**Module 4217 Unit 3 (Special Needs Dentistry)**
**Disability and Systemic Conditions**
**in relation to their**
**Impact on Oral health**
**11 Jul 2025**
**8-9 AM (WA Time)**
**G15 KJG Sutherland LT**
**Dr David Lim**
**Lecturer, Dental School, UWA**
**UWA**
**PERTH AUSTRALIA**
**Learning Objective**
1. Explain the cultural, legal and social context of individuals with a disability
using the International Classification of Functioning, Disability and Health
(C3)
2. Outline the appropriate consent process and legal requirements when
providing oral health care for people with communication, cognitive or
sensory impairments (C2)
3. Outline common impairments, disabilities and systemic conditions in
relation to their impact on oral health and oral function (C2)
4. Compare the medical, social and environmental factors that impact on risk
assessment and treatment planning for individual patients requiring special
care (C4)
5. Demonstrate personal and professional development (A2)
**ICF**
**Common Imp, Disab,
Syst**
**Personal/Prof Dev**
Definitions
**IMPAIRMENT** means the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function (safeworkaustralia.gov.au)
Persons are considered to have a **DISABILITY** if they have a limitation, restriction or impairment, which has lasted, or is likely to last, for at least six months and restricts everyday activities.
(APSC.GOV.AU)
* Sensory
* Intellectual
* Physical
* Psychosocial
* Head injury, stroke, or other acquired brain injury
* Others
How is this definition different from other countries?
**SPECIAL NEEDS DENTISTRY** supports the oral health care needs of people with an intellectual disability, medical, physical or psychiatric conditions that require special methods or techniques to prevent or treat oral health problems, or where such conditions necessitate special dental treatment plans. (RACDS, 2015)
**ICF**
**Common Imp, Disab,**
**Syst**
**Personal/Prof Dev**
**Equality, Equity, Justice, Reality**
**Equality**
The assumption is that
**everyone benefits from**
**the same supports.** This
is equal treatment.
**Equity**
**Everyone gets the**
**supports they need**
(this is the concept of
"affirmative action"), thus
producing equity.
**Justice**
All 3 can see the game
without supports or
accommodations because
**the cause(s) of the**
**inequity was addressed.**
The systemic barrier has
been removed.
**Reality**
REALITY
Barriers in societal
systems tend to be
synergistic in causing
vulnerability/
marginalisation.
Image sources: Variations of these images have been created by Craig Froehle, Angus Maguire, the Center for Story-Based Strategy and the
Interaction Institute for Social Change
**ICF**
**Common Imp, Disab,**
**Syst**
**Personal/Prof Dev**
ICF
1. Explain the cultural, legal and social context of individuals with a disability using the **International Classification of Functioning, Disability and Health (C3)**
The International Classification of Functioning, Disability and Health (ICF) is a framework developed by the World Health Organization (WHO) for describing and measuring health and disability. It provides a common language for health professionals to understand and communicate about functioning and disability, moving beyond a purely medical or social model to a biopsychosocial one. The ICF model views a person's level of functioning as a dynamic interaction between their health condition, environmental factors, and personal factors.
**Bio-psycho-social Model of Functioning, Disability and Health**
[Image of a flowchart titled "Bio-psycho-social Model of Functioning, Disability and Health". It shows "Health condition" at the top influencing "Body functions/ Body structures", "Activities", and "Participation". "Body functions/Body structures" influences "Activities", which in turn influences "Participation". "Environmental factors" and "Personal factors" are shown influencing all three: "Body functions/Body structures", "Activities", and "Participation".]
**Figure 1** Bio-psycho-social model of the International Classification of Functioning, Disability and Health (ICF)
**ICF**
**Common Imp, Disab, Syst**
**Personal/Prof Dev**
MWC - Manual Wheelchair Users
Example of how ICF is used
**Health Condition**
Elderly and Aging MWC
**Body Functions and**
**Structures**
* Injury severity and
neurologic level
* Cognition
* Fitness level
* Upper extremities and trunk
**Activities**
* Mobility in the home and
community
* ADL
* Physical activity and exercise
**Participation**
* Quality of life
* Community Participation
* Social Engagement
* Self-care, self-esteem
* Work/Employment
**Environmental Factors**
* Wheelchair design and
seating configuration
* Home, community, and work
barriers
* Transportation
**Personal Factors**
Age, skills, BMI, gender,
ethnicity, duration of
impairment, marital and
socioeconomicstatus,
**ICF**
**Common Imp, Disab,**
**Syst**
**Personal/Prof Dev**
**Parkinson's - neurodegenerative**
**NEUROLOGICAL DISORDERS**
**PRESENT WITH ABNORMAL**
**MOVEMENT (DYSKINESIA)**
* Tremors
* Chorea
* Tics
* Other involuntary movements
**Cerebral Palsy - neurodevelopmental**
**ICF**
**Common Imp, Disab,**
**Syst**
**Personal/Prof Dev**
CASE EXAMPLE
**Medical History**
* Huntingdon’s Disease (Dx 2000)
✦Moderate Chorea
* Dysphagia ( Severe )
✦declined PEG
✦Speech and Language Therapist,
stabilised BMI
**Social History**
✦used to work + housekeep
✦Walking stick
**Dental History**
✦Moderate caries risk
✦Food pouching
✦Self-brushing after meals
MEDS: Tetrabenazine, Citalopram (SSRI)
**Management**
✓ I/O Exam with Clinical Holding/
Protective Stabilisation
✓ Shared-decision/informed
consent
✓ Mild Sedation: 6mg Midazolam
Orally, 20mins prior
✓ CAP 15 Distal Occlusal
✓ Water control
✓ Mouth prop
**ICF**
**Common Imp, Disab,
Syst**
**Personal/Prof Dev**
Huntington's Disease
is an inherited **degenerative neurological condition** affecting the brain and central nervous system. It progressively impairs mental and physical abilities, eventually leading to the loss of critical functions such as walking, talking, eating and reasoning. Complications arising from HD ultimately resulting in death.
* Features
* Uncontrollable dance-like movements (chorea). Rigidity subtypes are rare
* changes behaviour, emotion, judgement, personality, hallucinations
* Causes:
* Mostly autosomal dominant, sometimes sporadic
* Mutation in Huntingtin gene, causing proteins to lodge in brain
* Prognosis: no cure, progress over 2 decades
* Epidemiology: 8-10 per 100,000 of European ancestry
* Treatment:
* Supportive: exercise, healthy diet, psychosocial support
* Palliative concepts of treatment
* Medication to reduce symptoms (movement, mood etc.),
https://huntingtonsaustralia.au/about/
https://www.ninds.nih.gov/health-
information/disorders/huntingtons-
disease
MakeAGIF.com
What other neuro-degenerative conditions do you know?
ICF
**Common Imp, Disab,
Syst**
Personal/Prof Dev
ICF for Huntington’s
**Health Condition**
**Huntington’s Disease**
(Top-left Box)
* Uncontrolled mvm
* Cognition
* Mood
* Psychiatric issues
(Top-middle Box)
* reduced mobility
* poor decision-making
* reliance of caregiving
* AODL/ADLs
* Employment
* Independence
* Community
* QoL
(Top-right Box)
(Empty)
(Bottom-left Box)
* accessibility,
* Societal/cultural
* social supports avail
* healthcare expertise
* family support
(Bottom-right Box)
* personal outlook
* socio-economic status
* age,
* concomitant health conditions
**ICF** **Common Imp, Disab, Syst** **Personal/Prof Dev**
**Flowchart: Interrelation of Health Aspects and General Well-being**
```
Medical Health Physical Health
↓ ↓
Oral Health general well being
↑ ↑
Mental Health
```
Bottom Labels:
- ICF
- Common Imp, Disab, Syst
- Personal/Prof Dev
```
ORAL DISEASES affects
├── Cardiovascular disease
├── High blood pressure
├── Lung infections
├── Sleep apnea
├── Medical and cancer therapies
├── Dementia
├── Stroke
└── Diabetes
Legend:
- ICF
- Common Imp, Disab, Syst
- Personal/Prof Dev
```
Diabetes Mellitus
* Diabetes and Gum health share **bi-directional** effect
* When gum health is restored, **HbA1c levels improve**
3-4mmol/L (0.3-0.4%).
Borgnakke & Poudel, 2021
ICF
**Common Imp, Disab,
Syst**
Personal/Prof Dev
SCAN ME
Dysphagia, poor oral hygiene & pneumonia
* Weekly high quality
oral care reduced
mean annual
**pneumonia** from
**1.24 to 0.48**
* reduce mortality
* reduce
hospitalisation
The effect of oral care intervention on pneumonia hospitalization,
Staphylococcus aureus distribution, and salivary bacterial
concentration in Taiwan nursing home residents: a pilot study
Chiang et al., 2020
**ICF**
**Common Imp, Disab,**
**Syst**
SCAN ME
**Personal/Prof Dev**
**Challenges for PwIDD**
* Medications cause overgrown gums
* Hyper-sensitive mouth
* Hypo-sensitive mouth
* Poor manual dexterity
* Communication
* Self-inflicted injuries\*
**periobasics.com**
**ICF Common Imp, Disab, Syst Personal/Prof Dev**
Common impairment/disability/
systemic conditions
**Outline common impairments,**
**disabilities and systemic conditions in**
**relation to their impact on oral health**
**and oral function (C2)**
**Down's Synd**
Access
Escort/accompanying person. Mild mobility issues. Sensory issues
Communication
Communication can vary. Appropriate language, repeated and scaffolded.
Possible sensory impairments (presbycusis, cataract)
Consent
PwDS have intellectual disability, and at risk of early-onset dementia, psychiatric conditions.
Consider Legal Capacity principles in consent taking
Education
Consider brushing techniques (Modified Bass vs scrub etc), and assistive devices
Assisted oral hygiene. Additional effort for effective self-care. Control diabetes
Surgery
GA concerns - atlanto-axial joint instability, restricted airways, anaemic
Cardiac, haematological, endocrine (hypothyroid, diabetes, osteoporosis) concerns
Epilepsy, risk of sleep apnea, gastric reflux
Spread
DS does not spread. Might be immunocompromised (neutropenia, leukaemia, etc)
Oral Finding
ICF
**Common Imp, Disab,**
**Syst**
**Personal/Prof Dev**
Some possible Oral Findings for DS (not all PwDS will have them)
**A**
Lip fisures, angular chelitis
**B**
hypoplastic tooth structure, AOB, tongue protrude
**C**
Bifid uvula, enlarged tonsils
**D**
cleft lip/palate
hypoplastic maxilla
pseudoprognathism
**E**
conical shaped
teeth, tooth wear,
caries risk, missing
teeth
**F**
ICF
**Common Imp, Disab, Syst**
Personal/Prof Dev
Improving tools for toothbrushing
**Modified**
**Brush-head**
**Collis Curve**
**Surround Brush**
ICF
**Common Imp, Disab,**
**Syst**
**Personal/Prof Dev**
Modified Handles
Improving tools for toothbrushing
ICF | Common Imp, Disab, Syst | Personal/Prof Dev
Caregiver’s
Assisted Brushing
Positioning
ICF Common Imp, Disab, Syst Personal/Prof Dev
Image showing "Caregiver’s Assisted Brushing Positioning" – a caregiver is brushing a patient's teeth while the patient is in a wheelchair reclined for support and stability.
**Common impairment/disability/ systemic conditions**
Outline **common impairments, disabilities and systemic conditions in relation to their impact on oral health and oral function (C2)**
| | **Cancer treatment** | **Frail seniors (>65 in WA)** |
|---|---|---|
| Access | | |
| Communicati on | | |
| Consent | | |
| Education | | |
| Surgery | | |
| Spread | | |
| Oral Findings | | |
**ASSCID** was established in August 1997 and has continued to grow, now including members representing every state and territory in the country.
**ASSCID**
australian society of special care in dentistry
**Committed to improving the oral health of people with special needs**
The aims of ASSCID are:
* To take an active role in educating the dental profession and other health care workers in the oral health needs of people with special needs.
* To be a resource centre for oral health professionals seeking information in the management of patients with special needs.
* To lobby for oral health services for people with special needs.
* To support oral health promotion that targets people with special needs.
* To be a fraternity of oral health professionals interested in the care of people with disabilities.
Members enjoy many benefits including professional networking opportunities, member newsletters, professional advice, discounts on events and up-to-date information on industry news.
In addition,
Generous discounts on attending our professional development events
Free membership of the International Association of Disability and Oral Health (IADH), which would normally cost over US$100
Free access to the IADH journal.
| Level | Price |
| :------------------------- | :--------------------- |
| Full | $165.00 now. Membership expires after 1 Year. |
| Student | $55.00 now. Membership expires after 1 Year. |
| Student - Recurring Annual Payment: | $55.00 per Year. |
| Full - Recurring Annual Payment | $165.00 per Year. |
**Australia New Zealand Academy of Special Needs Dentistry**
Our aims and objectives
The aims and objectives of the Academy are:
* To advocate for the oral and general health of persons with special needs.
* To encourage and support the development of the art of practice of special needs dentistry.
* To establish and advance the scientific evidence base on which clinical practices should be based.
* To popularise and disseminate this information.
**Demonstrate personal and professional development (A2)**
**Societies offering support for SND after your DMD**
| ICF | Common Imp, Disab, Syst | Personal/Prof Dev |
| :-- | :---------------------- | :---------------- |
**2025**
**MYSCD CARE**
**CONFERENCE**
**OPTIMISING CARE: PRACTICAL APPROACHES**
**TO SPECIAL CARE DENTISTRY**
**CPD POINTS**
**WILL BE**
**AWARDED**
Malaysian Association
for Disability and Oral
Health (MADOH)
**REGISTER NOW**
*Calling for abstracts!*
Sep 25-26, 2025,
Kuala Lumpur
**25 - 26 SEPTEMBER 2025**
**Dorsett Hotel Putrajaya**
**Meet our experts**
**DR SITI ZALEHA HAMZAH**
CONSULTANT IN
SPECIAL CARE DENTISTRY
(MOH)
**PROF. DATUK DR**
**KALAIARASU M.**
**PEARIASAMY**
CONSULTANT IN
PEDIATRIC DENTISTRY &
FORMER DIRECTOR OF NIH
**PROF. DR MOHD**
**YUSMIAIDIL PUTERA**
CONSULTANT IN
FORENSIC ODONTOLOGY
& OMF RADIOLOGY
(UITM)
**DR LIM BOON CHUAN**
CONSULTANT IN
DEVELOPMENTAL
PAEDIATRICS (MOH)
**DR DAVID LIM**
SPECIAL CARE DENTIST
(SINGAPORE)
**DR DARLINA MOHD**
**DHARI**
CONSULTANT IN
ANAESTHESIOLOGY
(MOH)
**ASSOC. PROF. DR FARHA**
**ARIFFIN**
SPECIALIST/LECTURER IN
PERIODONTOLOGY
(UITM)
**DR SITI FAUZZA**
**AHMAD**
SPECIALIST/LECTURER IN
PROSTHODONTIC
(UM)
**MR ABDUL MU'AZ**
**MUSTAPHA**
OCCUPATIONAL THERAPIST
(MOH)
**FOR MORE INFORMATION**
https://www.kkevents.org
**EVENT SCHEDULE** **25 SEPTEMBER 2025 (THURSDAY)**
**TIME**
**MAIN HALL**
**BREAKOUT ROOM**
**8.00 am - 9.00 am** **REGISTRATION - MAIN HALL/CONCOURSE**
**PLENARY 1 - MAIN HALL**
**9.00 am - 9.45 am** Shaping the Future of Special Care Dentistry - Integrating Policy, Education and Technology
**DR SITI ZALEHA HAMZAH**
**OPENING CEREMONY MAIN HALL**
**10.00 am - 11.00 am** VIP: DEPUTY DIRECTOR GENERAL (ORAL HEALTH PROGRAMME, MINISTRY OF HEALTH)
**11.00 am - 11.15 am** **TEA BREAK**
**11.15 am - 12:00 pm**
Conducting Ethical Research with Individuals with
Disabilities
**PROFESSOR DATUK DR KALAIARASU M. PEARIASAMY**
Periodontal Disease and Management in People With
Special Health Care Needs
**ASSOCIATE PROFESSOR DR FARHA ARIFFIN**
**FORUM:**
**12.00 pm - 12.30 pm** It takes a Village to Care for People with Autism
**1. DR MOHD HAKIMIN MOHAMED ASHRI**
**2. MR ABDUL MU'AZ BIN MUSTAPHA**
**3. DR LIM BOON CHUAN**
Prosthodontic Management in People With Special Health
Care Needs: Ideal versus Reality
**DR SITI FAUZZA AHMAD**
**12.30 pm - 1.00 pm** Oral Medicine and Pathology Related Lesions and
Management In People With Special Health Care Needs
**ASSOCIATE PROFESSOR DR NIK MAZUAN MOHD ROSDI**
**1.00 pm - 2.30 pm** **LUNCH SYMPOSIUM**
**MAIN HALL/CONCOURSE**
**2.30 pm - 3.30 pm**
Special Considerations in Oral Health Management for
People with Physical Disabilities
**DR NORJAHAN YAHAYA**
**ORAL PRESENTATION**
**3.30 pm - 4.30 pm**
Rehabilitation Medicine and Special Care Dentistry
**DR WAN SYASLIZA MOHAMED THANI**
**EVENT SCHEDULE** **26 SEPTEMBER 2025 (FRIDAY)**
**TIME**
**MAIN HALL**
**BREAKOUT ROOM**
**PLENARY 2 - MAIN HALL**
**8.30 am - 9.15 am** Artificial Intelligence and Its Application to The Management for People with Special Healthcare Needs
**PROFESSOR DR MOHD YUSMIAIDIL PUTERA**
**9.15 am - 10.00 am**
Domiciliary Oral Health Care Service
**DR DAVID LIM**
**POSTER PRESENTATION**
**10.00 am - 10.45 am**
Transition Clinic Initiative Is It Necessary?
**ASSOCIATE PROFESSOR DR ILHAM WAN MOKHTAR**
**10.45 am - 11.15 am** **TEA BREAK**
**11.15 am - 12.30 pm**
Frailty and Sarcopenia in Elderly Population - What
Dentists Should Know?
**DR UNGKU AHMAD AMEEN UNGKU MOHD ZAM**
Dementia/Alzheimer's Disease - It's Impacts in The Oral
Health Management
**DR JESSICA A/P FRANCIS**
**12.30pm - 2.30 pm** **LUNCH BREAK AND FRIDAY PRAYERS**
**2.30 pm - 3.30 pm**
The Challenges in General Anaesthesia for People with
Special Health Care Needs
**DR DARLINA MOHD DHARI**
Liaison Officer Programme in Sabah
**DR EILEEN YAPAILING**
**FORUM:**
Aligning the Special Care Dentistry Curriculum
**3.30 pm - 4.30 pm**
1. **ASSOCIATE PROFESSOR DR MAS SURYALIS AHMAD**
2. **ASSOCIATE PROFESSOR DR MARYANI MOHAMED**
**ROHANI**
3. **ASSISTANT PROFESSOR DR FARAH NATASHAH MOHD**
Conscious Sedation versus General Anesthesia
**DR MUHAMMAD SYAFIQ ASYRAF ROSLI**
**4.30 pm - 5.00 pm**
**CLOSING CEREMONY**
**PRIZE GIVING CEREMONY TO WINNERS OF ORAL AND POSTER COMPETITION**
INTERNATIONAL ASSOCIATION
FOR DISABILITY & ORAL HEALTH
**iADH 2026**
19-22 AUGUST 2026
DUBLIN IRELAND
Home Conference Information Registration Sponsorship Contact
**iADH 2026**
**Inclusion Health: Prioritizing,**
**Diversity, Equity and Oral Health**
19-22 August 2026
Trinity College Dublin, Ireland
**ICF**
**Common Imp, Disab,**
**Syst**
**Personal/Prof Dev**
Module 4217 Unit 3 (Special Needs Dentistry)
thank you
guangxudavid.lim@uwa.edu.au
manorial.ratnaweera@uwa.edu.au
Dr David Lim
Lecturer, Dental School, UWA
11 Jul 2025
8-9 AM (WA Time)
G15 KJG Sutherland LT