By Deborah Jeanne Sergeant
Few people relish a visit to the dentist. For patients with physical, intellectual or emotional disabilities, professional oral health care can become even more difficult. Only a few providers in the area offer “special needs” dentistry to ensure they receive proper care.
Paula Sepanik, dental director and clinical dentist at Baker Victory Services in Lackawanna, said that the most important aspect of her office’s care is employing staff with experience as direct care aides to help as assistants who don’t provide care but comfort.
“They’re accustomed to how to talk with special needs individuals,” Sepanik said. “A lot of it is attitudinal. You view individuals with special needs not as a burden but as part of the general population. They are individuals who deserve the best care you can give them. We do see on occasion people who are referred from private dentists who are overwhelmed.”
About one-third of Sepanik’s patients have special needs, so her office is not only accessible, but specially set up. They feature large exam rooms to allow parents or caregivers in; external bitewing X-ray equipment so they won’t have to hold media in their mouths; and freestanding exam and cleaning equipment so they can receive treatment in their own wheelchair, if that’s easier for the patients.
The hygienists receive on-the-job training to serve special needs clients. Her staff’s soft skills include patience to take more time, developing a special plan for them, discovering their triggers, and working with parents to find ways to improve the whole experience.
Sepanik earned a dental sedation certificate so she can help individuals who have uncontrollable muscle movement to safely receive treatment.
“Dental care is far more comfortable and they can tolerate care,” Sepanik said.
She’s a member of a New York state taskforce for special care dentistry, which includes training on desensitization for patients and safe and effective, medically necessary immobilization.
“You can hold the person so it’s safe for the person and stabilizing their heads,” Sepanik explained. “We use anything from specialized mouth props to additional staff to help with procedures. We can accomplish the treatment they need in a way that is effective for them.”
Some accommodations are simple. Some patients feel overwhelmed by too much stimulation, so scheduling their visits as the first of the day means they won’t have to sit in the waiting area. Others enter by the back stairs “and there’s not the opportunity to become agitated,” Sepanik said. “We have patients who come in with devices that just soothe them. They may need just that.”
She’s also used small gift cards as incentives for special care patients.
Patrick Anders, assistant professor in the UB School of Dental Medicine, also treats special needs clients. He said that most of them can receive their dental care in a traditional environment with a few accommodations; however for the 5 to 10 percent who can’t, general anesthesia is available.
Like Sepanik’s office, Anders uses strategies such as timing visits to meet patients’ needs, and scheduling longer visits.
“Also, if we don’t interrupt a person’s schedule like with a dayhab or work situation, they tend to receive treatment more willingly,” Anders said. “One thing that we have found is that people with developmental disabilities don’t do as well if they’re reclined fully. It’s a very vulnerable position. We tend to treat in an upright position.”
He acclimates patients unfamiliar with dental care by starting with the easiest procedure, such as cleaning.
By telling patients what they plan to do, showing what they plan to do and then doing it, patients know what to expect. Personnel also praise desirable behavior and ignore the rest.
“We try to tailor the approach to the reason for the behavior,” Anders said.
Some enjoy distractions like favorite DVDs, electronic games, comfort toys or conversation; others prefer no stimuli. Some autistic patients enjoy the feeling of pressure on their bodies, so using the office’s lead apron — even if not doing dental X-rays — provides a comfort measure without restraining them.
Anders’ office uses conscious sedation, medical immobilization and protective stabilization as needed.
“It’s not forceful holding,” Anders said. “It requires training, consent and a plan. Some patients do well under those circumstances; it’s more like a reminder.”
He offers on-the-the-job training for much of the special needs care his staff provides, since most dental schools don’t offer much training.
“There’s a great need and the need is growing,” Anders said. “It’s a real problem because there are many, many barriers to care and a fairly limited number of providers who will and can provide care.”