Special needs education in Canadian dental school curriculum: is there enough?

Persons with intellectual disabilities have an increased prevalence of caries, periodontal disease and poor oral hygiene compared to the general population.1,2 They are also one of the most underserved groups of dental patients in both Canada and the United States.3,4 Although some individuals with severe disabilities may require special patient clinics or services, most disabled persons can be treated by a general dentist who has some instruction and experience in the care of patients with special needs.2,5 Pediatric dentists receive extensive training in the area of special care dentistry, but because of their limited number and the size of the special needs population, the majority of patients with special needs most likely obtains care from general dentists.6 As such, “undergraduate programs are providing the most training in this area of special care dentistry.”6 It is crucial that general dentists and their staff be well versed in treating persons with special needs. Currently, fewer than 10% of general dentists see children with cerebral palsy, mental retardation or who are medically compromised, which underscores the lack of dental care for the special needs population.7,8 Much of the research on intellectual disability and access to health care points to several significant barriers to access.2,9-11 Persons with special needs cite cost, dental fear and anxiety, and lack of perceived need for dental care,9,11 whereas dentists cite concerns related to loss of time, patients’ potential behaviour, availability of funds and level of training.6,7 Of these barriers, the one that may be most practically addressed is the shortage of practitioners with appropriate training.3,12 Studies cite a direct correlation between training experience and a willingness to treat persons with special needs.4,7,13,14 Practising dentists identify lack of training in behaviour management, communication and treatment planning as their greatest areas of concern in treating patients with special needs.15 The Commission on Dental Accreditation of Canada (CDAC) issues accreditation requirements for all educational dental programs, i.e., dental assisting, dental hygiene and dental undergraduate, postgraduate and graduate training. The terminology used by CDAC identifies whether a requirement is mandatory (“must,” “shall”) or highly desirable but not obligatory (“should”). In its accreditation requirements for dental undergraduate programs, CDAC suggests that “experiences in the management of medically-compromised patients and patients with disabilities... should also be provided.” 16 The expectations for graduate training programs vary from providing information in didactic course material (e.g., periodontics) to requiring clinical proficiency in treating patients with special needs (e.g., pediatric dentistry). Overall, clinical experience in the management of medically compromised patients, including those with intellectual disabilities, is not a requirement of most Canadian dental programs. (For a discussion of the nuances in terminology in dental school accreditation standards, see Dr. Waldman’s debate article.17) Over the past 26 years, researchers have examined the dental curriculum of American and Canadian undergraduate dental schools with regards to the quantity of didactic and clinical experience provided to students in the area of special needs education.4,18,19 More recently, Caribbean and Latin American dental schools have been surveyed on this same topic.20 These studies have reached similar conclusions: dental curriculum varies significantly with respect to special needs education among dental programs, and greater emphasis on special needs education is required for undergraduate dentists. The purpose of our study was to develop and implement a survey for Canadian dental schools in order to assess the didactic and clinical education that students enrolled in these programs receive in the area of special needs education, and to evaluate the role of CDAC guidelines and requirements in curriculum related to persons with special needs. Special Needs Education in Canadian Dental School Curriculum: Is There Enough?