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Volume3 Issue3
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CDA
at
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Dental Care for Refugees:
CONSIDERATIONSFOR
CANADIANDENTISTS
Dr.CliveFriedman
Whatareyour concernsaboutdentists
treating refugees?
It’sheartwarming to see thenumber of
dentistswhoarewilling toworkwith this
populationgroup—the responsehasbeen
phenomenal. But apart ofme is concerned
that individualswill provide treatment to
aSyrian refugeeas theywoulda so-called
“regular” patient. I regardmost of theSyrian
refugees ashavinga special need, in that
theyhaveall experienced some formof
trauma. Theyhavebeen in refugeecamps
andfledacountrywhere therehasbeen
extremeviolence.Whenweexamine
theoral cavitiesof these individuals,we
may retrigger someof their traumatic
experiences. Sowehave toconsider
this carefullybefore treatment.
Howdoesadentistevaluatewhether
theirpatienthasaspecialneedornot?
I think the International Classification
of Functioning, DisabilityandHealth
(ICF) is veryuseful inhelping toevaluate
an individual andcomeupwithan
appropriate treatment approach. ICFuses
anumber of different domains toclassify
an individual’shealthbasedon interactions
betweenhealthconditions andcontextual
factors.
It’s thesecontextual factors that dentists
need tobeconcernedabout—those
related to theenvironment andpersonal
factors. For example, consideringwhether
thepatient suffers frompost-traumatic
stressdisorder (PTSD) is important because
dental treatment couldcauseapatient
to re-experiencea traumaticevent.
Environmental factors, like social attitudes
andbelief systems, shouldalso
beconsideredbecause these factors
mayhavean impact onan individual’s
experienceswithhealthcare. Sobefore
webegin treatment for an individual,we
have tobeawareofwhat someof these
underlying factorsmight be.
Whatmighthappen if I treatapatient
without considering thesecontextual
factors?
If theoral treatmentweprovide retriggers
a traumaticmemory, it can result ina
terrifyingexperience for thepatient. Their
flight or fight responsemaybeactivated
and thus theymightwant toget out of
your officeas fast aspossible, ormakean
appointment and just never showup. The
other neurobiological responsecouldbe
that they freezeand submit. Thepatient
couldbecomecompletelyquiescent
andquiet and seemas though theyare
no longer present. Theseareall possible
responses.
Doyouhaveanypractical steps for
treatingapersonwhomayhave
experienced trauma?
Thefirst step is tohaveaconversationwith
aparent andchildabout all the factors—
physical, personal and social— thatmight
beaffecting their healthbefore initiating
care. This couldenableus toprovide
moreempatheticcare to that individual.
Motivational interviewingcanalsobe really
important. Just beopen to their answers,
without assumingweare theexperts in
approaching their care. That’s
abigfirst step.
The second step is to lookat removal of
painand infection, and treat theunderlying
issues rather than theactual caries that
these individualsmayhave. Itmay require
us todoART,which isAtraumaticRestor-
ativeTreatment, until their psychological
well-being is improvedand theyaremore
comfortablewithwhat’sgoingon. Once
that’shappened,wecango inandbegin
definitive treatment.
a
AsSyrian refugeescontinue
toarrive inCanada—
anumberestimated to reach
25,000by theendof2016—
manywillneed treatment
for seriousdentalproblems.
Canadiandentistshave
responded in largenumbers
tomeet theseneeds, but
theymaynotbeawareof
the special considerations
required to treat thispatient
group.We spokewith
Dr.CliveFriedman,
apediatricdentistwith
an interest in special
caredentistry, forhis
perspectiveon this issue.
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Q
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This interviewhasbeencondensedandedited.
Theviewsexpressedarethoseoftheauthoranddonot
necessarilyreflecttheopinionsorofficialpoliciesofthe
CanadianDentalAssociation.
Tohear the full interview
withDr. Friedman, visit
oasisdiscussions.ca/
2016/01/14/tr
