Jacob Dent, DDS
Many parents of children with special needs report difficulty in finding dentists who are qualified to treat their children. Although there are nearly 60 million people with disabilities in the United States, a mere 10% of dental professionals are prepared to treat patients with special needs.1,2 A primary challenge for dentists treating patients with intellectual or developmental disabilities is addressing the manner in which many patients with special needs react to dentistry.
As the father of a child with special needs, I understand the stress that comes with doctors’ visits. It’s important to me to treat my patients and their caregivers with the same compassion and understanding I give my own family. For years, I have been working with the Pacific Dental Services (PDS) Foundation, which has been leading the charge to make dentistry more accessible to people with special needs through training and advocacy. After years of providing dentists with training and special needs education, the PDS Foundation recently opened the new Pacific Dental Services Foundation Dentists for Special Needs clinic in Phoenix, Arizona, where I am serving as a practicing dentist. The clinic’s leadership also includes Clinical Director Jack Dillenberg, DDS, dean emeritus of A.T. Still University Arizona School of Dentistry and Oral Health.
Unique set of challenges
Running a dental clinic that specializes in treating patients with intellectual and developmental disabilities involves unique challenges. Providing dentistry to patients while also grappling with behavioral manifestations, some of which are extremely difficult to manage without sedation, is a challenge. Appropriate intervention from caregivers is essential for a successful visit. We ensure that the entire team is in sync with patients’ caregivers and offer a holistic approach that includes developing a game plan with caregivers during the consultation. During this initial visit, the clinical team establishes how they will work together to provide the best dentistry possible for the patient.
Another unique challenge from an operations standpoint is dealing with frequent no-shows. Sometimes patients are emotionally or physically unable to keep their appointments. Other times, transportation can be an issue. No-shows are common within this patient population. For many families, success is defined just by surviving the day.
Clinicians running a special needs dental practice also face the reality that they often cannot treat as many patients in one day as other practices. Because of the level of personalized care needed for patients with special needs, the dental team might not be able to schedule back-to-back appointments.
Clinical and emotional training
When treating patients with special needs, it is often necessary to provide desensitization techniques that include a step-by-step approach to overcoming sensory issues that can cause anxiety when receiving dental work. Many patients, whether they have special needs or not, have strong reactions to dentistry. But patients with developmental disabilities often have heightened reactions to dentistry. Managing the reactions of adult patients, in particular, can be an even bigger challenge. To be successful, parents and caregivers need to implement a daily routine at home. Training caregivers to work day in and day out to help patients overcome dental fear is key for successful dental office visits.
For dental teams, including dental students who are unfamiliar with what special needs dentistry involves, treating patients with special needs can be unnerving. Our team, however, has been trained to recognize the difference between behavioral manifestations consistent with a patient feeling pain and being unable to communicate their discomfort, versus behavior that is aggressive in nature. As part of their training, the clinical team applies behavior modulation techniques to calm patients, such as having them go into a sensory room, removing them from the situation and redirecting their behavior, removing any triggers, or placing the patients in a controlled area. If necessary, protective medical stabilization designed for patients who cannot control their movements is applied, and in the most extreme cases, sedation is used. We show what really takes place in a special needs dental practice. We’re looking to increase providers’ confidence in their ability to treat patients with special needs, so they embrace the opportunity to treat special needs patients on their schedules.
Behavioral management, as well as managing the physical challenges without the use of sedation, is part of the training provided to the team at the clinic. While the standard for general dentistry practices is to resort to sedating many of their special needs patients, the providers at the PDS Foundation Dentists for Special Needs sedate less than 5% of their patients.
The nonprofit PDS Foundation Dentists for Special Needs clinic also provides patients with education and training to help them make proper oral health achievable between visits. Our sensory-friendly office provides patients a relaxing environment. In addition, building a foundation of long-term self-help skills for each patient is one of our main priorities. We have a collaborative approach to each individual’s oral health that includes the families and caregivers, as well as the medical and therapy teams who work with them. We can achieve more together.
1. Nearly 1 in 5 People Have a Disability in the U.S., Census Bureau Reports [news release]. Washington, DC: US Census Bureau; July 25, 2012. https://www.census.gov/newsroom/releases/archives/miscellaneous/cb12-134.html. Accessed on May 20, 2019.
2. Casamassimo PS, Seale NS, Ruehs K. General dentists’ perceptions of educational and treatment issues affecting access to care for children with special health care needs. J Dent Educ. 2004;68(1):23-28.
JACOB DENT, DDS, is a graduate of Louisiana State University School of Dentistry. He is a multiple-practice owner-dentist supported by Pacific Dental Services in Texas and Louisiana, and he practices at the PDS Foundation Dentists for Special Needs clinic in Phoenix, Arizona. He is a faculty member of the PDS University Institute of Dentistry and the clinical director for the Special Olympics Texas and Special Olympics Louisiana.