Enabled Life

Understanding Your Dental Options

Some Clinics Offer Expertise, Safety, Piece of Mind

• By Elisha Bury
• Mar 01, 2012

Putting off going to the dentist could be considered a national pastime. For most people, the reasons are simple: finding the time to go, dreading that little word “cavity” and perhaps a deep-seated fear of drills.

Yet people with mobility disabilities have a much longer list of worries and one major reason for putting off that appointment: access.

“We have many people who come to us who have never been able to sit in a dental chair. I realized the reason that most of our patients previously hadn't been to a dentist was because their special needs couldn't be accommodated by the dental offices and dentists. Some couldn't even fit their wheelchair through the door or into the dental operatories,” says Dr. Leslie Schiff, of CP Rochester Dental Clinic in Rochester, N.Y.

Access Denied

Beyond access to the clinic, treatment for oral health presents a number of challenges for those with mobility disabilities.

For example, someone with cerebral palsy might have a hard time finding a dentist willing to perform the necessary dental services.

“We do see a lot of people with cerebral palsy who have involuntary movements,” says Schiff. “As you might suspect, it can be a bit tricky doing dentistry on somebody with involuntary movements when you’re using these high-speed rotary instruments and sharp instruments. We have to just be able to work with them. Most dentists are scared to do that. They don't have the training or the experience to do that.”

And fear is one of the reasons access can be such a problem, explains Schiff. “There’s a fear factor for dentists in treating the population.”

Being a Medicaid patient presents additional difficulties. Schiff says many private offices do not accept Medicaid payments, which narrows the choices for many people with disabilities.

And while children with developmental disabilities might not have trouble finding a pediatric dentist to serve them, Schiff says “once they age out of pediatric practice, there aren’t many options. Once they get too big for somebody to lift, then it can become difficult.”

A New Kind of Clinic

A handful of dental clinics across the nation have sprouted to address the particular challenges associated with mobility conditions.

CP Rochester Dental Clinic, one such clinic that has been in operation for four years this March, has designed a space with extra-large operatories, a ceiling track lift system for transferring patients and a specially articulated dental chair for people with rigidity of limbs who can’t sit in a standard dental chair.

A new law in Minnesota is encouraging others to do the same. The Safe Patient Handling statute requires dental clinics to develop a plan to assist patients who need help transferring into a dental chair for treatment and getting into and out of dental offices. Dr. Steve Shuman, associate professor and director of the University of Minnesota School of Dentistry's Oral Health Services for Older Adults Program in Minneapolis, says many dental clinics "are addressing these issues via clinic designs with extra-large dental treatment rooms to accommodate large wheelchairs or scooters, airlift dental chairs that float out of the way to enable dental treatment in a wheelchair as well as the availability of mechanical lift equipment if needed."

If that sounds like a science fiction movie compared to your local dentist's office, you're not far off. The fact remains that many dentists are ill-equipped to handle the needs of someone with a mobility condition.

In fact, the inspiration behind the launch of the Minneapolis-based University of Minnesota Physicians Dental Clinic “was the lack of general dentists who are adequately trained to provide proper care to medically and dentally comprised patients in the area," says the clinic's director Dr. Brian Singletary.

Clinics such as PROVAIL Johnny Johnson Memorial Dental Clinic in Seattle, which has been serving the Northwest since 1962, specialize in working with different mobility conditions. At PROVAIL, the dentists, who are all volunteers, specialize in severe disabilities, says Mike Sink, director of development.

"Many of the people we serve utilize power wheelchairs, have limited mobility and need daily assistance with oral care from others. They often come to the clinic with higher levels of dental care needs," he says.

The University of Minnesota Physicians Dental Clinic recognizes that many neuromuscular disorders including cerebral palsy, multiple sclerosis, Parkinson's disease or dyskinesia make it difficult for patients to control movements, Shuman says. Those unexpected movements could interfere with delicate dental procedures.

Staff members learn techniques that can help, including mouth props and gentle cradling of the head.

Schiff says CP Rochester Dental Clinic can also provide dental treatment to individuals under oral sedation, while monitoring vital signs, which sometimes helps patients to relax and lessen involuntary movements.

"Experienced dental clinicians also learn how to 'go with the flow' for patients who may move occasionally during treatment," Shuman says.

Dentist Search

What do you do if you're not near these specialized clinics?

"The best advice I would be able to give a patient would be to contact a local dentist’s office and ask if any of the dentists have completed an accredited hospital-based general practice residency program," offers Dr. Singletary.

Dr. Singletary says patients should be ready to provide the name and telephone number of their current medical doctor and previous dentist.

"Currently, there is no known registry for locating dentists that have completed such programs or facilities that may be able to accommodate patients with mobility disabilities by area," he says.That leaves a lot of the footwork to the patient.

Fortunately Dr. Shuman has some tips:

• Alert the dental office to any special mobility disabilities as soon as possible, preferably when scheduling the first appointment.
• Let the dental team know if someone will accompany you to the appointment and whether that person will be able to offer any assistance or advice.
• Mention what dental services might be needed or whether a specific dental problem needs to be addressed.

"All of this information gives the dental team the opportunity to plan accordingly for the appointment by allowing adequate time and ensuring that the appropriate staff, facilities and equipment are available." Dr. Shuman says. "It is also important to think about issues such as taking necessary medications, brushing and flossing the teeth, and also toileting before the appointment to minimize possible disruptions during treatment."

If you're having trouble finding a dental provider comfortable with providing care to someone with a mobility disability, Dr. Shuman recommends contacting your local dental society, dental education programs or local hospitals to find out which dental offices or clinics are best suited for your particular needs.

Improved Smile

At CP Rochester Dental Clinic, patients get a little something extra: education.

Schiff says she and her staff make sure patients and their caregivers learn how to properly care for teeth on a daily basis. She explains that it’s not just the basics of brushing and flossing that the clinic teaches but how to do those things more easily with a disability.

“If there are wraps for a toothbrush handle so that they can hold it more easily, or if they can use a flosser rather than trying to maneuver string floss, that’s a huge thing,” says Schiff.

Beyond education, CP Rochester Dental Clinic provides what most people without a mobility disability take for granted.

“I try to treat the patients like I would want to be treated, just like I am treated when I go to the dentist. That's an important part of the care at our clinic,” says Schiff.