Special Needs and Communication in Dentistry Case: Cerebral Palsy (Daniel)

Publication ID Published Volume
9283 December 4, 2012 8


This particular case was created for use in the first semester of the pre-doctoral dental students’ second year. Case materials were created and gathered to fulfill the following primary objectives: to educate about caring for a medically complex dental patient (CP patient specifically), to become familiar with HIPAA in the context of electronic information exchange, to write an official medical consult letter, to practice oral hygiene demonstrations, to research and formulate a comprehensive periodontal treatment plan, and to cite sources properly.

Case-based learning is an effective way to achieve multiple objectives. First, case-based learning, when completed in small groups, facilitates small group communication, cooperation, and encourages a thorough understanding of concepts. Second, students profess to enjoy working with “real” patients in a “safe” setting. Third, facilitated small group discussions offer a less formal, more interactive forum for information exchange.

Practical Implementation

Session 1 (1-2 hours)
Student-only group session with initial look at selected case materials:

  • General objectives
  • Patient narrative
  • Patient videos
  • Medical Consult Letter: Assignment 1

Suggested topics for student discussion and action at Session 1:

  • What do you know about cerebral palsy?
  • What access-to-care issues might surround a case like this?
  • What is your level of comfort (and discomfort) with treating patients like Daniel?
  • How we should seek answers from our medical colleagues?
  • What do you know about HIPAA?
  • How do Daniel's physical limitations affect our process of gaining and documenting his consent to treatment?
  • Review medical consult letter assignment

Session 2 (1.5 hours)
Class session with instructors, facilitators, and all students

  • Review case goals and outcomes
  • Address initial student questions
  • Review and release electronic charting and radiographs
  • Offer tips and address questions regarding medical consult letter assignment
  • General discussion regarding HIPAA and electronic transfer of information
  • Discuss components and issues associated with scaling and root planing procedure

Session 3 (1-2 hours)
Student-only group session
Suggested topics and actions for student discussion at Session 3:

  • How does HIPAA affect our medical consult approach?
  • Complete and discuss research regarding HIPAA and electronic transfer of PHI
  • Fill in information gaps on cerebral palsy
  • Review charting and radiographs
  • Discussion of periodontal treatment plan for comprehensive care in typical patient and how this would differ in Daniel’s case
  • Complete medical consult assignment 1

Session 4 (1.5-2 hours)
First Facilitated Session (see Facilitated Discussion Guide: Part 1)
Suggested topics and actions for facilitated discussion at Session 4:

  • Cerebral Palsy
  • Special Needs Patients
  • Medical Consults
  • HIPAA and Electronic Transfer of Information
  • Periodontal Treatment Plan
  • Distribute HIPAA Breach: Assignment 2
  • Distribute Oral Hygiene Demonstration: Assignment 3

Session 5: (1-2 hours)
Student-only group session
Suggested topics and actions for student discussion at Session 5:

  • Review and discuss medical consult responses (if applicable)
  • Complete HIPAA Breach Assignment 2
  • Prepare for Oral Hygiene Demonstration Assignment 3
  • Completion of SOAP note and Periodontal Treatment Plan

Session 6 (1.5 hours)
Second Facilitated Session (see Facilitated Discussion Guide: Part 2)
Suggested topics and actions for facilitated discussion at Session 6:

  • Medical Consult Responses
  • HIPAA Breach
  • Oral Hygiene Role Playing Exercise
  • Periodontal Treatment Plan and SOAP Note Discussion

Session 7: (1-2 hours)
Class session with Case Review

  • Student group presentation of treatment plans
  • Discussion of issues relevant to treating Daniel specifically
  • Broad discussion of issues and challenges regarding special needs patients


McKenzie C, Mitchell S. Special needs and communication in dentistry case: cerebral palsy (Daniel). MedEdPORTAL Publications. 2012;8:9283. http://doi.org/10.15766/mep_2374-8265.9283

Educational Objectives

  1. To describe the biology, presentation, and treatment impacts of CP.
  2. To understand what HIPAA requires when electronically transmitting patient information, what steps to take to remain in compliance, and what possible actions to consider when a breach occurs.
  3. To write a request for medical consultation.
  4. To complete a standardized Caries Risk Assessment* form
    *Copyright American Dental Association, 2009, 2011. Used by permission.
  5. To demonstrate effective oral hygiene for this patient.
  6. To write a SOAP note and create a comprehensive periodontal treatment plan.
  7. To demonstrate evidence-based decision-making by proper citation of literature sources.


  • Small Groups, Cerebral Palsy, Periodontal Diseases, Treatment Plan, PBL

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ISSN 2374-8265