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As a specialist in special needs dentistry, Associate Professor Sharon Liberali sees her role as facilitating communication between dentistry and medicine, allowing patients with medically complex issues to get the dental care they need. By Lynne Testoni
In all professions, there are some people who make a real difference—they see what needs doing and they do it. This is the sort of a can-do attitude that sums up the career of special needs dentist, Associate Professor Sharon Liberali.
SA-based Dr Liberali has been working in the area of special needs dentistry for about 30 years—even before the specialisation was established.
Special needs dentistry (SND) is the management of oral health care and provision of dentistry to patients who are either medically compromised, and/or have intellectual, physical or psychiatric disabilities.
Dr Liberali’s passion for helping people with medically complex needs has been enduring, starting from her school years. She says that she wanted to be a dentist from the age of about 16, but the added layer of working with special needs arose from her high school education.
“I had the benefit of a catholic education and in that system, certainly the one I experienced, it was centred around social justice,” she explains.
“One of the things I had to do as a young girl was to provide community service once a month. I chose to go to the Spastic Centre at Woodville [in South Australia, now called scosa]. And I think that’s where my understanding and appreciation of the challenges faced by people with disabilities first began.
“I spent the three years going there maybe once a month and doing voluntary work.”
After completing her undergraduate dental degree at the University of Adelaide, Dr Liberali joined SA Dental, saying she was open to lots of career directions, and was given many opportunities, thanks to mentor Dr Edward Gorkic.
“He rostered me to provide dentistry to patients with disabilities, and most dentists didn’t want to, but I was quite happy to go,” she explains. “I grew as a person but also my clinical skill set grew because of what I was doing. And it sent me down the path of special needs dentistry.”
Dr Liberali is a frequent speaker at dental conferences and was awarded a Doctor of Clinical Dentistry in Special Needs Dentistry at the University of Adelaide in 2009. She is the director and senior consultant of the Special Needs Unit, Adelaide Dental Hospital, SA Dental Service, and holds an honorary associate dental consultant position at the Royal Adelaide Hospital.
In 2010 she became a Fellow of the Royal Australasian College of Dental Surgeons in the special field of Special Needs Dentistry. She was awarded a Fellow of the International College of Dentists in 2011 and in 2013 was made a Fellow of the Pierre Fauchard Academy.
However, Dr Liberali says that her career in special needs dentistry evolved, rather than being part of a strategic plan. “There was no real plan around anything that I’ve done in my career,” she says. “I only ever just wanted to do what I enjoyed, and that was practise dentistry.”
She also credits many of her achievements to the dentists who came before her in the specialisation, particularly Drs Elizabeth Coates and Mark Gryst.
“I don’t know that I created the space. The space was certainly created by the dentists that went before me such as Liz Coates and Mark Gryst and people that worked in those areas well before it was a specialty. It was Professor Alastair Goss who really pushed SND through the college to get it recognised as a specialty.
“I put a lot of work into it, there is no doubt about that, but I think I was in the right place at the right time. And luckily, my colleagues would actually listen to what I would say.”
Blazing a trail in SND
Primarily working in the public system, Dr Liberali says she finds it rewarding to help vulnerable people achieve access to oral healthcare and feels the area was under resourced and flew below the radar for many years. “All the early information that came out was very much about how this patient group was missing out—they had poorer oral health, and they had poorer oral health outcomes,” she says.
“There were fewer advocacy groups in those days to speak on their behalf. Whereas now we’ve had the Royal Commission in the last couple of years for the aged and a Royal Commission for people with disabilities.
“I saw there was a group of vulnerable and complex patients that needed help, and with the support of SA Dental and the support of the SND specialists that went before me, I was able to tread a path that enabled increased access to care for that group. I was fortunate to have people around me that supported the endeavours that I wanted to do. And also fortunate to find other up-and-coming and young dentists that were also interested in this area.”
A specialist in special needs dentistry requires a good understanding of a variety of different medical conditions, the medications or procedures used to treat these medical conditions, and their impact on oral health and the provision of dentistry. They also need to understand other potential influences on the patient’s care, so that they can provide oral health care that is holistic and compassionate.
Dr Liberali says she has worked hard to raise the profile of the specialty throughout her career, growing her team and reaching more patients as a result.
“When I finished my specialist training, I thought, ‘How can I get the profession to know what we’re doing and understand what we’re doing?’ I decided to get involved in the ADA at that time and became the [state] president,” she says.
“That was a way to bring special needs into the forefront by virtue of doing something else. They knew that I was a person who worked in special needs dentistry, so that was a way to make the broader profession aware of the specialty, I guess, and gave it a profile that otherwise we wouldn’t have been able to create.”
However, Dr Liberali has not only been part of raising the profile of special needs dentistry, she has also trained other dentists in her field of expertise, to ensure that the specialisation continues after her retirement—even if that’s not soon.
Training the next generation
“When I took on the management of the unit, I encouraged undergraduate students to come and work in the unit and to come and watch what we were doing,” she explains.
“It was about finding students who were interested, because I didn’t want people in the unit to be there because they had to be there or tick a box. It was more about getting the right people who have the right attitude.
“The four new specialists in the unit now are all specialists who have come through the University of Adelaide program and worked in the unit as undergraduates and then have decided to specialise.
“When I retire, the next group of clinicians can springboard off the little bit I’ve done to enhance the care for those vulnerable groups as well as support the dental profession to care for those really complex and vulnerable patients.”
Dr Liberali says that the many advances in medicine throughout her career have created new challenges for dentists working in the area of special needs, from people living with cancer to those living with complex disability.
“All the things that have happened in my practising lifetime means that there are dentists that need to understand those patients and the cocktail of medications that go with them. We need a whole group of dentists that understand that.
“I think there’s a huge opportunity now for the next generation of special needs specialists to really build upon the foundational work that people like Liz Coates and Mark Gryst did in Adelaide. It’s taken me 12 years to get to the point where I feel like if something happened to me, there’s a new group of SND specialists in Adelaide that can take over what I’ve been doing and take it to the next level.
“It’s a good feeling.”