Oral Health Group
Feature

Dentistry at Holland Bloorview Kids Rehabilitation Hospital

January 1, 2013
by Robert P. Carmichael, BSc, DMD, MSc, FRCDC


INTRODUCTION AND VISION
Holland Bloorview Kids Rehabilitation Hospital is Canada’s largest rehabilitation hospital, serving children and youth with dis­abilities, not only in Ontario, but also throughout Canada and around the world. By pioneering treat­ments, technologies and real ­world programs that give children with disabilities the tools to participate fully in life, Holland Bloorview strives to fulfil its vision of creating A World of Possibility for kids with disabilities.

Holland Bloorview is a teaching hospital fully affiliated with the University of Toronto, and trains future health­care specialists in the field of childhood disability. The Bloorview Research Institute, located onsite, allows for the integration of cutting ­edge research and teaching with frontline care to improve children’s quality of life. Holland Bloorview’s state­-of-­the­art facility has been recognized by the International Academy for Design and Health as “an inspirational building…which speaks to a child’s right to par­ticipate in our society.”

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Dentistry at Holland Bloorview provides the full range of dental services, including pediatric dentistry, orthodontics, oral maxillofacial surgery and prosthodontics. Our primary role is to provide specialized dental care for children and adolescents (under 22 years of age) with special health careneeds, whose treatment is best managed in a multidisciplinary outpatient environment. Dental services are also provided for Holland Bloorview’s inpatients.

HISTORY
In 1899 a group of 22 women, some of whom were founders of Toronto’s Hospital for Sick Children, gathered to establish a facility at 138 Avenue Road in Toronto solely dedicated to care for children with chronic ill­nesses and disabilities, which they named the Home for Incurable Chil­dren. The facility expanded over the years and received both private and governmental financial support. In 1959 it was renamed Bloorview Hos­pital, Home and School and later shortened to Bloorview Children’s Hospital.

Meanwhile, in 1961, the Ontario Crippled Children’s Centre was estab­lished at 350 Rumsey Road, and in 1962 the Cleft Lip and Palate Program was created. In 1984, the name changed again to the Hugh MacMil­lan Medical Centre, and in 1990 to the Hugh MacMillan Rehabilitation Centre.

By 1996, Bloorview Children’s Hos­pital and The Hugh MacMillan Reha­bilitation Centre officially became one organization called the Bloorview MacMillan Centre. In 2006 it was re­named Bloorview Kids Rehab (now Holland Bloorview Kids Rehabilitaion Hospital), after both sites moved to the current loca­tion at 150 Kilgour Road, near the in­tersection of Eglinton and Bayview Avenue in Toronto.

PROGRAMS AND SERVICES
Each year, 7,000 patients are treated at Holland Bloorview, with 644 inpatient and 53,600 outpatient visits. There are 850 employees and more than 1,000 volunteers.

Holland Bloorview assesses and treats children born with disabilities and special needs and those who ac­quire disabilities through serious ill­ness or accidents. Children with complex disabilities access services at Holland Bloorview on an inpatient or ambula­tory basis, according to their needs, and when they turn 18 clients are as­sisted with the transition to adult services.

Holland Bloorview offers inpatient, outpa­tient and day patient services in three main program groupings — Child De­velopment, Community, and Rehab and Complex Continuing Care. Pa­tients who are treated have complex medical conditions and special needs including:

• cerebral palsy

• acquired brain injury

• muscular dystrophy

• amputation

• epilepsy

• spina bifida

• arthritis

• cleft lip and palate and other cran­iofacial anomalies,

• and a range of developmental dis­abilities such as autism spectrum disorder.

BLOORVIEW RESEARCH INSTITUTE
The Bloorview Research Institute con­ducts research focused on enhancing therapies, developing assistive tech­nologies, and evaluating barriers re­stricting the inclusion of children with disabilities into communities.

The staff at the research institute is composed of a multidisciplinary group of scientists with expertise in medicine, surgery, nursing, occupa­tional therapy, physical therapy, speech and language pathology, engi­neering, epidemiology, biostatistics, and psychology.

FACILITY
Holland Bloorview’s current facil­ity opened its doors in 2006. (Fig. 1). It sets the standard for universal accessibility and demonstrates the highest level of respect for the patients it serves. The new building includes a number of innovative features that enable all of its clients and families to be served under one roof. From inpa­tient facilities, ambulatory clinics, recreation areas and therapy facilities to resource centres and conference services, the opportunity to further Holland Bloorview’s mandate as an organiza­tion and provide more comprehensive care to children with special health care needs and the general community, has never been more promising.

In addition to the hospital and clin­ics, the building also has accommo­dation suites for families, an active living centre, cafeteria, conference centre and meeting rooms, daycare, a health sciences library, a reflection room, a swimming pool and a school providing individualized educational programs for children and youth with special needs.

DENTISTRY AT HOLLAND BLOORVIEW
In keeping with Holland Bloorview’s mission, the dental department is a multidisci­plinary and interprofessional inpa­tient and outpatient service that provides dental care for children, ado­lescents and young adults with special health care needs such as congenital and acquired anomalies and other rare disorders. In 2011/12 there were 1,649 unique patient visits to the Dental Department, and in total more than 4,800 patient vis­its.

The dental team includes specialists in pediatric dentistry, orthodontics, oral and maxillofacial surgery, prosthodontics and dental hygiene. Depending on patient needs, the team draws upon the spe­cialties of plastic surgery, ear, nose and throat surgery, pediatrics, and ra­diology, in addition to speech and language pathology, occupational therapy, social work, physiotherapy and psychology. Patients benefit from having many of the team mem­bers who will be involved in their care present during their initial consulta­tion, case presentation and treatment sessions. The team members there­fore have the ability to combine their expertise, resulting in more effective and efficient treatment planning, ex­ecution and follow-­up for patients with complex problems requiring in­terdisciplinary care.

DENTAL PROGRAMS AND SERVICES
Holland Bloorview offers dental services in Pediatric Dentistry, Cleft Lip and Palate/Craniofacial Dental Anomalies, Northern Outreach, and together with the Child Development Pro­gram, Feeding Disorders, Saliva Man­agement and Protective Headwear.

PEDIATRIC DENTISTRY
The Pediatric Dental Program pro­vides outpatient and inpatient pedi­atric dental services and outpatient or­thodontic services to children with di­agnoses such as cerebral palsy, spina bifida, Duchenne’s muscular dystro­phy, cleft lip and palate and other craniofacial and dental anomalies, along with autism spectrum disorder, trauma and other complex medical conditions and syndromes (Fig. 2). Together with the Child Development Program, Dentistry at Holland Bloorview also offers a range of specialty clinics sup­ported by consulting physicians from other organizations s
uch as The Hos­pital for Sick Children. These clinics include Feeding Disorders, Saliva Man­agement and Protective Headwear for children with seizure disorders.

CLEF LIP AND PALATE/CRANIOFACIAL DENTAL ANOMALIES PROGRAM
Dentistry at Holland Bloorview provides out­patient orthodontic, oral and max­illofacial surgical and prosthodontic services to children, adolescents and young adults with cleft lip and palate (Fig. 3), congenital dental anom­alies (Fig. 4), acquired dental and orofacial anomalies (Fig. 5), trauma (Fig. 6) and craniofacial anomalies (Fig. 7). Holland Bloorview also serves as one of seven designated assessment centres to de­termine eligibility for financial assis­tance through the Ontario Cleft Lip and Palate/Craniofacial Dental Pro­gram. More information on this gov­ernment program is available at http://www.health.gov.on.ca/en/public/publications/child/cleft.aspx

CLEF LIP AND PALATE/CRANIOFACIAL DENTAL NORTHERN OUTREACH PROGRAM
There are regions of Ontario that are medically under­serviced, and lacking in health­care services for children with cleft lip and palate or other cran­iofacial or dental anomalies. Over the past four decades, Holland Bloorview has developed a community-­based and family-centred outreach program designed to ensure access throughout northern Ontario to co­ordinate cleft lip and palate and cran­iofacial care.

The Northern Outreach team is a group of medical and dental specialists and allied health­care professionals seconded from the Cleft Lip and Palate/Craniofacial teams at Holland Bloorview and the Hospital for Sick Children (Fig. 8). Residents and fel­lows from their respective academic teaching programs take part in the clinics to complement clinical human resource requirements and to augment their clinical experience in the provi­sioning of cleft lip and palate/cranio­facial care.

Volunteers from local service clubs assist with transportation to and from airports, and help with meals and clinic operations. Local clinicians are encouraged to attend clinics to take part in the assessment of their own patients, empowering them to pro­vide rehabilitation services more ef­fectively in their own communities, and reducing the frequency of review required at outreach clinics.

Outreach Clinics are held at the fol­lowing facilities:

Thunder Bay: George Jeffrey Children’s Centre

Sudbury: Cambrian College

Sault Ste. Marie:Children’s Rehabilitation Centre — Algoma

Timmins: Cochrane Temiskaming Children’s Treatment Centre

An initiative between Holland Bloorview and Ontario Telemedicine Net­work is presently underway to test the use of two-­way videoconferencing systems and the latest tele­diagnostic instruments, including high-­resolu­tion patient examination cameras and digital imaging facilities. The purpose is to transfer data between team mem­bers in Toronto and northern out­reach clinics and other remote sites across the province. The use of telemedicine will further enhance ac­cess and quality of health care deliv­ered to children with cleft lip and palate and other craniofacial anom­alies in northern Ontario.

EDUCATION AND SCHOLARSHIP
Holland Bloorview’s Dentistry department works closely with the Faculty of Den­tistry at the University of Toronto and with dental departments at other Uni­versity of Toronto affiliated hospitals, especially The Hospital for Sick Chil­dren. Gen­eral dentistry residents from The Hospital for Sick Children are as­signed to Holland Bloorview on a rotational basis throughout the year, where they are given supervised clinical experi­ence in delivery of pediatric dentistry to patients with special health care needs. Candi­dates enrolled at the University of Toronto in MSc/specialty dental pro­grams including pediatric dentistry, oral and maxillofacial surgery and anesthesia, and prosthodontics are as­signed to Holland Bloorview, where they take part in the treatment of patients with special needs including cleft lip and palate and other craniofacial or dental anomalies, and other rare syndromes.

ITI SCHOLARSHIP CENTER
In 2007, Holland Bloorview Kids Rehabilitation Hospital/ Uni­versity of Toronto was designated a Scholarship Centre by the Interna­tional Team for Implantology (ITI). The primary goal of the ITI Clinical Scholarship Program is to help young clinicians further their training in im­plant dentistry and related treat­ments, with particular emphasis on case planning, implant surgery and prosthetic restoration. The ITI scholar also interacts closely with graduate students and fellows in many clinical disciplines at the U of T’s Faculty of Dentistry and The Hospital for Sick Children to further enhance the scholarship experience, and completes a research project with the mentorship from Holland Bloorview and/or U of T staff. The program also aims to foster interna­tional exchange as an enriching educational experience. Scholars are assigned for a period of one year, and have come from Brazil, Bulgaria, the People’s Republic of China and Japan.

ITI UNIVERISTY EDUCATION PROGRAM
Holland Bloorview was selected by the International Team for Implantology in 2009 to join an international network of six other educational institutions around the world, the aim of which is to enhance dental implant education worldwide. Annual Education Weeks offer continuing education courses in implant dentistry aligned to evidence-based treatment approaches, and utilize lecture and discussion sessions, participation in treatment planning, surgical and prosthetic hands-on sessions and live broadcast of surgical and prosthetic sessions. Read more at http://www.iti.org/?a=1&t=8&y=3103&r=0&n=191&i=0&c=0&v=page&o=&s=

DIGITAL DENTIRSTRY EDUCATION CENTER
Straumann Canada has funded the establishment of a Digital Dentistry Education Center at Holland Bloorview in order to expand the educational offerings to the dental community, and to teach and train participants in the safe and effective use of digital dental technology including treatment planning software, surgical guide fabrication, CADCAM systems and intra-oral scanning. Continuing Education courses will be given on “Digital Implant Dentistry: Imaging, Planning, Placement, and Restoration” starting May 31 and June 1, 2013, then again on November 22 and 23, 2013.

Holland Bloorview’s dental department is currently accepting referrals from dentists and physicians. The referral form can be found at http://bloorview.ca/pages/referrals.php OH

Dr. Carmichael is Chief of Dentistry and Director, Ontario Cleft Lip and Palate/Craniofacial Dental Program at Holland Bloorview Kids Rehabilitation Hospital. He is also coordinator of prosthodontics, The Hospital for Sick Children and assistant professor, Faculty of Dentistry, University of Toronto. He may be reached at 416.425.6220 (Ext. 3464) or by email at rcarmichael@hollandbloorview.ca.

Oral Health welcomes this original article.

REFERENCE

1. Adapted from Dentistry at Bloorview Kids Rehab. Carmichael RP and Noble J, Ontario Dentist 2009 December, 14-19.


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