One of the foundations upon which health care professionals practice is a commitment to provide the best possible treatment to each and every one of their patients. For some patients, medical or socioeconomic circumstances may present a challenge to the delivery of optimal care. Fortunately, we live and practice in a country that provides an abundance of riches for its citizens, including leading edge infrastructure, access to highly trained professionals, and various levels of provincial healthcare funding.
As orthodontists, we take great pride and pleasure in knowing that we can play a part in improving an individual’s oro-facial aesthetics and function. These improvements often have a positive impact on self esteem and confidence, and never so profoundly as in children and youth with facial differences and other dento-facial anomalies (Figs. 1 a–d).
Let us consider this scenario …you see in your private practice a 14-year-old female with a medical diagnosis of cerebral palsy, who is wheelchair bound and non-verbal, and has trouble holding her head still. Dentally, she exhibits a large overjet, lips apart, generalized spacing and mal-alignment. Her family also happens to have limited financial resources. Thankfully, in Ontario a dental practitioner may consider referring this patient to an orthodontist. How so? Because we have a world leading centre–Holland Bloorview Kids Rehabilitation Hospital — with a dental department equipped and staffed with individuals trained specifically to care for such patients.
The Dental department at Holland Bloorview is a centre where individuals with varying degrees of physical and developmental challenges may be treated for a wide range of orthodontic problems ranging from crossbites, maxillary constriction, early Class III correction (Fig.2) or habit management to jaw deformities requiring surgical orthodontic correction (Fig.1). Holland Bloorview provides a multi-disciplinary environment involving orthodontists, oral and maxillofacial surgeons, pediatric dentists and prosthodontists who work together seamlessly and in unison over years to make certain that children and youth with orthodontic and dentofacial deformities are able to participate in life to the fullest.
I would like to share the story of two thirteen year old twin sisters who come to Holland Bloorview from a small farming town, 75km away. Both suffered from significant upper incisor protrusion, which made obtaining a lip seal almost impossible. Recall and cleaning appointments were always a challenge, and restorative work required sedation to manage behaviour issues following from their diagnoses of developmental delay. Their treatment plans involved extraction of two upper bicuspid teeth, and maximal anchorage to retract the upper incisors. Full fixed appliances and upper temporary anchorage devices (TADs) were employed to facilitate retraction. Sedation was only used during the TAD insertion and extraction appointment. What was perhaps one of the most gratifying moments of my professional career was when their mother said to me a year-and-a-half into treatment: “for the first time in their entire lives, the girls have been able to give me a kiss, puckered lips and all, on my cheeks.” One can only imagine the improvements the girls must have experienced in their social lives.
Critical to the success of orthodontic treatment carried out at Holland Bloorview is the existence of the Cleft Lip and Palate/Craniofacial Dental Program funded by the Ontario Ministry of Health and Long-Term Care. This program provides, in certain cases, funding of a significant portion of the cost of orthodontics, implant surgery, prosthodontics and other specialized dental care required for the treatment of cleft lip and/or palate, a craniofacial anomaly or other severe dental dysfunction. Specific details about this program including who may be eligible, how to apply, what is covered, how the program works and where the designated centers are located can be found by following this link: http://www.health.gov.on.ca/en/public/publications/child/cleft.aspx#five
In addition to patients with cleft lip and palate and other craniofacial and dental anomalies, Holland Bloorview welcomes referrals of children and youth with conditions which might preclude treatment in a private practice setting, including cerebral palsy (Figs. 3 & 4), acquired brain injury, muscular dystrophy, amputation, epilepsy, spina bifida, arthritis, autism and other developmental disabilities (Fig.6). A small number of our patients have complex chronic diseases that require round-the-clock medical care (Fig. 5).
As oral healthcare professionals, we appreciate the value of an aesthetic smile on self confidence and the effects it can have on someone’s quality of life. This can be especially true for youth with disabilities and special needs. Access to orthodontic care is a key priority for Holland Bloorview, and our commitment to barrier-free access is an ongoing focus. We owe it to all of our patients to provide them with the best our profession has to offer.OH
Shervin Abbaszadeh, BSc, DDS, MSc, FRCDC Certified Specialist in Orthodontics Staff Orthodontist, Holland Bloorview Kids Rehabilitation Hospital.
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