Providing dental care for patients with disabilities

Dennis Fitzpatrick had 17 cavities by the time he arrived at the Rutgers School of Dental Medicine's special care center seven years ago. Fitzpatrick, 27, who suffers from cerebral palsy, had regular checkups throughout childhood, but his dental decay had progressed so far, four of his teeth had to be removed.

Because of his disability, other dentists were nervous about treating Fitzpatrick. They couldn't accommodate his wheelchair, so he was placed in a dental chair, which failed to hold him securely. His difficulty communicating and the sounds he made during episodes of reflux prompted dentists to wonder if he was choking.

"They were terrified of him,'' remembers Dennis's father, Tom Fitzpatrick. "They would clean his teeth but they wouldn't even drill.''

For disabled patients, dental care is often scant or nonexistent, and the experience of visiting a dentist can be filled with panic and confusion. But at the newly renovated Rutgers clinic – named the Delta Dental of New Jersey Special Care Center – staff are trained to work with a variety of special needs patients, including those with autism, Alzheimer's and psychiatric disorders ranging from schizophrenia to severe dental phobia. Geriatric patients, particularly those in nursing homes, are another population that receives treatment at the center.

The program, which treats more than 4,000 patients annually, is one of few in the region, drawing patients from Delaware, Pennsylvania and New York.

"The special care center is a unique place, providing dental care to patients whose families often face great challenges in accessing care,'' says Christopher Hughes, chair of the Department of Pediatric Dentistry.

The population of special needs dental patients is increasing, but there's a severe shortage of treatment facilities. Disabled dental patients take more time and expertise to treat and offices must be outfitted to accommodate them – all of which is costly.

Hughes hopes that by training students at Rutgers School of Dental Medicine – who are all required to spend time working in the center– they will be better able to treat the growing influx of special needs patients when they graduate.

The dental school's special care center, which reopened in a new and expanded space on the dental school's first floor in February, includes facilities for patients who are wheelchair bound or must be transported via stretcher. Some operatory spaces are private, which is especially important for patients who are troubled by noise or too much stimulus. Founded 20 years ago by two private practitioners, Justin Stone and Robert Kroll, the clinic moved to the dental school when the two retired in 2001 and treats mostly Medicaid patients.

After years of lapsed or inadequate dental care, some have suffered serious infections that spread throughout their bodies. "It's not just about fixing a tooth,'' says Evan Spivack, a professor of pediatric dentistry who has worked at the center for more than a decade. "This can be lifesaving.''

Regular checkups are especially important for patients who have trouble communicating. When their needs go unmet, and they aren't able to let caregivers know the source of their pain, some resort to self-injurious behaviors. Spivack recalls one man who chewed off part of his tongue.

For others, dental problems are part of their condition or disability. Patients with Down syndrome, for instance, are at high risk for periodontal disease, which can cause painful infections and early loss of teeth. Down syndrome patients also have anatomical differences including larger tongues, smaller teeth and narrow upper jaws, which can make it more difficult for dentists to work on them.

Judith Brown, whose two sisters have Down syndrome, discovered the clinic 15 years ago after failing to get proper care for them at regular clinics. At RSDM, staff have helped prevent complications from gum disease. But like other patients, they're especially grateful for the staff's warmth and sensitivity.

Her sisters, Alice, 55, and Elizabeth, 49, actually look forward to visiting the dentist, Brown says. "Some people aren't that comfortable with people who are different,'' says Brown. "They're not like that there. My sisters refer to the staff as 'my friends'.''