One of our core beliefs as dentists is that everyone deserves the chance to smile. For people with dental anxiety, autism, developmental disabilities, or other needs, accessing oral health care can be difficult, expensive, and sometimes impossible.
Dentists want to be able to expand access to care for all patients, which means pushing ourselves to find ways to treat vulnerable populations. This isn’t a small number of patients, either. One study found that approximately 36% of Americans experience fear of dental treatment.1 For youth with autism spectrum disorder, dental anxiety could affect more than twice that number at 68%.2
While it can be difficult to provide care for these patients, we need to learn to flex our styles as providers, lean into patient management, and expand compassionate dental care access for those who really need it. I’ve worked with many patients with specific needs, and here are some key lessons I’ve learned.
Don’t punt care down the line
People with specific needs have extremely limited dental care access points. Too often, patients like these, especially those with autism, have to go to a university for general anesthesia for any dental care needs. The waiting list for these dental appointments is incredibly long, the number of dentists who provide this kind of care is very small, and the number of locations where these procedures are offered is even smaller. Furthermore, not all types of treatments can be administered under general anesthesia. The result is a massive group with a tremendous number of care needs with very limited access points.
When confronted with a patient with specific needs, it’s very easy to just refer them to a university for care. However, from my perspective on my oath as a provider, that’s not fulfilling my responsibility. Many families who need that level of care either can’t afford it, can’t travel to the care location, or can’t access it for any number of reasons.
If every provider says no to patients with specific needs, then we as a profession are telling these people, “No, we won’t treat you.” We can’t let this keep happening; all it takes to make a huge difference is some courage, a bit of research, and some patience.
Be open and willing to change your care style
I recently worked with a two-year-old patient, Weston Emmick, with hypohidrotic ectodermal dysplasia (HED). His tooth abnormalities were making it difficult for him to speak and eat. Normally, he would have visited a pediatric dentist, but he needed removable services that are outside the purview of pediatric dentists. Unfortunately, most general dentists won’t work with patients that young because they’re precooperative.
This left my HED patient in a dental care no-man’s land, but I was determined to provide him the care he needed. I’d never made a denture for a two-year-old, but I wasn’t going to let him go to preschool without a smile. I did some research, reached out to colleagues, and set realistic expectations with the patient’s parents. My team and I managed to create usable dentures for this child, and there was a fun side story: he earned a place in the Guinness World Records for the youngest patient with full dentures.3
I could have simply referred this patient to a prosthodontist or punted his care down the line, but I did not want to do that. I understand that many dentists hesitate to treat patients with specific needs, whether due to finances, lack of time, or insurance concerns. I get it. Plus, we’re not always going to get it right. However, if we’re willing to flex our care style and bridge the care gap for these families, we can see massive shifts in the overall health of some of our most vulnerable populations.
Start by building trust and compassion
If you’re willing to venture into treating patients with specific needs, you’ll need to build a connection with the patient and their guardian. Set the correct expectations and spend time with the patient to find what motivates them so you can build trust. Getting an early win—like successfully using a Cavitron—can be a game changer and tell you, your patient, and the guardian that dental care in a general dentistry setting is possible.
When I work with a patient with specific needs, I try to connect with them in a way that allows them to cooperate in short bursts of time. There’s a lot of physical touch, holding hands, close eye contact, using their name, providing a tangible reward, and explaining the sensory input. They might require stronger numbing agents and more frequent breaks.
Most important, don’t be afraid to try and fail. Some of my patients cooperated in many ways, but they just couldn’t get through the procedure. Even though that might have been a clinical failure, it was a psychosocial win. By trying to help these patients, I showed their families that I cared about their child and valued them as I would any other patient.
Be an access point
Many dentists hesitate to treat patients with specific needs due to a lack of information. As dentists, we absolutely have the ability to treat these patients, we just need to take that first step. There are many different ways to work toward providing more accessible care; for example, I volunteer with a program called Floss and Gloss, which provides care to students in Kentucky. For only a meager time commitment each week, I’ve been able to donate more than $6,000 of asynchronous chart review for more than 350 children.
Dentists want to give everybody a smile they love. This means saying ”yes" to all patients, even or especially to those with specific needs.
PHOTO: The Emmick family, left: Weston's mother holding him, his father behind them. Center, lab technician Julie Bostwick, and Dr. Deitz, right, holding her daughter. Dr. Dietz and Bostwick used an impression of Dr. Deitz's daughter's teeth to create Weston's dentures.
References
1. Dentophobia (fear of dentists): Causes, symptoms, and treatments. Cleveland Clinic. March 22, 2022. Accessed June 21, 2024. https://my.clevelandclinic.org/health/diseases/22594-dentophobia-fear-of-dentists
2. Park Y, Guzick AG, Schneider SC, et al. Dental anxiety in children with autism spectrum disorder: Understanding frequency and associated variables. Front Psychiatry. 2022;13(4): 838557. doi:10.3389/fpsyt.2022.838557
3. Dr. Whitney Deitz brings smile to youngest patient in the world with full set of dentures. Aspen Dental. Accessed June 21, 2024. https://careers.aspendental.com/us/en/blogarticle/dr-whitney-deitz-brings-smile-to-youngest-patient-in-the-world-with-full-set-of-dentures
