DENT5311: Population informed clinical case summary Dr Mohammed Junaid **BDS, MDS (Public Health Dentistry), MFDS RCPS (Glasg), DDPH RCS (Eng), SFHEA, MDPH (U Syd), PhD (UWA)** Senior Lecturer, Dental Public Health UWA Dental School and OHCWA Dr Mohammed Junaid BDS, MDS (Public Health Dentistry), MFDS RCPS (Glasg), DDPH RCS (Eng), SFHEA, MDPH (U Syd), PhD (UWA) Senior Lecturer, Dental Public Health UWA Dental School and OHCWA The University of Western Australia **Acknowledgement of country** Our university is located alongside the Derbal Yerrigan (Swan River) on Whadjuk Noongar Boodja. The University of Western Australia acknowledges that we are situated on Noongar land and that Noongar people remain the spiritual and cultural custodians of their land and continue to practise their values, languages, beliefs and knowledge. Artist: Dr Richard Barry Walley OAM © The University of Western Australia | 2026 2  The University of Western Australia Our university is located alongside the Derbal Yerrigan (Swan River) on Whadjuk Noongar Boodja. The University of Western Australia acknowledges that we are situated on Noongar land and that Noongar people remain the spiritual and cultural custodians of their land and continue to practise their values, languages, beliefs and knowledge. *Artist: Dr Richard Barry Walley OAM* © The University of Western Australia | 2026 Stylized artwork: a black swan with a yellow beak set within concentric rings and swirling patterns in blue, grey, and yellow. The slide text identifies this as an Acknowledgement of Country piece by artist Dr Richard Barry Walley OAM, representing the university's location on Whadjuk Noongar Boodja alongside the Derbal Yerrigan (Swan River). - **Do not edit** **How to change the design** From you perspective, what factors make a dental visit a positive experience or, conversely, a negative one? **slido** 🔹 **The Slido app must be installed on every computer you’re presenting from** 🔹 **Do not edit** 🔹 **How to change the design**  From your perspective, what factors make a dental visit a positive experience or, conversely, a negative one? A stylized icon of a cloud, likely representing the Slido app or cloud-based interaction mentioned in the slide text. The figure carries no numbered or lettered labels. Do not edit How to change the design ## From your perspective, what is the most important outcome to measure the success of dental treatment? The Slido app must be installed on every computer you’re presenting from | slido  From your perspective, what is the most important outcome to measure the success of dental treatment? A stylized purple icon depicting a cloud with a smaller cloud in front and a curved line inside representing rain. Do not edit How to change the design **What kind of care or support do you hope to provide your patients who receive care at your dental care service?** The Slido app must be installed on every computer you’re presenting from slido  What kind of care or support do you hope to provide your patients who receive care at your dental care service? Icon: A purple graphic depicting a stylized cloud with a smaller cloud shape in the lower right foreground. This image illustrates the 'Slido app' referenced in the text, symbolizing a cloud-based application or service. **Dent ## Voices **Community Conversation Summary Report ** Prepared By Dr. Mohamed Junaid Professor Robert Anthonappa Dr. David Lim Dr. Anita Sakia ** August 2023 Western Australia Local Healthcare Network ### Dent Voices #### Prepared By - Dr. Mohamed Junaid - Professor Robert Anthonappa - Dr. David Lim - Dr. Anita Sakia August 2023 Western Australia Local Healthcare Network **Learning outcomes** By the end of this tutorial, students will be able to: 1. Recognise the limitations of biomedical care and explain patient-centred care. 2. Analyse how social determinants, barriers and intersectionality influence oral health and care. 3. Apply the population informed clinical case summary (PICCS) framework to real clinical cases. 4. Develop equitable, realistic and patient-centred management strategies. 5. Reflect on their assumptions and clinical practice By the end of this tutorial, students will be able to: 1. Recognise the limitations of biomedical care and explain patient-centred care. 2. Analyse how social determinants, barriers and intersectionality influence oral health and care. 3. Apply the population informed clinical case summary (PICCS) framework to real clinical cases. 4. Develop equitable, realistic and patient-centred management strategies. 5. Reflect on their assumptions and clinical practice. Do not edit How to change the design # What do you ask your patients when you record their social history? The Slido app must be installed on every computer you’re presenting from slido  #### Discussion Question What do you ask your patients when you record their social history? Icon: A stylized purple cloud graphic with a smaller white cloud overlay, representing the Slido app or cloud-based interaction mentioned in the slide text. # **How many among you have heard of the term "Social Dental Practice" ?** Do not edit How to change the design The Slido app must be installed on every computer you're presenting from **slido** #### Discussion Question How many among you have heard of the term "Social Dental Practice"? What comes in mind when you think of social dental practice? **Slido app** The Slido app must be installed on every computer you’re presenting from **How to change the design**  #### Discussion Question What comes in mind when you think of social dental practice? A stylized graphic icon depicting a cloud with a smaller cloud overlapping its bottom right corner, rendered in purple outlines with light purple shading. **Why is it hard to practice social dentistry?** **Answer:** Our Biomedical approach to training! This page has detected figure regions. Each is given an arbitrary LABEL (BOX_A, BOX_B, BOX_C, ...) followed by the exact box it occupies (grounding coords 0-1000, top-left origin) and a rough position: BOX_A: [64,187,925,906] (center, middle area) Biomedical focus Individualism Standardisation Hierarchies Cultural blindness McGough S, Wynaden D, Gower S, Duggan R, Wilson R. There is no health without Cultural Safety: why Cultural Safety matters. Contemp Nurse. 2022 Feb;58(1):33-42. https://www.abc.net.au/news/science/2018-08-17/culture-may-affect-the-way-your-brain-processes-everything/10120068 11  #### Barriers to Practising Social Dentistry - **Biomedical approach to training** serves as a core obstacle - Biomedical focus - Individualism - Standardisation - Hierarchies - Cultural blindness *McGough S, Wynaden D, Gower S, Duggan R, Wilson R. There is no health without Cultural Safety: why Cultural Safety matters. Contemp Nurse. 2022 Feb;58(1):33-42.* *https://www.abc.net.au/news/science/2018-08-17/culture-may-affect-the-way-your-brain-processes-everything/10120068* Labelled diagram: An inverted pyramid divided into five horizontal segments illustrating the components of a biomedical approach. Top orange segment = Biomedical focus, second green segment = Individualism, third blue segment = Standardisation, fourth purple segment = Hierarchies, bottom green segment = Cultural blindness. # Patients journey in seeking oral health services [[The university of Western Australia]] | | | | | | :--- | :--- | :--- | :--- | | **First phase** | | | **Second phase** | | Lay referrals and interventions | Health care organization | | | | Geographic availability | Ability to pay | | | | Self-care, self-help | Geographical availability | | | | | | | | | **Perception of need** | $\rightarrow$ | **Identify a source of care** | $\rightarrow$ | **Gain entry to health care** | $\rightarrow$ | **Obtain health care** | $\rightarrow$ | **Achieve a desirable outcome** | | | | | | | | | | | | | | | | | | | | | Cultural variation | $\uparrow$ | | | | | $\uparrow$ | $\uparrow$ | | | | | | | | Presentation and knowledge of disease | | | | | | Fit between health care and patient: | | | | | | | | | Triggers | | | | | | | | | | | | | | | Perceptions of costs and benefits | | | | | | Availability | | | | | | | | | | | | | | | Affordability | | | | | | | | | | | | | | | Acceptability | | | | | | | | | | | | | | | Accessibility | | | | | | | | | | | | | | | Accommodation | | | | | | | | Source: Daly B, Batchelor P, Treasure ET, Watt RG, Essentials in Dental Public Health, Second Edition, Oxford university press  #### Stages of the Seeking Process Perception of need → Identify a source of care → Gain entry to health care → Obtain health care → Achieve a desirable outcome #### Influencing Factors Across Phases ##### First Phase - Lay referrals and interventions - Geographic availability - Self-care, self-help - Cultural variation - Presentation and knowledge of disease - Triggers - Perceptions of costs and benefits ##### Second Phase - Health care organization - Ability to pay - Geographical availability ##### Fit Between Health Care and Patient - Availability - Affordability - Acceptability - Accessibility - Accommodation *Daly B, Batchelor P, Treasure ET, Watt RG, Essentials in Dental Public Health, Second Edition, Oxford university press.* A flowchart illustrating the two-phase patient journey in seeking oral health services, moving from 'Perception of need' to 'Achieve a desirable outcome.' The diagram details inputs for the first phase (e.g., Lay referrals, Health care organization) and factors influencing later stages such as cultural variation and the fit between health care and patient. # Understanding the concept of wise mind – patient level perspective THE UNIVERSITY OF WESTERN AUSTRALIA ```mermaid flowchart LR subgraph Emotion_Mind["Emotion Mind"] direction TB E1["reacting quickly"] E2["wanting to hurt who hurt you"] E3["behaving impulsively"] E4["acting on urges"] end subgraph Wise_Mind["Wise Mind"] direction TB W1["taking emotions and logic into account"] W2["seeing the situation from multiple perspectives"] end subgraph Reasonable_Mind["Reasonable Mind"] direction TB R1["feeling cut off or numb to your emotions"] R2["rationalizing behavior (even when it's unacceptable)"] R3["avoiding or being in denial about something that's happening"] R4["minimizing or shrugging off your feelings"] end Emotion_Mind --- Wise_Mind --- Reasonable_Mind ``` Image source: https://thewellnesssociety.org/wise-mind-dbt/ 13 ```mermaid flowchart LR subgraph Emotion_Mind["Emotion Mind"] direction TB E1["reacting quickly"] E2["wanting to hurt who hurt you"] E3["behaving impulsively"] E4["acting on urges"] end subgraph Wise_Mind["Wise Mind"] direction TB W1["taking emotions and logic into account"] W2["seeing the situation from multiple perspectives"] end subgraph Reasonable_Mind["Reasonable Mind"] direction TB R1["feeling cut off or numb to your emotions"] R2["rationalizing behavior (even when it's unacceptable)"] R3["avoiding or being in denial about something that's happening"] R4["minimizing or shrugging off your feelings"] end Emotion_Mind --- Wise_Mind --- Reasonable_Mind ``` *Image source: https://thewellnesssociety.org/wise-mind-dbt/* # Understanding social dentistry **Social medicine** It is the practice of medicine that integrates: 1. Understanding and applying the social determinants of health, social epidemiology, and social science approaches to patient care; 2. An advocacy and equity agenda that treats health as a human right; 3. An approach that is both interdisciplinary and multi-sectoral across the health system; 4. Deep understanding of local and global contexts; 5. Voice and vote of patient, families, and communities. **Social prescribing** It is a way of linking patients in primary care with sources of support within the community to help improve their health and well-being. A social prescribing scheme may include: i) a referral from a healthcare professional ii) a consultation with a link worker and iii) an agreed referral to a local voluntary, community and social enterprise organisation Source: Bedos, C., Apelian, N. & Vergnes, JN. Social dentistry: an old heritage for a new professional approach. *Br Dent J* **225**, 357–362 (2018) #### Social Medicine The practice of medicine that integrates: 1. Understanding and applying the social determinants of health, social epidemiology, and social science approaches to patient care 2. An advocacy and equity agenda that treats health as a human right 3. An approach that is both interdisciplinary and multi-sectoral across the health system 4. Deep understanding of local and global contexts 5. Voice and vote of patient, families, and communities #### Social Prescribing A way of linking patients in primary care with sources of support within the community to help improve their health and well-being. A social prescribing scheme may include: 1. A referral from a healthcare professional 2. A consultation with a link worker 3. An agreed referral to a local voluntary, community, and social enterprise organisation *Bedos, C., Apelian, N. & Vergnes, JN. Social dentistry: an old heritage for a new professional approach. Br Dent J 225, 357–362 (2018).* # Determinants of oral health | **Structural determinants**<br>(Socioeconomic, political, and environmental context)<br>**Intermediate determinants**<br>(Social position and circumstances)<br>**Proximal determinants**<br>(Behaviours and biological factors)<br>**Outcomes** | |---| | **Macro-economic policies**<br>**Social and welfare policies**<br>**Trade policies**<br>**Overseas development policies**<br>**Globalisation**<br>**Urbanisation** | | **Social class**<br>**Income**<br>**Education**<br>**Gender**<br>**Ethnicity** | | **Material circumstances**<br>**Social relationships**<br>**Psychosocial factors**<br>**Health service availability or use**<br>**Environmental setting** | | **Diet**<br>**Alcohol consumption**<br>**Tobacco use**<br>**Physical activity**<br>**Hygiene** | | **Inflammation**<br>**Infection**<br>**Immune response** | | **Oral disease and NCD burden** | ## Commercial determinants—corporate strategies | Political and economic power and influence | Lobbying to influence policy | Corporate citizenship | Targeted and tailored marketing and promotion strategies | Influence on research agenda | Influences on social norms and local policies | Media influence to distract attention and cause confusion | Influence on consumers' choices and behaviours | |---|---|---|---|---|---|---|---| Marco A Peres, Lorna M D Macpherson, Robert J Weyant, Blánaid Daly, Renato Venturelli, Manu R Mathur, Stefan Listl, Roger Keller Celeste, Carol C Guarnizo-Herreño, Cristin Kearns, Habib Benzian, Paul Allison, Richard G Watt, Oral diseases: a global public health challenge, The Lancet, Volume 394, Issue 10194, 2019, Pages 249-260, #### Levels of Influence - **Structural Determinants** (socioeconomic, political, and environmental context): - Macro-economic policies - Social and welfare policies - Trade policies - Overseas development policies - Globalisation - Urbanisation - **Intermediate Determinants** (social position and circumstances): - Social class - Income - Education - Gender - Ethnicity - Material circumstances - Social relationships - Psychosocial factors - Health service availability or use - Environmental setting - **Proximal Determinants** (behaviours and biological factors): - Diet - Alcohol consumption - Tobacco use - Physical activity - Hygiene - Inflammation - Infection - Immune response - **Outcomes**: - Oral disease and NCD burden #### Commercial Determinants: Corporate Strategies - Political and economic power and influence - Lobbying to influence policy - Corporate citizenship - Targeted and tailored marketing and promotion strategies - Influence on research agenda - Influences on social norms and local policies - Media influence to distract attention and cause confusion - Influence on consumers' choices and behaviours *Marco A Peres, Lorna M D Macpherson, Robert J Weyant, Blánaid Daly, Renato Venturelli, Manu R Mathur, Stefan Listl, Roger Keller Celeste, Carol C Guarnizo-Herreño, Cristin Kearns, Habib Benzian, Paul Allison, Richard G Watt, Oral diseases: a global public health challenge, The Lancet, Volume 394, Issue 10194, 2019, Pages 249-260.* Determinants of oral health Time Environment Community-Level Influences Dental care system characteristics Health care system characteristics Social environment Physical safety Physical environment Socioeconomic status Family-Level Influences Social support Family composition Child-Level Influences Physical and demographic attributes Development Use of dental care Oral Health Family function Biologic and genetic endowment Social capital Health behaviors and practices Family-Look Health behaviors, practices, and coping skills of family Microflora Host and teeth Substrate (diet) Culture Health status of parents Culture Dental insurance Source: Sanders AE 2007. Social Determinants of Oral Health: conditions linked to socioeconomic inequalities in oral health and in the Australian population. AIHW cat. no. POH 7. Canberra: Australian Institute of Health and Welfare (Population Oral Health Series No. 7).  #### Multi-Level Influences on Oral Health ##### Environmental & Temporal Context - Time - Environment ##### Community-Level Influences - Dental care system characteristics - Health care system characteristics - Social environment - Physical safety - Physical environment - Socioeconomic status ##### Family-Level Influences - Social support - Family composition - Family function - Social capital - Health behaviors, practices, and coping skills of family - Culture - Health status of parents - Dental insurance ##### Child-Level Influences - Physical and demographic attributes - Development - Use of dental care - Biologic and genetic endowment - Health behaviors and practices - Microflora - Host and teeth - Substrate (diet) *Sanders AE 2007. Social Determinants of Oral Health: conditions linked to socioeconomic inequalities in oral health and in the Australian population. AIHW cat. no. POH 7. Canberra: Australian Institute of Health and Welfare (Population Oral Health Series No. 7).* Labelled diagram: A conceptual model illustrating the social determinants of oral health using concentric ovals to represent nested levels of influence—Community-Level, Family-Level, and Child-Level—surrounding a central 'Oral Health' outcome. The diagram is encircled by arrows representing 'Time' and 'Environment', while lines connect the central outcome to a Venn diagram below detailing the interaction of 'Microflora', 'Host and teeth', and 'Substrate (diet)'. Social/Structural determinants of health Enabling Processes Rights Empowerment Opportunities Resources Autonomy Respect Supportive family environment Social inclusion Access to support Structural Determinants (Socioeconomic, political and environmental context) Macro economic policies Social, welfare and education policies Cultural and social norms Early life Intermediate Determinants (Social Position and circumstances) Social class Income Education Social standing Material circumstances Social relationships Psychosocial factors Health services Proximal Determinants (Behavioural and biological factors) Diet Alcohol Tobacco Hygiene Inflammation Infection Immune response Oral Health Disabling Processes Adverse childhood events Discrimination Stigma Lack of opportunities Abuse & violence Stress Harassment Marginalisation Social exclusion Poor self esteem Source: Watt, R., Venturelli, R. & Daly, B. Understanding and tackling oral health inequalities in vulnerable adult populations: from the margins to the mainstream. *Br Dent J* **227**, 49–54 (2019)  #### Enabling and Disabling Processes ##### Enabling Processes - Rights - Empowerment - Opportunities - Resources - Autonomy - Respect - Supportive family environment - Social inclusion - Access to support ##### Structural Determinants (Socioeconomic, Political, and Environmental Context) - Macro economic policies - Social, welfare, and education policies - Cultural and social norms - Early life ##### Intermediate Determinants (Social Position and Circumstances) - Social class - Income - Education - Social standing - Material circumstances - Social relationships - Psychosocial factors - Health services ##### Proximal Determinants (Behavioural and Biological Factors) - Diet - Alcohol - Tobacco - Hygiene - Inflammation - Infection - Immune response - **Outcome:** Oral Health ##### Disabling Processes - Adverse childhood events - Discrimination - Stigma - Lack of opportunities - Abuse & violence - Stress - Harassment - Marginalisation - Social exclusion - Poor self esteem *Watt, R., Venturelli, R. & Daly, B. Understanding and tackling oral health inequalities in vulnerable adult populations: from the margins to the mainstream. Br Dent J 227, 49–54 (2019).* Labelled diagram: A conceptual model of social/structural determinants of health showing how 'Enabling Processes' (top) and 'Disabling Processes' (bottom) influence Structural, Intermediate, and Proximal Determinants, which collectively impact Oral Health. Arrows indicate directional relationships between these layers. # Role of intersectionality in oral health ## INTERSECTIONALITY IN ORAL HEALTH Oral health is shaped by how different parts of our identity and life experience come together. ### HOW THESE FACTORS INTERSECT * A low-income woman from an ethnic minority may face gender discrimination AND racism AND financial barriers. * A person with a disability from a rural area may face inaccessible services AND stigma AND transport challenges. * An older adult with low education and limited income may experience ageism AND financial strain AND poor living conditions. ### SOCIOECONOMIC POSITION * Income, education, employment, financial security ### CULTURE & ETHNICITY * Language, norms, belief, traditions, experiences of racism ### GEOGRAPHY & ENVIRONMENT * Where we live, housing, pollution, climate, rurality ### DISABILITY & HEALTH * Physical, mental, intellectual impairments, chronic conditions ### AGE * Different needs and vulnerabilities across the life course ### ORAL HEALTH * **ORAL HEALTH** ### EXAMPLES OF ORAL HEALTH IMPACTS * Higher risk of cavitis, gum disease, and tooth loss * Less likely to access preventive care * Delayed treatment and higher pain levels * More out-of-pocket costs and financial stress * Impact on self-esteem, wellbeing, and quality of life ### WHY IT MATTERS Overlap inequalities -> Create greater vulnerability -> Increase barriers to care -> Worsen oral health outcomes ### THE WAY FORWARD Recognize the whole person. Address structural inequities. Design inclusive, accessible, and respectful oral health services for all. Oral health equity happens when every part of who we are is seen, respected, and supported. Slack-Smith L, Ng T, Macdonald ME, Durey A. Rethinking Oral Health in Aging: Ecosocial Theory and Intersectionality. J Dent Res. 2023 Jul;102(8):844-848. doi: 10.1177/00220345231175061. Epub 2023 Jun 14 Image AI Generated using CHATGPT V5.5       Oral health is shaped by how different parts of our identity and life experience come together. #### Intersecting Dimensions - **Socioeconomic Position**: Income, education, employment, financial security - **Culture & Ethnicity**: Language, norms, beliefs, traditions, experiences of racism - **Geography & Environment**: Where we live, housing, pollution, climate, rurality - **Disability & Health**: Physical, mental, intellectual impairments, chronic conditions - **Age**: Different needs and vulnerabilities across the life course #### Examples of Intersection - A low-income woman from an ethnic minority may face gender discrimination AND racism AND financial barriers. - A person with a disability from a rural area may face inaccessible services AND stigma AND transport challenges. - An older adult with low education and limited income may experience ageism AND financial strain AND poor living conditions. #### Oral Health Impacts - Higher risk of cavities, gum disease, and tooth loss - Less likely to access preventive care - Delayed treatment and higher pain levels - More out-of-pocket costs and financial stress - Impact on self-esteem, wellbeing, and quality of life #### Why It Matters Overlapping inequalities → Create greater vulnerability → Increase barriers to care → Worsen oral health outcomes #### The Way Forward - Recognize the whole person - Address structural inequities - Design inclusive, accessible, and respectful oral health services for all > Oral health equity happens when every part of who we are is seen, respected, and supported. *Slack-Smith L, Ng T, Macdonald ME, Durey A. Rethinking Oral Health in Aging: Ecosocial Theory and Intersectionality. J Dent Res. 2023 Jul;102(8):844-848. doi: 10.1177/00220345231175061. Epub 2023 Jun 14.* Pictogram illustration showing three stylized female figures in varying shades of purple and maroon, representing the concept of 'Culture & Ethnicity' (specifically the sub-point regarding 'experiences of racism') or the general theme of identity intersectionality mentioned in the text. Labelled diagram: A blue icon of a person in a wheelchair, which is the universal symbol for disability. This visual corresponds to the slide's section 'DISABILITY & HEALTH', illustrating physical, mental, and intellectual impairments as factors intersecting with oral health. A black silhouette icon of an elderly person leaning on a cane, representing the concept of 'DISABILITY & HEALTH' (Physical, mental, intellectual impairments, chronic conditions) and illustrating how individuals with disabilities may face barriers like inaccessible services and stigma. Icon: A purple oval containing a white silhouette of a human head in profile, featuring stylized hair and an ear. This graphic serves as a visual symbol for the 'ORAL HEALTH' section of the slide, representing the person or patient. Flowchart: A horizontal sequence of four circular icons connected by arrows illustrating a causal chain: 1. Overlapping inequalities (purple icon with connected figures), 2. Create greater vulnerability (pink icon with a shield), 3. Increase barriers to care (orange icon with a roadblock), 4. Worsen oral health outcomes (green icon with a tooth and lightning bolt). Illustration of a diverse group of individuals representing the intersection of various identity factors, including a woman in a hijab, an older adult, a mother with a child, and a man in a wheelchair, to visually demonstrate the concept that oral health is shaped by how different parts of our identity and life experience come together. Intersectionality: Wheel of power/privilege Jamieson L, Ju X, Haag D, Ribeiro P, Soares G, Hedges J (2023) An intersectionality approach to Indigenous oral health inequities; the super-additive impacts of racism and negative life events. PLoS ONE 18(1): e0279614. https://doi.org/10.1371/journal.pone.0279614  Intersectionality: Wheel of power/privilege *Jamieson L, Ju X, Haag D, Ribeiro P, Soares G, Hedges J (2023) An intersectionality approach to Indigenous oral health inequities; the super-additive impacts of racism and negative life events. PLoS ONE 18(1): e0279614. https://doi.org/10.1371/journal.pone.0279614.* Labelled diagram of the 'Wheel of power/privilege' showing two concentric circles: an inner circle representing POWER (with traits like White, Cisgender man, Rich) and an outer ring representing MARGINALIZED statuses (like Undocumented, Trans, Poor). Blue lines connect specific segments from the marginalized outer ring to a simplified version of the wheel on the right. # What do our patients want? | | | | :--- | :--- | | | | * “Friendly and welcoming reception stuff really set the tone for my whole visit.” * “I feel overhelmed by the noise, bright lights, and crowded waiting room.” * “My dentist was gentle, explained everything, and made sure I was numb before starting.” * “They never asked about my past trauma. I felt panicky and dismissed when I tried to explain.” * “The long wait times and lack of aftercare information were stressful.” * “The cost of treatment means I postpone or avoid dental visits. It’s hard to be consistent.” Bedos, C., Apelian, N. & Vergnes, JN. What should people expect from person-centred dental visits? The Montreal-Toulouse Wheel of expectations. *Br Dent J* **231**, 249–253 (2021). -Junaid, M., Anthonappa, R., Lim, D., & Saikia, A. (2026). *Dental Voices Community Conversations Summary Report*. https://cciprogram.org/wp-content/uploads/sites/2/2026/02/Dental-Community-Conversation-Summary-Report.pdf **THE UNIVERSITY OF WESTERN AUSTRALIA** 20   #### Patient Voices and Experiences - “Friendly and welcoming reception stuff really set the tone for my whole visit.” - “I feel overhelmed by the noise, bright lights, and crowded waiting room.” - “My dentist was gentle, explained everything, and made sure I was numb before starting.” - “They never asked about my past trauma. I felt panicky and dismissed when I tried to explain.” - “The long wait times and lack of aftercare information were stressful.” - “The cost of treatment means I postpone or avoid dental visits. It’s hard to be consistent.” *Bedos, C., Apelian, N. & Vergnes, JN. What should people expect from person-centred dental visits? The Montreal-Toulouse Wheel of expectations. Br Dent J 231, 249–253 (2021).* *Junaid, M., Anthonappa, R., Lim, D., & Saikia, A. (2026). Dental Voices Community Conversations Summary Report. https://cciprogram.org/wp-content/uploads/sites/2/2026/02/Dental-Community-Conversation-Summary-Report.pdf* Labelled diagram: The Montreal-Toulouse Wheel of expectations for dental visits, featuring a central red circle divided into four quadrants (1 = BE UNDERSTOOD, 2 = BE RESPECTED, 3 = SHARE POWER, 4 = BE GIVEN ENOUGH TIME) surrounded by three outer segments connected by arrows (5 = BE INFORMED and UNDESTAND, 6 = SHARE DECISIONS, 7 = BE COMFORTABLE). A labelled diagram consisting of six speech bubbles arranged vertically, illustrating specific patient quotes about dental visit experiences. The figure presents alternating feedback: 1 = “Friendly and welcoming reception staff really set the tone for my whole visit.”, 2 = “I feel overwhelmed by the noise, bright lights, and crowded waiting room.”, 3 = “My dentist was gentle, explained everything, and made sure I was numb before starting.”, 4 = “They never asked about my past trauma. I felt panicky and dismissed when I tried to explain.”, 5 = “The long wait times and lack of aftercare information were stressful.”, and 6 = “The cost of treatment means I postpone or avoid dental visits. It’s hard to be consistent.” FRAMEWORK: Patient centred care **HIERARCHY OF INFORMATION AND CHOICE** A patient-centered framework for informed decision-making IV. PATIENT IN FULL CONTROL III. INFORMATION, CHOICE AND TOOLS FOR INFORMED CHOICE II. INFORMATION AND CHOICE I. INFORMATION 1. EXPLORING DISEASE AND ITS CONTEXT 2. THE PATIENT AS A WHOLE PERSON 3. DOCTOR-PATIENT RELATIONSHIP ETHOS 4. THE DOCTOR-PATIENT RELATIONSHIP: COMMON GROUND/SHARING RESPONSIBILITY 1 **EXPLORING DISEASE AND ITS CONTEXT** This involves the clinician considering both the presenting disease and the way the patient experiences it. 2 **THE PATIENT AS A WHOLE PERSON** Here the clinician seeks to understand illness within the person's bio-psychosocial circumstances. 3 **DOCTOR-PATIENT RELATIONSHIP ETHOS** This is about HCPs showing compassion and empathy and developing a long-term relationship that is going to be conducive to decision-making. 4 **THE DOCTOR-PATIENT ENLASHIPSHP: COMMON GROUND/SHARING RESPONSIBILITY** This relates to patients and HCPs sharing responsibility in the way each conceptualizes the patient's illness experience. **HIERARCHY OF INFORMATION AND CHOICE** I Information – A range of, generally disease information relevant to the patient’s health is provided. II Information + Choice – Level 1 & the potential of choice between different treatment alternatives and/or non-treatment. III Information, choice + tools for informed choice – Patients are supported in fully informed choice with all treatment alternatives considered from a medical and psychosocial perspective. IV Patient in full control – Information, choice and tools to make informed choice are given to patients who make the final treatment decision that is appropriate to their psychosocial and contextual circumstances. **EMPOWERING PATIENTS. ENHANCING CARE. SHARING DECISIONS.** A collaborative approach to better health outcomes. Scambler S, Gupta A, Asimakopoulou K. Patient-centred care--what is it and how is it practised in the dental surgery? Health Expect. 2015 Dec;18(6):2549-58 Image AI Generated using CHATGPT V5.5 21                      #### Core Dimensions of Care 1. **Exploring Disease and Its Context** - Involves the clinician considering both the presenting disease and the way the patient experiences it. 2. **The Patient as a Whole Person** - Clinician seeks to understand illness within the person's bio-psychosocial circumstances. 3. **Doctor-Patient Relationship Ethos** - HCPs showing compassion and empathy and developing a long-term relationship conducive to decision-making. 4. **Doctor-Patient Relationship: Common Ground and Sharing Responsibility** - Patients and HCPs sharing responsibility in conceptualizing the patient's illness experience. #### Hierarchy of Information and Choice A patient-centered framework for informed decision-making: - **Level I: Information** - A range of generally disease information relevant to the patient’s health is provided. - **Level II: Information and Choice** - Level I plus the potential of choice between different treatment alternatives and/or non-treatment. - **Level III: Information, Choice, and Tools for Informed Choice** - Patients are supported in fully informed choice with all treatment alternatives considered from a medical and psychosocial perspective. - **Level IV: Patient in Full Control** - Information, choice, and tools are provided to patients, who make the final treatment decision appropriate to their psychosocial and contextual circumstances. > Empowering patients. Enhancing care. Sharing decisions. A collaborative approach to better health outcomes. *Scambler S, Gupta A, Asimakopoulou K. Patient-centred care--what is it and how is it practised in the dental surgery? Health Expect. 2015 Dec;18(6):2549-58.* Iconographic illustration of a stylized human figure with raised arms and radiating lines above the head, symbolizing empowerment or enlightenment. The image visually represents the concept 'EMPOWERING PATIENTS' mentioned in the slide text. Icon: A blue oval containing a white lowercase 'i', representing the concept of 'Information' as defined in the slide text under the 'Hierarchy of Information and Choice' (Level I). Labelled diagram: A signpost with two arrows pointing in opposite directions, illustrating the concept of choice. The labels correspond to the 'HIERARCHY OF INFORMATION AND CHOICE' defined in the text: II = Information + Choice (Level 1 & the potential of choice between different treatment alternatives and/or non-treatment), III = Information, choice + tools for informed choice (Patients are supported in fully informed choice with all treatment alternatives considered from a medical and psychosocial perspective). A generic blue icon depicting a document with a folded corner and horizontal lines representing text. Icon: A white circle containing a dark blue magnifying glass symbol. This figure corresponds to the slide's first point, '1. EXPLORING DISEASE AND ITS CONTEXT', which involves the clinician considering both the presenting disease and the way the patient experiences it. Icon: A white oval containing a generic user silhouette (head and shoulders) on a blue background, serving as a visual symbol for the patient. Icon: A stylized graphic of a handshake inside a white oval, representing the concept of 'The Doctor-Patient Relationship' and specifically point 4 on the slide regarding common ground and sharing responsibility. Icon: A white oval containing three stylized blue figures representing people, set against a blue background. The figure is marked with the number '4', which corresponds to the slide text section '4 THE DOCTOR-PATIENT RELATIONSHIP: COMMON GROUND/SHARING RESPONSIBILITY'. A blue circular icon containing the number '1', which serves as a visual marker for the first step in the patient-centred care framework: 'EXPLORING DISEASE AND ITS CONTEXT'. Icon of a magnifying glass with a blue handle and teal rim, representing the concept of 'Exploring disease and its context' as described in point 1 of the slide text. Labelled diagram: A blue oval containing the number '2', which corresponds to the section 'THE PATIENT AS A WHOLE PERSON' where the clinician seeks to understand illness within the person's bio-psychosocial circumstances. Icon: A blue silhouette of a person (head and shoulders) used as a visual symbol for the 'Patient' in the context of the slide's patient-centred care framework. Labelled diagram: A blue oval containing the number '3', which corresponds to item 3 in the slide text: 'DOCTOR-PATIENT RELATIONSHIP ETHOS'. Iconographic illustration of a handshake between two individuals, representing the concept of the doctor-patient relationship, specifically 'Common Ground/Sharing Responsibility' and the collaborative ethos described in the slide text. A blue circular icon containing the white number '4', which serves as a label for the fourth point in the framework: 'THE DOCTOR-PATIENT RELATIONSHIP: COMMON GROUND/SHARING RESPONSIBILITY'. Iconographic illustration showing three stylized blue silhouettes of people (a larger central figure flanked by two smaller figures), visually representing the group of individuals involved in the patient-centred care framework described in the text. A blue circular icon containing the Roman numeral 'I'. This visual label corresponds to Level I in the slide's 'Hierarchy of Information and Choice', which is defined as 'Information' where a range of disease information relevant to the patient’s health is provided. Icon: A blue oval containing the white Roman numeral II. This visual marker corresponds to the second level of the 'Hierarchy of Information and Choice,' where the slide text defines II as 'INFORMATION AND CHOICE' and further explains it as 'Information + Choice – Level 1 & the potential of choice between different treatment alternatives and/or non-treatment.' Labelled diagram: A blue oval containing three vertical white bars, representing the Roman numeral III. According to the slide text under 'HIERARCHY OF INFORMATION AND CHOICE', this label corresponds to level III: Information, choice + tools for informed choice. Labelled diagram: A blue oval containing the Roman numeral 'IV'. According to the slide text, IV represents 'Patient in full control', where information, choice, and tools for informed choice are given to patients who make the final treatment decision appropriate to their psychosocial and contextual circumstances. Icon: A white silhouette of a person's head and shoulders enclosed within a circle on a blue background, serving as a visual symbol for the 'Patient' or 'Person' in the context of the slide's patient-centred care framework. # Understanding Trauma informed dental practice ## TRAUMA-INFORMED CARE FOR ORAL HEALTH PRACTITIONERS Safety + Trustworthiness + Choice + Collaboration + Empowerment | Impact of trauma | Treating patients with physical injuries | Treating patients with identified trauma history | |:---:|:---:|:---:| | | Providing treatments for physical injuries from traumatic events<br>E.g. Orofacial injuries from abuse | Providing oral healthcare for patients with disclosed history of traumatic events<br>E.g. Domestic violence | | Higher risk of Trauma | | | | Re-traumatisation | | | For everyone involved in oral health care: 1) Realise trauma is common 2) Recognise signs and symptoms of trauma 3) Respond with trauma-informed care principles 4) Resists re-traumatisation Treating patients in isolation and disadvantages and certain occupations Treating patients with past traumatic dental treatment Treatments for all patients Choi KS, Sohn W, Leadbeatter D. Safe haven - a trauma-informed care model for oral health practitioners: a commentary. Br Dent J. 2025 Nov;239(10):717-721. 22  #### Core Principles for Oral Health Practitioners Safety + Trustworthiness + Choice + Collaboration + Empowerment #### The Four Rs Framework For everyone involved in oral health care: 1. **Realise** trauma is common 2. **Recognise** signs and symptoms of trauma 3. **Respond** with trauma-informed care principles 4. **Resist** re-traumatisation #### Trauma-Informed Practice Scenarios - **Treating patients with physical injuries**: - Providing treatments for physical injuries from traumatic events (e.g., orofacial injuries from abuse) - **Treating patients with identified trauma history**: - Providing oral healthcare for patients with disclosed history of traumatic events (e.g., domestic violence) - Treating patients in isolation and disadvantages and certain occupations - Treating patients with past traumatic dental treatment - Treatments for all patients (higher risk of trauma and re-traumatisation) *Choi KS, Sohn W, Leadbeatter D. Safe haven - a trauma-informed care model for oral health practitioners: a commentary. Br Dent J. 2025 Nov;239(10):717-721.* This labelled diagram illustrates the 'Safe haven' model for trauma-informed care using a house-shaped structure. The central section lists four key actions: 1 = Realise trauma is common, 2 = Recognise signs and symptoms of trauma, 3 = Respond with trauma-informed care principles, and 4 = Resists re-traumatisation. The foundation layers represent treatments for all patients, treating patients with past traumatic dental treatment, and treating patients in isolation and disadvantages and certain occupations. # Steps in Trauma informed practice ## Trauma-Informed Dental Care: The 4 Rs in Practice **Better for patients. Better for everyone.** ### 1. REALISE Trauma is common. Many people carry invisible experiences. ### 2. RECOGNISE Behaviour may be a sign of trauma, not non-compliance. What if it hurts?" I don't like needles I want to leave #### Examples * Past abuse or violence * Painful dental experiences * Loss, grief or neglect * Discrimination or racism * Refugee or war experiences "Not all trauma is visible. #### Examples of behaviours * Cancelling or not attending appointments * Appearing anxious, angry or withdrawn * Refusing treatment * Becoming emotional * Difficulty trusting Think: "What might this person have been through?" ### 3. RESPOND Create safety, trust and choice. #### How we respond * Ask what can make them comfortable * Explain each step * Use show-tell-do * Ask permission to touch or examine * Offer choices * Involve in decisions * Allow more time "First, I will check your teeth with a small mirror." ### 4. RESIST **RE-TRAUMATISATION** Avoid causing further distress. #### Ways to prevent re-traumatisation * Do not force treatment * Be patient and non-judgmental * Respect boundaries and culture * Check consent throughout * Pause if the person is distressed "How are you feeling? Do you want to take a break?" **We do no harm. We support healing.** *** 1. Patient feels safe, heard, respected and in control. 2. The trauma-informed question is: "**What happened to you?**" **Not:** "**What's wrong with you?**" *** **Choi KS, Sohn W, Leadbeatter D. Safe haven - a trauma-informed care model for oral health practitioners: a commentary. Br Dent J. 2025 Nov;239(10):717-721.** Kindness • Respect • Safety • Choice • Collaboration • Empowerment Thank you, I felt safe today. *Better experience. Better outcomes. Better together.*              #### The 4 Rs in Dental Practice ##### 1. Realise Trauma is common. Many people carry invisible experiences. *Examples of trauma:* - Past abuse or violence - Painful dental experiences - Loss, grief, or neglect - Discrimination or racism - Refugee or war experiences > "Not all trauma is visible." ##### 2. Recognise Behaviour may be a sign of trauma, not non-compliance (e.g., "What if it hurts?", "I don't like needles", "I want to leave"). *Examples of behaviours:* - Cancelling or not attending appointments - Appearing anxious, angry, or withdrawn - Refusing treatment - Becoming emotional - Difficulty trusting > Think: "What might this person have been through?" ##### 3. Respond Create safety, trust, and choice. *Clinical responses:* - Ask what can make them comfortable - Explain each step (e.g., "First, I will check your teeth with a small mirror.") - Use show-tell-do - Ask permission to touch or examine - Offer choices - Involve in decisions - Allow more time ##### 4. Resist (Re-traumatisation) Avoid causing further distress. *Ways to prevent re-traumatisation:* - Do not force treatment - Be patient and non-judgmental - Respect boundaries and culture - Check consent throughout - Pause if the person is distressed (e.g., "How are you feeling? Do you want to take a break?") #### Guiding Principles - Patient feels safe, heard, respected, and in control. - The trauma-informed question is: **"What happened to you?"** Not: **"What's wrong with you?"** > We do no harm. We support healing. > Kindness • Respect • Safety • Choice • Collaboration • Empowerment > *Better experience. Better outcomes. Better together.* *Choi KS, Sohn W, Leadbeatter D. Safe haven - a trauma-informed care model for oral health practitioners: a commentary. Br Dent J. 2025 Nov;239(10):717-721.* Illustrated diagram depicting the first step of trauma-informed practice, labeled '1. REALISE', which states that trauma is common and many people carry invisible experiences. The visual shows a dental professional in a mask observing a patient who appears anxious or withdrawn in a dental chair. A flat, yellow circular icon featuring a white line-art illustration of a glowing lightbulb, serving as a visual symbol for the "REALISE" step in the trauma-informed practice framework. A simple graphic illustration of a teal heart, likely serving as a visual symbol for the themes of kindness and safety mentioned in the slide text. Illustration of a distressed patient with arms crossed, accompanied by thought bubbles expressing anxiety and avoidance ("What if it hurts?", "I don't like needles", "I want to leave"). This figure illustrates the concept under step 2 (RECOGNISE) that a patient's behavior may be a sign of trauma rather than non-compliance. A simple graphic illustration of a yellow heart shape, visually reinforcing the slide's theme of kindness, empathy, and the sentiment expressed in the text "Thank you, I felt safe today." Iconographic illustration of a handshake inside a purple circle, symbolizing the concepts of trust, collaboration, and agreement within the trauma-informed care model. Illustration of a diverse group of four individuals, including two people in medical scrubs and two in casual clothing (one wearing a hijab), standing together to represent the collaborative team or patient-provider relationship central to trauma-informed care. Illustration of a dental professional using a model to explain a procedure to an anxious patient, demonstrating the 'RESPOND' step of trauma-informed practice where the provider explains each step (e.g., 'First, I will check your teeth with a small mirror') to create safety and trust. A simple graphic illustration of a solid purple heart. A graphic icon consisting of a red circle containing a white shield with a red cross, symbolizing protection and safety in the context of trauma-informed dental care. Illustration depicting a dental professional checking in with a patient, specifically demonstrating the 'RESPOND' step of trauma-informed practice by asking permission and offering control. The speech bubble contains the text 'How are you feeling? Do you want to take a break?', which corresponds to the slide's instruction to 'Pause if the person is distressed'. Graphic illustration of a pink heart symbol. Illustration showing a positive interaction between a dental professional and a patient, where they are high-fiving to celebrate the successful appointment. A speech bubble from the patient reads 'Thank you, I felt safe today,' illustrating the outcome of trauma-informed care where the patient feels heard, respected, and in control. Do not edit How to change the design # Do you feel confident in providing adequate person centred and trauma informed care to your patients? ⓘ The [Slido app](https://www.slido.com) must be installed on every computer you’re presenting from **slido** ### Poll Do you feel confident in providing adequate person centred and trauma informed care to your patients? # Lets have a break! ### Break Let's have a break! ## Case: Space Regaining for a Drifted Molar ### Question **Scenario:** A patient presents with a missing first molar where the adjacent first permanent molar has drifted mesially, preventing the eruption of the second premolar. **What's shown:** A clinical scenario of space loss due to the mesial drift of the first molar into the extraction space, blocking the eruption path of the second premolar. **Consider:** How can this be managed with a removable appliance, and what are the limitations of this approach? ### Answer **Observations:** - The first molar has drifted mesially into the space of the missing tooth. - The second premolar cannot erupt due to the lack of space. **Reasoning:** A spring can be activated on a removable appliance to move the first molar distally and open space for the second premolar. However, there are limitations: a removable appliance can typically only regain up to 2 mm of space. If the molar has drifted more than half the space, the second molar may also have moved mesially, blocking further movement. Additionally, moving a large tooth like a first molar requires significant anchorage, which is challenging in the lower arch where the acrylic base cannot be as extensive. **Takeaway:** While removable appliances can be used to regain space for a drifted molar, they are limited in the amount of space they can recover and require careful consideration of anchorage, especially if adjacent teeth have also drifted. ## Case: Clasp Interfering with Canine Eruption ### Question **Scenario:** A removable appliance design is being evaluated for a patient who has a canine that needs to erupt. **What's shown:** An exhibit of a removable appliance where the clasp is positioned in a way that it blocks the eruption path of the canine. **Consider:** What is the problem with this design and how should it be modified to accommodate the erupting tooth? ### Answer **Observations:** - The clasp is positioned in a way that prevents the canine from erupting. **Reasoning:** If a clasp is placed over or near an erupting tooth, it will physically block its vertical movement. To resolve this, the design must be changed, such as by extending the clasp to the premolar area, to clear the canine's eruption path. **Takeaway:** Removable appliance designs must account for the eruption paths of teeth to avoid blocking them with clasps or acrylic components. ## Case: Poorly Adapted Adams Clasp ### Question **Scenario:** An upper removable appliance is being evaluated for fit and retention. **What's shown:** An exhibit showing the bridge or buccal arm of an Adams clasp that is not properly adapted and is sitting far away from the tooth surface. **Consider:** What is the consequence of this poor adaptation on the appliance's function and stability? ### Answer **Observations:** - The bridge or buccal arm of the Adams clasp is far from the tooth surface. - There is a complete lack of retention on the affected side. **Reasoning:** Because the clasp is not engaging the tooth properly, it fails to provide retention. Even if the other side of the appliance has adequate retention, the lack of retention on this side means the plate will not stay in position, especially when the active components are activated. **Takeaway:** Proper adaptation of clasps is critical for retention; a poorly adapted clasp compromises the anchorage and stability of the removable appliance. ## Case: Space Regaining for a Drifted Molar ### Question **Scenario:** A patient presents with a missing first molar where the adjacent first permanent molar has drifted mesially, preventing the eruption of the second premolar. **What's shown:** A clinical scenario of space loss due to the mesial drift of the first molar into the extraction space, blocking the eruption path of the second premolar. **Consider:** How can this be managed with a removable appliance, and what are the limitations of this approach? ### Answer **Observations:** - The first molar has drifted mesially into the space of the missing tooth. - The second premolar cannot erupt due to the lack of space. **Reasoning:** A spring can be activated on a removable appliance to move the first molar distally and open space for the second premolar. However, there are limitations: a removable appliance can typically only regain up to 2 mm of space. If the molar has drifted more than half the space, the second molar may also have moved mesially, blocking further movement. Additionally, moving a large tooth like a first molar requires significant anchorage, which is challenging in the lower arch where the acrylic base cannot be as extensive. **Takeaway:** While removable appliances can be used to regain space for a drifted molar, they are limited in the amount of space they can recover and require careful consideration of anchorage, especially if adjacent teeth have also drifted. ## Case: Clasp Interfering with Canine Eruption ### Question **Scenario:** A removable appliance design is being evaluated for a patient who has a canine that needs to erupt. **What's shown:** An exhibit of a removable appliance where the clasp is positioned in a way that it blocks the eruption path of the canine. **Consider:** What is the problem with this design and how should it be modified to accommodate the erupting tooth?    ### Answer **Observations:** - The clasp is positioned in a way that prevents the canine from erupting. **Reasoning:** If a clasp is placed over or near an erupting tooth, it will physically block its vertical movement. To resolve this, the design must be changed, such as by extending the clasp to the premolar area, to clear the canine's eruption path. **Takeaway:** Removable appliance designs must account for the eruption paths of teeth to avoid blocking them with clasps or acrylic components. ## Case: Poorly Adapted Adams Clasp ### Question **Scenario:** An upper removable appliance is being evaluated for fit and retention. **What's shown:** An exhibit showing the bridge or buccal arm of an Adams clasp that is not properly adapted and is sitting far away from the tooth surface. **Consider:** What is the consequence of this poor adaptation on the appliance's function and stability? ### Answer **Observations:** - The bridge or buccal arm of the Adams clasp is far from the tooth surface. - There is a complete lack of retention on the affected side. **Reasoning:** Because the clasp is not engaging the tooth properly, it fails to provide retention. Even if the other side of the appliance has adequate retention, the lack of retention on this side means the plate will not stay in position, especially when the active components are activated. **Takeaway:** Proper adaptation of clasps is critical for retention; a poorly adapted clasp compromises the anchorage and stability of the removable appliance. Case: Space Regaining for a Drifted Molar Labelled diagram: A blue oval containing the number '2', which corresponds to the section 'THE PATIENT AS A WHOLE PERSON' where the clinician seeks to understand illness within the person's bio-psychosocial circumstances. A blue circular icon containing the Roman numeral 'I'. This visual label corresponds to Level I in the slide's 'Hierarchy of Information and Choice', which is defined as 'Information' where a range of disease information relevant to the patient’s health is provided. Icon: A blue oval containing the white Roman numeral II. This visual marker corresponds to the second level of the 'Hierarchy of Information and Choice,' where the slide text defines II as 'INFORMATION AND CHOICE' and further explains it as 'Information + Choice – Level 1 & the potential of choice between different treatment alternatives and/or non-treatment.' ## Case: Labial Bow Interfering with a Retraction Spring ### Question **Scenario:** A removable appliance is designed to retract a canine distally using a spring, while also utilizing a regular labial bow for retention. **What's shown:** An exhibit showing a regular labial bow resting on the distal aspect of the canine, in the exact area where a spring is meant to be activated to move the tooth. **Consider:** What is the issue with this design and how can it be resolved to allow the canine to move distally? ### Answer **Observations:** - The regular labial bow is in contact with the distal face of the canine. - This physical presence prevents the activation of the spring intended to move the canine distally. **Reasoning:** The labial bow physically blocks the spring from engaging and moving the tooth. To fix this, the design of the labial bow or clasp must be modified so it does not contact the distal surface of the canine, allowing the spring to function properly and move the tooth backwards. **Takeaway:** When designing removable appliances, ensure that passive retention components like labial bows do not interfere with the activation path of active components like springs. ## Case: Labial Bow Interfering with a Retraction Spring ### Question **Scenario:** A removable appliance is designed to retract a canine distally using a spring, while also utilizing a regular labial bow for retention. **What's shown:** An exhibit showing a regular labial bow resting on the distal aspect of the canine, in the exact area where a spring is meant to be activated to move the tooth. **Consider:** What is the issue with this design and how can it be resolved to allow the canine to move distally?  ### Answer **Observations:** - The regular labial bow is in contact with the distal face of the canine. - This physical presence prevents the activation of the spring intended to move the canine distally. **Reasoning:** The labial bow physically blocks the spring from engaging and moving the tooth. To fix this, the design of the labial bow or clasp must be modified so it does not contact the distal surface of the canine, allowing the spring to function properly and move the tooth backwards. **Takeaway:** When designing removable appliances, ensure that passive retention components like labial bows do not interfere with the activation path of active components like springs. Case: Labial Bow Interfering with a Retraction Spring Labelled diagram: A blue oval containing the number '2', which corresponds to the section 'THE PATIENT AS A WHOLE PERSON' where the clinician seeks to understand illness within the person's bio-psychosocial circumstances. [^1]: Original PDF page 1: [[W1 Project PDH population informed clinical case.pdf#page=1|W1 Project PDH population informed clinical case, p.1]] [^2]: Original PDF page 2: [[W1 Project PDH population informed clinical case.pdf#page=2|W1 Project PDH population informed clinical case, p.2]] [^3]: Original PDF page 3: [[W1 Project PDH population informed clinical case.pdf#page=3|W1 Project PDH population informed clinical case, p.3]] [^4]: Original PDF page 4: [[W1 Project PDH population informed clinical case.pdf#page=4|W1 Project PDH population informed clinical case, p.4]] [^5]: Original PDF page 5: [[W1 Project PDH population informed clinical case.pdf#page=5|W1 Project PDH population informed clinical case, p.5]] [^6]: Original PDF page 6: [[W1 Project PDH population informed clinical case.pdf#page=6|W1 Project PDH population informed clinical case, p.6]] [^7]: Original PDF page 7: [[W1 Project PDH population informed clinical case.pdf#page=7|W1 Project PDH population informed clinical case, p.7]] [^8]: Original PDF page 8: [[W1 Project PDH population informed clinical case.pdf#page=8|W1 Project PDH population informed clinical case, p.8]] [^9]: Original PDF page 9: [[W1 Project PDH population informed clinical case.pdf#page=9|W1 Project PDH population informed clinical case, p.9]] [^10]: Original PDF page 10: [[W1 Project PDH population informed clinical case.pdf#page=10|W1 Project PDH population informed clinical case, p.10]] [^11]: Original PDF page 11: [[W1 Project PDH population informed clinical case.pdf#page=11|W1 Project PDH population informed clinical case, p.11]] [^12]: Original PDF page 12: [[W1 Project PDH population informed clinical case.pdf#page=12|W1 Project PDH population informed clinical case, p.12]] [^13]: Original PDF page 13: [[W1 Project PDH population informed clinical case.pdf#page=13|W1 Project PDH population informed clinical case, p.13]] [^14]: Original PDF page 14: [[W1 Project PDH population informed clinical case.pdf#page=14|W1 Project PDH population informed clinical case, p.14]] [^15]: Original PDF page 15: [[W1 Project PDH population informed clinical case.pdf#page=15|W1 Project PDH population informed clinical case, p.15]] [^16]: Original PDF page 16: [[W1 Project PDH population informed clinical case.pdf#page=16|W1 Project PDH population informed clinical case, p.16]] [^17]: Original PDF page 17: [[W1 Project PDH population informed clinical case.pdf#page=17|W1 Project PDH population informed clinical case, p.17]] [^18]: Original PDF page 18: [[W1 Project PDH population informed clinical case.pdf#page=18|W1 Project PDH population informed clinical case, p.18]] [^19]: Original PDF page 19: [[W1 Project PDH population informed clinical case.pdf#page=19|W1 Project PDH population informed clinical case, p.19]] [^20]: Original PDF page 20: [[W1 Project PDH population informed clinical case.pdf#page=20|W1 Project PDH population informed clinical case, p.20]] [^21]: Original PDF page 21: [[W1 Project PDH population informed clinical case.pdf#page=21|W1 Project PDH population informed clinical case, p.21]] [^22]: Original PDF page 22: [[W1 Project PDH population informed clinical case.pdf#page=22|W1 Project PDH population informed clinical case, p.22]] [^23]: Original PDF page 23: [[W1 Project PDH population informed clinical case.pdf#page=23|W1 Project PDH population informed clinical case, p.23]] [^24]: Original PDF page 24: [[W1 Project PDH population informed clinical case.pdf#page=24|W1 Project PDH population informed clinical case, p.24]] [^25]: Original PDF page 25: [[W1 Project PDH population informed clinical case.pdf#page=25|W1 Project PDH population informed clinical case, p.25]]