THE CDA DENTAL PATIENT WITH SPECIAL HEALTHCARE NEEDS TRANSITION PROCESS

BY CLIVE S. FRIEDMAN, DDS

In dentistry, when a young person reaches 12 to 18 years of age, they usually transfer from a pediatric dentist to a general dentist who will continue to provide oral healthcare for them in a new dental home. This process is called transition.

The oro-facial region is subject to increased sensitivity, and when invaded can elicit responses that are far more impactful than a typical medical exam. Behavioral interventions are thus more complex in pediatric dentistry and this is just one of the reasons this transition can be particularly difficult. Few resources are available to help parents/caregivers when the time comes to transfer to a new provider. There are transitioning documents available, such as the GOT transition process, but they are not designed for oral healthcare.

In 2019, I partnered with a general practitioner and a parent of a child with special needs to create a better resource to help families navigate the oral health care transition. Beyond helping patients and their families, we wanted this resource to arm new providers with information that would enable them to provide the highest level of care possible to the patients they were welcoming into their practices.

TEETH WISDOM: CREATING AN ORAL HEALTH CARE TRANSITION PROCESS

We began by assessing available medical transitioning documents, and created a process and series of adapted forms to more specifically address oral healthcare needs. The process and forms were piloted in my pediatric practice and in the GP's practice, and updated to reflect the results of that pilot. They are currently being prepared for publication by the Canadian Dental Association. The process includes three key steps:

STEP 1: TRANSITION READINESS ASSESSMENT

This step is an assessment of the patient's ability to take care of their oral health. Are they able to make oral healthcare decisions? What is their awareness of their oral health needs? Do they have the ability to express these needs? How well do they tolerate the dental environment?

The assessment also has patients and families identify difficult issues that might come up during the transition, and consider actions that can be taken to alleviate these problems.

STEP 2: DENTAL SUMMARY AND CARE PLAN

In this step, the current dental home care provider (often a pediatric specialist) completes a dental summary and care plan. The specialist will outline the specifics of what works and what does not work for the individual. Specific behavioral interventions can be highlighted. What treatment has been accomplished successfully? How was this treatment provided?

Sometimes the new practitioner may be unaware of specific techniques, and in certain areas of the form, it will have embedded video material to help demonstrate some of the nuances of the methodologies used by the current provider.

STEP 3: MEET AND GREET

Here, we provide a brief example of a letter that the new practitioner can send out to the family, welcoming them to the new practice and detailing the process by which they plan on incorporating them into the new office.

SMILES AHEAD: "This pilot project has allowed for a more concise and effective method of communication between the specialist and general practitioner related to the patient's medical history, social behavior, and dental needs."

THE FORMS WE ADAPTED TO GUIDE THIS PROCESS INCLUDE:

• A form to assess a patient's readiness for transitioning;

• A letter to parents explaining the steps of the transition process in detail;

• An in-depth oral health history and behavior form;

• An example of a welcome letter that the GP can send to the parent before the transition process begins.

The two most common barriers identified by caregivers that enable adequate transfer from a pediatric dental home to an adult dental home are understanding SHCN and insurance. The dental summary care plan is an attempt to provide extra educational material to the new dental team. It also offers an opportunity to discuss financial and other perceived barriers individualized to each family.

QUOTE FROM PARENT (HELPED DESIGN THE TRANSITIONING FORM)

"It's true; parents do know their children best, especially when their child has been in their care for many years and may require their assistance and advocacy. It's important that parents see themselves as an integral part of the treatment team. It's doubly important that parents willingly and knowingly appreciate the role they play in the successful transition from the care of a pediatric dental environment to one serving the community at large."

"Change can be stressful. Parents will have questions. The new, receiving dentist will have questions. Take the necessary time to ask those questions, to listen, and provide each other with helpful feedback. Working together works best. Dentists, dental technicians, reception staff, patients and parents alike are key to a smooth outcome –one more likely to ensure that all participants are comfortable and ready to make the change."

QUOTE FROM GP

"Transitioning patients with special needs from an office of a specialist to general practitioner can be quite challenging for all parties involved, including both the practitioners, staff members, as well as the parents/caregivers of the patient. This pilot project has been quite successful in making this transition process much more straightforward and effective. It has allowed for a more concise and effective method of communication between the specialist and general practitioner related to the patient's medical history, social behavior, and dental needs. In addition, the easy-to-use template helps staff members become effective liaisons of this transition. More important, this process has provided the parents/caregivers with the comfort and confidence that a smooth and seamless transition is taking place from one environment to another. I am both proud and happy to have been a part of this project, and am hoping that it becomes more mainstream in the years ahead. •

ABOUT THE AUTHOR:

Clive Friedman, DDS, FAAPD, is a pediatric dentist who sees patients at Pediatric Oral Health and Dentistry, his private practice located in London, Ontario, Canada. He has an impressive professional journey, spanning more than four decades, and has a special interest in persons with special needs, behavior, prevention, education, and wellness. Contact him at clive@dentistryforkids.ca