantly. The waiting area was set outside, in the (luckily) sunny courtyard of the clinic. While waiting for their treatment sessions, participants got one-on-one personalised toothbrushing instructions from members of the Turkish team and Romanian PD residents.
Most beneficiaries were SO athletes – children and teenagers with intellectual disabilities. They all got dental examinations and treatments, including oral prophylaxis, dental sealing, restorations of carious teeth, root canal treatments and even extractions. This accomplishment made everybody happy and proud, as both dentists and SHCN patients and their families are aware that dental treatments are often unfairly denied to this category by dentists who feel discouraged by the complexity of these patients’ general conditions. This leads to numerous referrals for dental treatments under general anaesthesia, even in patients that could be correctly and efficiently managed under common dental office circumstances, just by understanding the underlying condition and by following specific dental management protocols.
This LTT event confirms that even dentists with little or no previous experience in the field can provide high quality treatments to SHCN patients as long as they have the will to do it. Even the most uncooperative patients that answered the invitation and came to the clinic got the chance to have some dental treatment done under proper behaviour management.
For most of the dentist participants this was their first encounter with a SHCN patient. Within the context of Covid-19 pandemic, for some student participants this was their very first opportunity to directly interact with a patient of any kind. It was an exciting and very rewarding experience for all involved. Most kids cooperated nicely and were stimulated with goodie bags containing oral hygiene kits generously provided by Colgate Romania, OSCAR booklets containing useful info for parents and funny theme toys.
The outcome of the event was excellent for all participants, dental professionals and patients at the same time. Dentists got the opportunity to learn more about dental management of SHCN patients and actually put into practice the theoretical concepts that they had acquired, which boosted their confidence for future collaborations with this category of special patients in office. Andrei Ilie, a 4th year dental student, participated to the event (Figure 6) and shared his experience:” For me, this was my very first hands-on experience. I was pleasantly surprised by the involvement and skills of the residents and I am glad to see so many people getting the treatment they needed. Moreover, the fact that I was able to actually fill a cavity meant my very first step in the career I chose and I realised that I like it more and more.”
Viorel, a funny and cheerful young man with Down syndrome, was so happy about this experience that he kept smiling at all times and wanted all his teeth to be treated at the same time. Rounds of applause followed every successful treatment session. The international multicultural context of the event added fun even for the children who were very happy and excited to talk to foreign guests. (Figure 7).
Positive post-event feedback encourages the OSCAR team to be optimistic and hope that this kind of events will continue to be organised and to spread the inclusion message towards more and more dental practitioners that could thus become more open and willing to discover the amazing satisfaction given by treating SHCN patients. Go, OSCAR!