One in seven Americans is paralyzed by a fear of dentists to the extent of avoiding dental care altogether. These individuals sometimes endure years of severe pain and infections before grudgingly seeking help. An even greater number of Americans who have severe medical conditions, dementia or other disabilities are offered only dentures or tooth removal, rather than the more functional and cosmetically appealing dental solutions readily available to the general public. Still others who have experienced abuse or trauma involving the face find they re-live traumatic memories when their mouths are manipulated during dental treatment.
Why is something as valuable as a bright, healthy smile inaccessible to so many people? Practitioners in the field of special needs dentistry have devoted their careers to this question. They concentrate on a population of patients who are poorly served by traditional dentistry – seniors, people with dental phobias or medical conditions; and adults and children with disabilities. In addition to their specialized training, these dentists often offer treatment rooms that accommodate patients who use wheelchairs, acknowledging the accessibility issues that confront many of their patients when trying to access a typical dentist’s office.
Most dentists a patient with special needs encounters are able to offer only limited treatments or limited sedation; however, it is important for patients and caretakers not to settle for the minimum level of care and to investigate their options. Dentists in the field of special needs dentistry are experienced in providing treatment under a variety of sedation techniques. Options range from nitrous oxide (laughing gas, which leaves patients awake but relaxed), to mild oral sedatives such as Halcion or Valium, to intravenous sedation or full general anesthesia. Over the course of one or two visits, specialists can complete full-mouth rehabilitation – extensive dental work that might be done over several months of appointments in traditional dental practices. Patients can then return home to their family dentists for routine care.
Dr. David Blende’s San Francisco-based Blende Dental Group, one of the forerunners in special needs dentistry, has learned that few problems or medical concerns are insurmountable. Dr. Blende and his team of periodontists, endodontists, oral surgeons and anesthesiologists believe all patients are deserving of the very best dentistry; the team has performed more full-mouth rehabilitations under general anesthesia than any other practice in the nation. Last year, patients traveled from 27 states and 14 countries to receive care from the Blende Dental Group.
Mandy Robbins, a 22-year-old from New Mexico who has autism, was referred to the Blende Dental Group two years ago with teeth that were discolored, jagged, and deteriorating quickly. Predisposed to tooth decay because her adult teeth came in without a protective enamel coating, she also had an overbite that prevented her from closing her mouth properly or chewing effectively. Nevertheless, she could not tolerate braces or the other procedures dentists had recommended to preserve her teeth. Her parents grew more and more concerned as the decay accelerated and it looked as though she would soon begin losing teeth, marring her appearance and self esteem.
With general anesthesia, the Blende team performed full mouth rehabilitation while Robbins slept. Three root canals, five tooth extractions, gum surgery, and 27 crowns later, she emerged with a set of radiant, functional new teeth, that likely will last for the next 40 years. All the work - including two office visits and procedures - was completed over the course of Robbin’s five-day visit to California. She now smiles and eats with ease and calls the attention of friends and visitors to her beautiful white teeth.
James Garrett of Walnut Creek, California, had lost all hope of finding a dentist who could treat his wife, who had advanced Alzheimer’s disease and had difficulty cooperating with traditional treatment. He explains, “The Alzheimer's Association chapter in Walnut Creek gave me a list of dentists who were willing to treat people with Alzheimer's, but when I contacted them and explained the severity of her condition, no one was willing to treat her.”
Since it had been five years since his wife’s last dental appointment, Garrett worried that she might be in pain and in dire need of treatment but unable to tell him. Having pressed the issue with dentist after dentist, Garrett was finally referred to the Blende group, who were able to treat his wife with the assistance of sedation.
For those patients for whom sedation is not an option, whether due to personal or medical reasons, the focus may be on finding a dentist with an extra-caring touch. The special needs dental community in this country is small; if a special needs dentist is not available locally, another option might be a pediatric dentist. Since pediatric dentists undergo an additional two or more years of education beyond dental school, the American Academy of Pediatric Dentistry suggests they may be the clinicians of choice for children as well as adults with special needs.
As you chew, talk and laugh, consider the ways in which your life or your loved one’s life might be enriched with a healthier set of teeth. Everyone - regardless of disability or fear – is a candidate for top-notch dental treatment and that bright, healthy smile.