SmileCon 2021: Dentistry for Patients With Special Needs
Getting patients to, from, and through treatment in a conventional practice setting is often physically and mentally challenging.
October 13, 2021 – In an interview recorded at SmileCon 2021, which took place in Las Vegas, Nevada from October 11 to 13, Dr. Brooke Fukuoka, owner of a portable/hospital dental practice described the impracticalities of provision of dental care to medically complex patients and those with special needs in a conventional dental practice. Getting patients to, from, and through treatment in a conventional practice setting is often physically and mentally challenging and exhausting for patient, caregiver, and dental staff alike, and can cause patients to dread future dental visits.
Dr. Fukuoka has outfitted a mobile dental hospital/practice van so she can take dental care to the place where the patient resides, be it the family home, group home, or assisted-living facility. Using asynchronous teledentistry, the dental hygienist uses an intraoral camera to videotape the patient’s oral cavity, pausing after each quadrant. The dental hygienist transmits the videotape and other clinical data back to Dr. Fukuoka, who plans treatment and then takes the van on location, usually for 2 to 5 days at a time, to treat patients in that area. A mobile dental chair is taken into the home/facility. Notably, she finds that patients with cognitive disorders and dementia are much more receptive to dental care when it is being provided at their place of residence, among people and things they know, and in which they feel a sense of control. When a patient “drives the bus,” the bus runs better. When the patient can see the hole in his tooth on the video, he is more likely to want it fixed. In residential settings, equipment such as Hoyer lifts are available to move the patient, and, certified nursing assistants (CNAs) are available to liaise between the dentist and the facility.
Dr. Fukuoka is currently building a brick-and-mortar dental practice for treating patients with special needs, sponsored by Delta Dental of Idaho and the local Rotary Club. It is a sensory-integrated office, with green grass projected on the floor and blue skies on the walls. There are a series of fun education stations, such as the toothpaste tasting station and the toothbrush station. If patients can choose the flavor of toothpaste and the toothbrush style they like, they are much more likely to engage in oral hygiene activities and take more responsibility for oral self-care. The physical space of this practice is integral to its success; the “prize” is the dental visit itself.
Turning to a discussion about logistics, Dr. Fukuoka indicated that, as the practice objective is to treat patients with special needs, who are classified as a disadvantaged group, it qualifies for designation as a Federal Qualified Health Center (FQHC). Grants for loan repayment are available from the Health Resources and Services Administration (HRSA). Local dental community support in the form of equipment donations has been invaluable. While there have been some struggles with Medicaid reimbursement, use of the Delta Dental Health through Oral Wellness (HOW) program risk-assessment tool has improved reimbursements. The ADA, Special Care Dentistry Association (SCDA), and American Association for Developmental Medicine and Dentistry (AADMD) all provide tremendous support and mentorship. Dr. Fukuoka strongly encourages dentists to consider the practice of special care dentistry; there is tremendous need among this population, and the work is extremely fulfilling.
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