For Patients With Special Needs, Any Dentist Is Hard to Find

For someone who uses a wheelchair, a visit to the dentist’s office means first the hurdle of getting into the dental chair. For someone with autism, the lights and sounds of a routine dental exam may be unbearable. In San Francisco, a person requiring special-needs anesthesia dentistry faces an appointment wait time of three to five years.

Across California, few dental offices are equipped to accommodate patients with special needs, leaving many patients with no option but to allow their dental diseases to go untreated, sometimes leading to serious health complications.

The UCSF School of Dentistry is helping to lead an initiative to build the state’s capacity to provide special needs dental care to every Californian who needs it. As a first step, the school hosted a Special Needs Dentistry Summit on Feb. 12, bringing together dentists, patients, educators and policymakers to raise awareness of the problem and formulate next steps.

“The reason why all of you are here today is because you can help us break through those barriers to care,” said Michael Reddy, DMD, DMSc, dean of the School of Dentistry in his opening remarks. “Each one of you brings expertise, insight and ideas that will lead us to solutions. Because everybody deserves access to care.”

The demand for special needs dentistry is huge, said Ray Stewart, DMD, MS, chair of pediatric dentistry at UC San Francisco, but has been difficult to quantify. According to the U.S. Census Bureau, some 37.9 million Americans have a disability, with about two-thirds of these having a severe disability. A broad range of conditions, from asthma to skeletal deformities to Down syndrome, may require special needs dentistry.

Pediatric dentists generally have more experience with special needs patients, said Stewart. As a pediatric dentist, he sees two or three patients every week who are in the their 20s but have nowhere else to turn.

“We could essentially fill our schedules at UCSF Dental Center with nothing but special needs patients,” he said.

“Once they age out and need adult treatments – root canals, gum disease, removal of wisdom teeth – they find it almost impossible to find dentists in the community who have the training and expertise to accommodate special needs.”

Frankie LaRocca has grappled for years to get dental care for her daughter, Maggie, who has Down syndrome, heart problems and must use a wheelchair. “For five years we tried to get care for Maggie” and repeatedly were told by providers that “we don’t do those special procedures,” said LaRocca. Her daughter’s cardiac condition accelerates calculus build up on her teeth, necessitating more frequent dental procedures. It’s not easy for Maggie, who is nonverbal, to understand. “When you can’t explain what’s going on” during a procedure “and you can’t sooth them, it’s heartbreaking,” said LaRocca.

Besides lack of facilities and training, insurance further narrows the options for special needs patients in California. Most are covered by Denti-Cal, California’s Medicaid dental program, but virtually no private dental office accepts public insurance. San Francisco, for instance, has only 50 private dentists who accept Denti-Cal and 48 of them are general practice dentists. Only one is a pediatric dentist with a special-needs-focused dental practice. At UCSF, 46 percent of dental patients have Denti-Cal as their insurance.

Only two facilities in the city – UCSF and California Pacific Medical Center – can accommodate patients who need procedures to be done under general anesthesia. At UCSF, many of these patients are treated by the Department of Oral and Maxillofacial Surgery, headed by Brian Bast, MD, DMD.

A few schools across the country, including New York University and the University of Pennsylvania have developed programs and centers to address special needs dentistry in their communities, and UCSF aims to do the same for Northern California. Building or modifying clinical facilities to accommodate special needs patients, training dentists and staff to better care for this population, and improving insurance reimbursements to attract more providers were among the critical steps identified by attendees of the Feb. 12 summit.

Assemblymember David Chiu, who also gave opening remarks at the summit, has introduced legislation to allow California’s public dental schools to draw on federal funds to help expand oral health services for the special needs population.

“Special needs dentistry is a problem that needs the attention of the community, the state, and the nation,” said Stewart. “It’s a problem that’s been begging for a solution for as long as I can remember.”