Bridging the Gap

One out of four individuals in the United States has a disability and nearly all Americans will experience some form of disability in their lifetimes.¹ Unfortunately, individuals with special needs and disabilities (SND) face greater barriers to accessing routine oral healthcare and experience poorer oral health outcomes than those without disabilities.²

This inability to access dental care stems largely from dental clinicians’ lack of training in managing these patients.³ Often, dentists refer patients with SND to specialists, which frequently leads to delayed care and the need for emergency treatment.⁴

Addressing the Issue

The Health Resources and Services Administration (HRSA), the federal agency supporting health infrastructure including health professional training programs, is working to reduce the barriers to professional oral healthcare experienced by vulnerable populations through its grant programs.

The New York University (NYU) College of Dentistry’s Department of Pediatric Dentistry received a HRSA Title VII training grant to educate oral health professionals on providing dental care to individuals with disabilities and complex medical conditions.

The Bridging the Gap Associateship Program aims to create a sustainable primary care dental workforce dedicated to improving oral healthcare for individuals with disabilities and complex health conditions through the following methods:

1. Community outreach programs
2. Didactic instruction
3. Teledentistry
4. Advocacy for vulnerable populations

In its second year, the Bridging the Gap program includes two dental hygienists and one dentist. I am fortunate to serve as one of the dental hygienists.

Improving Oral Healthcare for Those With Disabilities

While working in private practice, I often felt the need to refer patients with SND to specialists due to my lack of knowledge. I did not receive specific training on treating this populaton in dental hygiene school, which created anxiety about effectively and safely caring for those with SND. These factors led me to pursue the Bridging the Gap Associateship Program.

The program’s mission is to improve the quality of oral healthcare provided to vulnerable populations through training. Dental and dental hygiene students are offered rotations in the NYU Dentistry Oral Health Center for People with Disabilities facility. The center encompasses a sensory room, which includes dim lighting and a rest area, tailored to patients with special needs to ease anxiety and support positive behavioral management. The center offers separate treatment rooms with sound-proof doors, along with an operating room to provide general and oral sedation when necessary.

I am honored to work with experienced dentists at this center, learning about behavioral management with patients with SND. The Bridging the Gap program has helped me gain confidence in providing oral prophylaxes to complex patients; even more rewarding is the consistent exposure to multiple rare medical conditions. Much of the experience with these medical anomalies comes from attending craniofacial seminars with first- and second-year pediatric dental residents and in clinic.

The Bridging the Gap grant has also afforded me the opportunity to lead dental students, dental hygiene students, and nurse practitioner students on Head Start programs, which assist families with incomes below the federal poverty level by providing housing, education, and employment, along with meals and health screenings.

On a weekly basis, I witness first-hand the transformation of what was an ordinary classroom into a dental clinic examination room. Using such techniques as “tell-show-do” and knee-to-knee examinations, the students can see as many as 50 children in one morning from multiple New York boroughs.

Some of the children reside in homeless shelters and, for most, this is their first dental experience. With only gauze, mouth mirror,  flashlight, and personal protective equipment (PPE), the students and I provide children ranging from age 6 months to 5 years with oral hygiene instructions, exams, fluoride treatments, toothbrushes, and a healthy dose of stickers.

When children present with rampant decay, we provide a guideline to parents and referrals for additional treatment at the NYU College of Dentistry Department of Pediatric Dentistry.

Bringing Smiles

The associateship also integrates another community outreach comprehensive care program called Bringing Smiles. We visit public schools and schools devoted to those with special needs to provide comprehensive dental treatment on a weekly basis.

The treatment consists of, but is not limited to exams, prophylaxes, sealants, extractions, and restorative therapy. We, along with two other fellow post-graduate residents, dental students, or dental hygiene students, bring the equipment to the schools, including a handheld Xray machine, portable dental unit, instrument cassettes, and various PPE.

We transform a public-school facility into a dental clinic by converting a classroom, or in our case, a kitchen, into a dental treatment room. Our group delivers billable treatment to approximately 5 children to 10 children while also building a relationship similar to those experienced in private practice.

In addition to the community outreach and rotations in the Oral Health Center for People with Disabilities, my fellow Bridging the Gap associates and I are working on a teledentistry pilot program. Using intraoral images, we hope to create a baseline framework that will enable synchronous diagnosis through imaging.

End Result

As I am halfway through my training, the Bridging the Gap Associateship Program can be summed up by the “4 Ps:” prevention, patience, perseverance, and passion. As a dental hygienist, I recognize that prevention is the foundation for lifelong oral health and it can reduce the risk for costly complications in the SND population.

I have learned so much already, mainly the importance of patience and empathy. Treating patients with SND may require multiple visits. The first appointment might involve gaining familiarity with the instruments and the dental chair. Clinicians must persevere to ensure these patients receive the oral healthcare they need. My participation has sparked a passion to promote oral health for these populations by reducing barriers to care.

I am grateful to learn from my fellow dentist and dental hygienist colleagues and expand my knowledge in providing oral healthcare to populations with SND. In the latter half of my associateship, I hope to build on my research, knowledge, and training with the goal to empower others within the dental field.

References

1. Okoro CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of disabilities and health care access by disability status and type among adults—United States, 2016. MWR Morb Mortal Wkly Rep. 2018;67:882–887.
2. Lopez Silva CP, Singh A, Calache H, et al. Association between disability status and dental attendance in Australia—a population-based study. Community Dent Oral Epidemiol. 2021;49:33–39.
3. Ting Lim MAW, Liberali SAC, Calache H, et al. Mentoring of oral health professionals is crucial to improving access to care for people with special needs. PLoS ONE. 2022;17:1–17.
4. American Academy of Pediatric Dentistry. Management of Dental Patients With Special Health Care Needs. Available at: cchealth.org/dental/pdf/AAPD-Best-Practices-Patients-with-Special-Health-Care-Needs.pdf. Accessed April 11, 2023.

From Dimensions of Dental Hygiene. May 2023; 21(5):14-15.

photo credit: Rose Amable, DDS