Dental Project Meets Patients’ Special Needs

Barbara Drake knows the important role oral health plays in a person’s overall health. That’s why her son Louis’ challenges in getting adequate dental care troubled her so deeply.

Few private dental practitioners will treat autistic patients and accept Medicaid, so she had to drive Louis from their Charleston home to a provider two hours away, in Lexington, S.C. She says he received little meaningful care there beyond the pulling of his wisdom teeth, a procedure for which he was put to sleep. She says the staff simply couldn’t overcome the 25-year-old’s antipathy toward having dental instruments placed in his mouth.

She and Louis have had a much different experience at the Special Health Care Needs Clinic run by the Medical University of South Carolina’s James B. Edwards College of Dental Medicine. Here, Louis gets regular treatment by dentists and dental students trained to understand the needs and preferences of special-needs patients. Barbara says the dentists and their students took time to listen to her insights about Louis and worked to gain Louis’ trust. Now he allows them to count his teeth, take X‑rays, and perform other vital services when he visits once every six months or so.

“It’s been a true blessing to go to MUSC so close to home,” Barbara says. ​“They really listen. They adapt to his needs. They just really seem to know how to deal with him. It’s a lot less nerve-wracking for me.”

A two-pronged solution

Far too many other South Carolina families face similar struggles. That’s why MUSC has partnered with The Duke Endowment and Family Connections South Carolina to establish the Special Health Care Needs Clinic at MUSC and Project SANDs (Special Adult Network of Dentists).

Project SANDs aims to increase access to dental care for all patients with special needs in South Carolina. It treats patients at MUSC’s clinic, but also identifies oral health care providers for them closer to home. The patients receive concierge care in locating a provider and follow-up with patient navigator services to ensure quality care was provided.

MUSC’s clinic wasn’t near Kiran Math’s home in Greenville, S.C., but Project SANDs linked him with specially trained dentists in nearby Anderson, S.C., who could help his two teenagers with special needs. He said that since the new practice doesn’t need to put his son, Yash, and daughter, Janhavi, to sleep, he also saves money on the sedation fees other dentists charged.

“They’re so well-trained they can handle both of our kids,” he said. ​“I just thank God for sending these good people to me.”

The Duke Endowment is supporting the dental college’s efforts because research shows oral health is a critical part of overall health. Dental disease has been connected to diabetes, heart and lung diseases, stroke, and low birth weight. With adequate preventive care and education, dental disease is 100 percent preventable. But many people in the Carolinas, including those with Medicaid coverage, struggle to access dental care.

Meeting the need

The clinic was established in January 2015, opening only one day a week. It saw only a dozen patients that first year. Today, there are over 400 patients with special health care needs being treated at this clinic, and dentists see 60 or more patients per month. The number rises by six to eight patients monthly.

To increase the number of dentists with special needs experience, the dental school’s students and residents observe, assist, and provide direct services in the clinic. By July 2018, 300 undergraduate students and 31 residents had hands-on clinical experience treating special needs patients in an outpatient setting. These patients include adolescents and adults with autism, intellectual or other development delays, traumatic brain injuries, physical disabilities resulting from stroke, and seniors with dementia/Alzheimer’s.

Part of Project SANDs included the creation of a directory that is used to connect patients with providers who will treat clients with special health care needs. Dental practitioners throughout the state were surveyed and this information is presented as a web-based directory of providers. (www​.SAND​Sc​.org) This directory allows anyone to search for a provider based upon location, dental specialty, type and severity of special need served, languages spoken, sedation techniques, and whether or not the practice accepts Medicaid.

Project SANDs personnel provide patient care coordination, continuing education for dental providers throughout the state, and support for providers through telehealth consults. Project SANDs patients receive follow-up care on missed appointments and those seen in our university setting are transferred to community dentists closer to home when care is stable.

Much remains to be done when it comes to meeting the dental care needs of our special needs population. But each day, Project SANDs is increasing access for patients like Louis.

“It’s been a totally good experience,” Barbara Drake says. ​“I can’t tell you how well the dentists and students understand the autism spectrum. Even before I walk in, they seem to know what to do. I’m just so grateful that they’re there.”