TC WHITE CONFERENCE PRESENTATION AWARD REPORT

by Gemma Gaw BSc (Hons) BDS

MFDS RCPS (Glasg)

PhD

Care Dentistry has unique challenges. I particularly enjoyed a session delivered by Dr Karve and Dr Farrell on airway management. They discussed airway assessment, medical factors and risk reduction.

This insight will help me to risk assess patients in the dental clinic and improve communication with the anaesthetics team. Other highlights included learning about education in Special Care Dentistry and applying the IADH curriculum across the world, and treating patients with a neurodisability.

I presented a research project on 'Management of patients at risk of adrenal crisis in the dental setting: A review of current practice in UK dental teaching hospitals'.

It was a pleasure to attend the International Association for Disability and Oral Health (IADH) Conference where I met world leading experts contributing to the rapidly developing specialty of Special Care Dentistry. The IADH is multidisciplinary network who are concerned with the oral health of people living with disabilities, and aims to advocate for equality and promote scientific research. A bi-annual conference provides an opportunity for researchers and clinicians to share knowledge and experiences to improve health outcomes for people with disabilities. The IADH 2022 congress was the first face to face event since the pandemic and was hosted by the French national association Santé Orale et Soins Spécifiques (French association for disability and oral health) in Paris, France. The theme of the conference was 'Quality Matters – ensuring equitable health outcomes'

The conference began with a keynote lecture by Philippe Aubert, a lecturer and author who lives with cerebral palsy.

He spoke about the importance of access to dental care for dignity, respect and self-care. Listening to each patient in the way they express themselves, is required to understand the way their oral health impacts their life. He described his experiences of dental care in the clinic with clinical holding and sedation, as well as general anaesthesia. Philippe encouraged us to question how we share skills and knowledge with patients, and respect their autonomy, trust and humanity.

On the theme of successful ageing, I learned more about the shortened dental arch and nutrition and the association between number of teeth and mortality. The restorative challenges of the elderly patient, with increased risk of aspiration pneumonia and the risks of denture wearing at night were discussed, and I learned that PMPR and intensive oral hygiene reduces this risk. An interesting study from Japan showed that patients have improved oral and respiratory function when they participate in karaoke!

A session on behaviour change, oral hygiene and how to support care givers was very reassuring as this is often a difficult issue to address. Providing dental care under general anaesthesia in Special

This is a particular area of interest to me following referral of steroid dependent patients to the Oral Surgery department at Glasgow Dental Hospital as a DCT1. I was taught the importance of evidence based clinical decision making, and realised this is an area where evidence is lacking and guidance is conflicting. Therefore, I wanted to find out more. The study I presented gives evidence that variation in the management of steroid dependent patients. Identifying patients who are at risk of adrenal crisis due to systemic glucocorticoid use varies, and dose regime for steroid cover varies between hospitals. Participants expressed their wishes for pragmatic evidence-based guidance. From discussions, it appears that the situation is similar to the UK and often surgeon’s preference dictates the identification and management of patients taking exogenous steroids who may be at risk of adrenal crisis whilst undergoing dental treatment. The need for further research, including evidence on the risk of dental procedures to this group of patients was highlighted. The presentation was selected as a finalist in the Clinical Research Presentation Oral Category.

Presenting to a global expert audience was an invaluable opportunity to improve my communication skills to peers with a wide variety of backgrounds, cultures and languages. I enjoyed discussing implications of my findings such as directions for further research and increasing awareness of the risk of adrenal crisis to this group of patients. Undertaking this research project and presenting my findings at the IADH conference has increased my confidence in participating in clinical research. I was keen to find out how colleagues in other countries manage this group of patients and if their practice varies in the same way as the UK.

I wish to sincerely thank the Royal College of Physicians and Surgeons of Glasgow for supporting me to attend this event and to present my research to a worldwide audience through the TC White Conference Presentation Award. I have gained confidence to pursue further research and embark on Specialist Training in Special Care Dentistry. My eyes have been opened to the global challenges in providing dental care to patients with additional needs and I will use all that I have learned to improve the care I deliver in NHS Greater Glasgow & Clyde Special Care Dentistry service.