The development of special needs dentistry service in Malaysia - a situational analysis (based on New Zealand experience)

Abstract

Aim: The aim of this project is to understand the expectations of the Malaysian population for future development of Special Needs Dentistry (SND) service in Malaysia. Along with the current recognition of the specialty by Ministry of Health, Malaysia, the Ministry has identified New Zealand as an appropriate nation to provide information on service developments and lessons learnt from an established service.

Methodology: Mixed-methods research design was adopted to carry out this study which contained both qualitative and quantitative components. The qualitative part involved interviewing fifty five participants who represented the major stakeholders in the SND service, both in Malaysia and New Zealand which comprised people with special needs, caregivers, policy makers, dentists and disability support group representatives. The qualitative data were analysed using applied grounded theory. The dominant themes identified were used to formulate the survey questionnaire for the quantitative part in which 345 paper questionnaires were posted. A response rate of 17.0% was calculated from the original surveys returned.

Results: The data suggested inadequate home and professional dental care for people with special needs which underline the necessity to develop the SND service in Malaysia. Transportation difficulties, lack of awareness about the importance of dental care, negative attitude, the difficulties in finding an accompanying person for the dental visit as well as an extended time required by the dentist to treat people with special needs (PSN) were identified as barriers to access dental care facilities. In addition, inadequate knowledge and experience of the local dentists could be one of the contributing factors for their unwillingness to provide the service. The results also suggested that patients who required general anaesthesia for dental treatment, those with complex medical problems and uncooperative patients should be treated under the specialist care. This would be more appropriately provided in the hospital environment than in the community setting. Even though it was suggested that a domiciliary service was necessary, this practically depended on the achievement of the adequate number of specialists in this field and the existence of a well established service and network. Nevertheless, it appeared that the Ministry of Health Malaysia is well prepared to face the challenges in the development of the SND service in Malaysia.

Conclusions: There were definitely some issues regarding dental health care of people with special needs which had to be considered and could be managed by the Ministry of Health in the future development of the service. Oral health promotion covering areas such as building public health policy, creating supportive environments, strengthening community action, developing personal skills or reorientating health service in the pursuit of oral health goals would help to strengthen the service in the near future.