Oral Community Project

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‫بسم الله الرحمن الرحيم‬

Raise the awareness level about complications of incomplete dental treatment in patients attending the clinics in Al-quds university dental school An oral community project SUPERVISED BY: DR.ELHAM AL-KHATEEB & Project team: MOHAMMAD SALAH QREA MAHMOUD MODALL HUSAM AL-RJOOB & FADI ABU_HELAL TH 5 YEAR DENTISTRY

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2007\2008

Raise the awareness level about complications of incomplete dental treatment in patients attending the clinics in Al-quds university dental school Introduction The difference between the reality and the hopes always exist. That you will never see that both reality and hopes are identical. As a dentist you work hardly to get your patient healthy but you'll be shocked when you find your patient is careless about his problem firs and his treatment plan. Whom you do your optimum to make him healthy. Actually you must not be shocked because your patient is not the only one who doesn’t respond well to his treatment plan. According to many dentists and to our experience as dental students of the 2nd clinical dentistry year in AL-QUDS dental faculty, it's found that significant member of patients are barely complaint to their treatment plan … In this study we'll try to look for the causes that make some patients poorly aware to their treatment plan, WHY DO THEY DO SO???? . Also to discuss what can be done to improve the compliance of the patients? What roles does the dentist have to do improve this compliance??? Finally this study conducted for 40 students in AL-QUDS dental school for the patients they had seen in the past year. It showed that 50 % of the patients came to our faculty clinics are not fully compliant fro the treatment. That they don’t return anymore to our clinics after his complaints ends up.

Goals Raise the awareness level about complications of incomplete dental treatment in patients attending the clinics in our faculty. And give them the optimum knowledge for complete the treatment plan.

Objectives • Measure the general knowledge of patients concerning dental treatment. • Aware patients about unfinished treatment. • Aware the people about oral health which may promote oral health in community. • Raise the level of professional attitude among students. • To gradates students capable of convincing patients about complications.

Epidemiology

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For the purpose of our project we conducted a simple and small survey that involved 40 students in the fifth – clinical – year of our faculty. Randomly chosen subjects were asked to answer three simple questions about their experiences with patients in this last semester (September 2007- January 2008). The questions were namely: 1. How many patients did you treat this semester? 2. How many of these patients abandoned their treatment plan? 3. Can you mention the reasons that made these patients abandon treatment? These forty students have treated the amazing number of 719 patients. We may expect that over 1000 patients come to our clinics by semester. A total of 114 patients abandoned treatment for some reason.

patients complete treatment 84.15%

patients abandoned treatment 15.85%

Chart 1: percentage of the patients that abandoned their treatment plan to total number of patients.

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6%

4%

1 2

36% 31%

3 4

22%

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Chart 2: reasons patients didn’t return to our clinics.

REASON Money Lack of Knowledge Busy or inappropriate appointment Disliked clinics , instruments, etc. Fear Other

LEGEND 1 2

PERCENTAGE 36% 22%

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31%

4 5 6

6% 0.90% 4%

This numbers show a simple sample that has to be revised if it is to be used for purposed of a major study, since the probabilities of error and the chances of patients being mentioned twice as being treated by several students may influence the results. Although simple, it is very informative in finding out the number of patients that attend to our faculty for treatment and the main reasons they may abandon treatment for. Mentioned as an entertaining point in our findings, male students faced being dumped by their patients more frequently than female students. So stop giving them credit for being active, and give us some credit for holding to what they have left for us.

Theory From the conclusions we obtained after our quick survey we notice that there is a relatively fair number of patients which have chosen not to complete treatment as planned for several reasons which include; financial issues (36%), inadequate appointments of treatment (31%), and most important of all what we have

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denominated as the “relief of pain phenomenon”, which implies lack of patients knowledge about treatment procedures and complications that may arise (22%). This phenomenon has lead to several cases of endodontic flare ups, recurrent carious lesions destruction of teeth and perhaps even more complicated situations such as cellulites and abscesses that may have needed surgical intervention. It is this phenomenon that we have to confront in our patients. According to the many cases and many causes of this self-conscious act we have came to the conclusion that this program is to be designed upon two approaches which have been previously mentioned as our goals: • The raise in the level of knowledge about dental treatment and complications. • The encouragement of people to follow their respective treatment plan by facilitating all possible factors impeding it. To achieve the first part we have to spend some time finding suitable ways to put our dental and scientific knowledge into a form that is easy for all kinds of patients.The following ideas are proposed: • Modified attitudes during history taking • Brochures about the treatment just received • Presentations to institutions most prone to dental problems. The first idea involves the development of new student attitudes to enlighten the problems patients have and increase their awareness about their chief complaint. This chief complaint and/or problems should be fully discussed with the patient in a way that includes their respective complications, treatment options and prognosis. The patient should not leave the diagnostic clinic without the determination to follow up his treatment. The second proposal is to prepare brochures explaining several treatments, to be given to patients after receiving treatment. These brochures may help answer several questions the patient was not able to ask intraoperatively and also prepare for following sessions. Their importance increase due to the fact that they might be a factor influencing the patient to come back since there are complications that may arise or for the mere purpose of fulfilling their need to know more about the treatment they have received. The last proposal is directed to the long term change of attitudes in the community since it is designed to aware people that dental disease is no different than any other systemic disease or condition , and that it may worsen with time even to become life threatening. Therefore dental treatment is no different than other types of treatment. This type of awareness and response can only be achieved by allowing people to discuss with professionals the issue of dental disease. Conferences, presentations, open days are the activity of choice for this purpose. Within these several options may be adjunct to serve the purpose of each activity. This first part accounts for only 22% of our patients. Therefore there are still other reasons that make patients refuse treatment. The second approach for this program is the encouragement of people to follow their respective treatment plan by facilitating all possible factors impeding it.

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For this part we have to look at the other reasons that impede our patients from following their treatment. The first reason is inadequate times of some clinics. Many people have to work during the day, especially in the morning hours. A fair solution may be designating some clinics which most concern our patients into the late hours of the day such as conservative and endodontic clinics. Other suggestion is related to pediatric clinics. They may be re-scheduled in the afternoon period or in weekends; but will it truly solve the problem. An important addition would be to clarify the role of the students undergoing the post graduate or excellence training period at our clinics. They should have clear schedules and working times that are most acceptable to patients; that is the late hours of the day. In this way we may fill that gap of the lack of a permanent clinic appointment at these times without interfering with any of the undergraduate clinics. It is impossible to come out with a schedule that pleases all patients but we believe that it can be much better with some little improvements. The second reason is out of any type of debate or discussion. We have all faced cases in which the patient refuses to come to a clinic because of its expenses. Here we are absolutely discussing clinics that provide services along with the laboratories that we are in company with. Well there is nothing we can do, unless we work ourselves all the orthodontic and prosthodontic lab work. The idea of a permanent lab technician affiliated only to the faculty’s work would be good but maybe not enough. The problem stands in the unavailability of funding for such kind of work. The need of a sponsor or some kind of donation program may be helpful. As another thought for limiting the problem, we have came with the idea that some treatments may be charged such as endodontic treatments or composite restorations. As a theoretical example; if 100 patients were to receive endodontic treatment per semester, and other 100 were to receive conservative restorations, a sum of about one thousand NIS could be raised for the purpose of lowering bridge costs if only 5 NIS were the designed cost for treatment. This simple example shows that a budget can be raised and since relatively small amounts of money are the cost, people may feel unbothered to pay and maybe even encouraged to come back since they have spent money. Sometimes we face patients unwilling to go get an x-ray. Maybe in the near future we may found a center in cooperation with the faculty of health professions and the department of medical imaging that will allow us to provide this service in the university. Until then the issue of these patients who can’t afford treatment remains unclear since it is somewhat unethical for a undergraduate health institution to charge their patients for treatment, as it is unacceptable for such an institution to remain without a permanent stable budget and funding for these kind of treatments. The financial issue will be of increasing concern in the following years as the faculty keeps growing along with the growing demands of larger amounts of students and less patients. Other reasons that raised our alertness-from the patients’ point of view- was that the clinics ambient was not favorable, or that the instruments were not clean, and even some patients complained about the attitudes of some doctors, including both sides of the equation, students and instructors. In this little survey 6% of the patients that abandoned treatment had something to say to us. this matter should be of most importance since we can’t afford to lose this percentage of patients just because it was somebody’s fault to burn out trays or instruments, or because some careless student left his clinic as a ‘war zone’. As students we do not have the authority to make rules to punish those who have been involved in such act, but we have the right to ask from

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our administration to be strict in this concern. As a solution for the instrumentation issue, we have to make sure our nursing staff is also well oriented about how to sterilize things appropriately. Not all plastic instruments can go into a dry heat oven. Without further delay a fair solution may be involving students in a monthly occasion just for the purpose of maintenance, cleanliness and readiness of out hand instruments. Students from second year and above may take turns monthly for this purpose. This may also help to introduce students to instruments that we use at an early stage without the pressure of being under constant question about them. Other minor issues that are not of big interest were the facts that 4 % of patients had different other excuses to be unengaged from treatment. Another 0.9% complained of fear from dental treatment. In this last part we would like to draw the attention of our dearly administrators and almost colleagues that a waiting room designed specially to serve our clinics would be the best place to find all information regarding treatment. All means of patient education can be found in a waiting room including brochures, posters, dietary advice and even a receptionist in some times. It would help achieve our objectives in this project by providing a shelter in which our ideas can come into life at any time, and an accommodation necessary for any health institution. Before moving forward in our project we present our apologies to our administration and dearly colleagues if any statement above was perceived with a look of criticism, it is not our job neither to criticize nor to look for faults. All that was written above was driven by the passion and the affection we share for our careers, for our faculty and our superiors. Our only hope is that this project may reveal the truth from a new point of view, the students’ point of view, in order to grow a bigger, stronger and better institution for all. "The pure and simple truth is rarely pure and never simple" Oscar Wilde

Activities Pressures about the treatment plan, and the possible complications of uncompleted treatments after treatment, in addition to other educational pressures in the suggested waiting room. • Pressures about services provided, and its prices, with each new patient's file. • Direct educational contact during history taking (verbal assurance). • Lectures done by the students in specific days to increase the awareness of our patients about most dental problems. • Organizing additional clinical units opened in the evening to make our clinics time more suitable for most of patients. • Internal prosthodontic lab technicians. • Renewing the old instruments. • Permanent maintenance employee. • Using some media devices such as newspapers, TV, etc, about our dental school and the services presented to patients. • A full day for cleaning and repairing the clinics and instruments each week. •

Indicators

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Re-conduct an assessment need after the implementation. Perform detailed study on the benefits of the program.