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Caring for patients with special needs in dental school clinics

The population of dental patients who need special-needs care is growing dramatically. While predoctoral dental programs are incorporating more curriculum that allow students to treat special-needs patients, they still have a long way to go to develop competent practitioners.

CODA requirements state that “graduates must be competent in assessing the treatment needs of patients with special needs.” The intent is that students will have access to a special-needs patient pool; however, not every student will have the chance for substantial experiences with these individuals. Additionally, there is no current accredited pathway for a specialty degree in special-needs dentistry, yet there are still many ways to stay current with and learn how to treat this patient population. Here is some advice offered by three professors in different special-needs clinics on how to do so.

Dr. Kimberly Espinoza is from the University of Washington (UW). She runs the Dental Education in the Care of Persons with Disabilities (DECOD) clinic at UW, which has seven operatories and averages 6,000 patients a year. Third- and fourth-year dental students spend about three weeks of clinic in DECOD, in addition to electives such as the second-year patient care selective course. The DECOD clinic also offers a unique one-month fellowship program.

Dr. Espinoza emphasizes that students embrace the opportunities in school to work with special-needs patients, specifically regarding patients with intellectual disabilities (ID) or developmental disabilities (DD). She says we should not assume we cannot treat these patients because they do not always present challenges. She mentioned that some of her patients with ID/DD are even easier to treat than neurotypical patients. However, there will be patients that will always require some higher level of care. For instance, many patients who visit the special-needs clinic are medically complex and are not always good candidates for IV sedation or general anesthesia. Additionally, those who are candidates need to be able to cooperate with those treatments. In complex scenarios when it is difficult to treat the patient, we must be realistic with our treatment goals and outcomes and communicate them with the families who care for our patients. It is our job to educate them on the treatments with the best outcomes.

Dr. James Keenan from New York University (NYU) says students there have a five-week rotation in the school’s special-needs clinic. Additionally, students have the opportunity to pursue an honors course during their fourth year for more exposure to patients with special needs. As the general population ages, he says, there is greater potential for individuals to develop disabilities. Thus, we’ll have a growing population of individuals who need special care.

Additionally, he mentioned that a healthy team environment is crucial in managing patients with special needs. A team with similar treatment philosophies and a cohesive method of care makes all the difference. The GPR residents at NYU work with individuals who have special needs in both external facilities and nursing homes. Additionally, Stony Brook University has a post-graduate program for special care.

At Arizona School of Dentistry and Oral Health (ASDOH), third- and fourth-year dental students spend two weeks rotating through the special-needs clinic. Additionally, the AEGD residents treat patients with complex dental procedures in the special-needs population. Dr. Scott Howell, who is faculty at ASDOH, offers a new perspective on how teledentistry can help those in this population. Beyond individuals who are medically complex due to intellectual or developmental disabilities, he reminds us that many individuals with specific mental health conditions also require special care. At ASDOH, the third-year dental students, under the advisory of faculty, review medical records, clinical videos and radiographs of patients who have special needs and are geographically distant from the school. They direct them to clinics that offer specific services they need.

In addition, students see patients in juvenile detention facilities. Dr. Howell observed that often patients in those facilities can have depression or behavioral issues such as oppositional defiance disorder. This presents a different challenge because maintaining good oral health is also linked to the ability to motivate patients and their guardians to invest in their oral health. Dr. Howell emphasizes that students should have an open mind and be willing to get more education on how to treat the special-needs population. In doing so, we can offer more access to care to these patients.

All three professors highlighted the importance of joining dental associations such as the American Academy of Developmental Medicine and Dentistry or the Special Care Dental Association to broaden skills to treat patients with special needs. Through these organizations and others, dentists can help advocate for the rights and opportunities for care for these patients. Both organizations offer free membership for students, so take advantage joining while in school. Ultimately, as the future generation of dentists, it is up to us to recognize deficiencies in access to care for our future patients and to take action towards providing better care for them.

~Christine Chen, Washington ’19, District 10 trustee

Christine Chen

Christine Chen is a second year student at the University of Washington. She currently serves as ASDA's District 10 trustee. Service in the community is hugely important to her, and she loves to do dental volunteering, as well as serving in the community with her church. Outside of school, she enjoys baking delicious treats, salsa dancing the night away, and her favorite philanthropic cause is domestic violence awareness.

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