Posted on 29th May 2019
As the only special-needs dentist in Western Australia, Daniel has a wealth of knowledge to share – however, his interest in special-needs dentistry happened quite by chance.
“I graduated with a Bachelor of Dental Surgery from the University of Otago in New Zealand, and it is quite common after graduation in New Zealand to do a couple of years in a hospital to build up your skills,” he recalls.
“I worked at Auckland District Health Board and was rotated between different specialties, such as maxillofacial surgery, oral medicine and special needs. We only had the one lecture on special needs through dental school and to be honest, it wasn’t very exciting. But during my time at Auckland,I got to see whatspecial needs looked like in a hospital setting,and found it to be both challenging andinteresting.
“I took a special interest in it and the consultant I was working under took me under their wing. It is not a very big speciality, so they were quite keen to take me on board and show me the ropes.”
Daniel’s passion for special needs led him to Perth in January last year, accepting a position at Fiona Stanley Hospital as a specialist in special-needs dentistry.
“It was a really good opportunity to set something up in Perth,” he says. “We haven’t really had special-needs dentistry, let alone a training programme,at the university, so the opportunity to be part of buildingsomething from the ground up is pretty exciting.”
At Fiona Stanley, Daniel says most of the special-needs patients he sees are medically compromised.
“Special needs is an umbrella term for managing patients that can present as medically complex or have an intellectual disability,physical disability or a psychiatric diagnosis,” he explains. “At Fiona Stanley, we see a lot of the medically complex patients. We are part of the head and neck cancer MDT, the bone-marrow transplant unit, and we see a lot of patients being worked upfor organ transplants, as well as thosewith bleeding disorders.
“We are also seeing an increasing number of patients with intellectual and physical disabilities being referred from community practitioners, as we try to see the full gamut of special needs.”
As well as his position at Fiona Stanley, Daniel is a clinical senior lecturer at the University of Western Australia, responsible for the Special Needs curriculum for the Doctor of Dental Medicine.
“The lectures are an introduction to special needs for third- and fourth-year dental students,” he says. “They help students be aware of the issues facing special-needs patients and how this impacts their ability to access care. The reality is that we have a very small workforce and are very much dependent on community dentists managing some of these patients in their clinics.”
Daniel says realising the variety involved in special needs dentistry is exciting for the students. “I think once students appreciate the variety of what special needs is and what we can achieve under that umbrella then they get a bit more excited,” he says. “The ones that do come to the hospital and see what we do gain a lot from that experience.”
Daniel has a full calendar, with four days at the hospital and one day at the university, but he also finds time to volunteer with YWAM Medical Ships Australia and Papua New Guinea; indeed, he only recently returned from an outreach.
“It was a great experience once again,” Daniel says. “We spent two weeks in one of the rural provinces in Papua New Guinea. There are not many situations when you are in the middle of nowhere, and you have dentists, doctors, nurses, midwives, pharmacists, and other health professionals from all over the world in a single space. It is a great opportunity to exchange ideas and information but also to upskill and train the local dental workforce. Hopefully the next outreach will be later this year.”
In the meantime, Daniel is committed to educating others about the importance of special needs dentistry and will be presenting on treatment-planning considerations for the dementia patient at July’s Eat and Meet.
“Everyone knowswe have an increasingly aging population,” Daniel says. “Dependingon what you read, there are some estimates that one in three people over the age of 80 will have dementia.
“Increasingly, because these patients are unable to come in to a hospital or a dental practice, there is an expectation now that dentists will go into aged-care facilities. Additionally, community dentists will probably have seen these patients for the last 30-40 years, so will be best placed to look after them given the history they have with the patient.
“As a patient’s dementia worsens, we need to start thinking about what sort of things we look for, and how do we manage these patients taking this all into account?
“The take-home message is that there are plenty of ways to go about managing a patient. There is no right or wrong. It is more a discussion about how we do things differently and what works well, because dementia patients can present very differently. One method will not work for everyone.”
Dr Daniel Sundaresan will be presenting at Eat and Meet on July 10 on the topic: I think my patient’s in pain: treatment planning considerations for the dementia patient.