New St. Louis program provides dental care for people with severe disabilities


By Michele Munz

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ST. LOUIS (St. Louis Post-Dispatch) — Cassandra Holland, 42, of St. Louis, has spastic quadriplegic cerebral palsy. She uses a wheelchair because her muscles are stiff and stiff. She is prone to seizures. She can’t speak.

For years, her mother and caretaker, Sallye Holland, 69, struggled to find a dentist for Cassandra. Each time they stopped Sallye when she told them that Cassandra had special needs, that they should take extra care with her.

“They would tell me they’re not trained or equipped or don’t have everything they need to care for her,” Sallye said. “They would just refer us to someone else or just say they couldn’t do it.”

Sallye ultimately failed to get her daughter to open her mouth so she could brush her teeth. She could see that some of Cassandra’s teeth were chipped and turning black.

Sometimes an infection caused the side of Cassandra’s face to swell. Sallye should take her to the emergency room, where she was prescribed antibiotics and told to follow up with a dentist.

“Nobody seemed to be able to help me,” she said. “I got to the point where I called the same people over and over again.”

She decided to try calling the human resources department at Barnes-Jewish Hospital. She didn’t know the department was for Barnes employees only. The name sounded like they helped people in difficult situations.

The woman who answered heard Sallye’s story and put her on hold. Sallye waited over 10 minutes. The woman finally got back on the phone – with a date for Cassandra.

“Oh my God, I can’t tell you what that meant to me. I get so emotional every time I tell this story,” Sallye said, choking on tears, “because that was, like, the difference. That was all. That’s when things started to change for us.

A year ago, Cassandra was among the first patients to receive care under a program created by the hospital, AT Still University School of Dentistry and Affinia Healthcare to serve seriously ill adults. disabled persons whose only means of receiving dental care is under general anesthesia in a hospital.

Sixteen people have now received care through the program. Affinia supplies the patients, the university supplies the dentists, and Barnes supplies the support staff and the operating room for the procedures on the first and third Thursdays of the month.

“This is a group in the community that has been really marginalized and neglected for a long time because people didn’t know how to do it, how to help them,” said Dr. Jackie Martin, vice president of perioperative services. at Barnes.

“It’s really a testament to the coming together of key players who want to solve a problem and have a shared mission and vision for how to get there.”

Unique collaboration brings dental aid to people with disabilities, affinia, AT Still University, program, medical Christian Gooden, Post-Dispatch

Sallye Holland finishes brushing her daughter Cassandra’s teeth Friday, Sept. 30, 2022 at her home in St. Louis before taking her to adult daycare.

The partnership between Kirksville-based AT Still University and Affinia Healthcare, which cares for Medicaid patients, began in 2015 when they opened the 93-chair St. Louis Dental Center, just south of the center -city of St. Louis.

The university provided professors and third- and fourth-year dental students to provide dental care at the center for Affinia patients and others in need.

Most dentists won’t accept Medicaid patients, explained Dr. Dwight McLeod, dean of the university’s Missouri School of Dentistry and Oral Health. The hope was not only to provide care to the marginalized, but also to inspire more students to work as dentists in underserved areas.

The center quickly began to see a need for care in patients with disabilities, McLeod said. Group home leaders wanted to bring their residents.

For some of these patients, the experience is too confusing or frightening, and they refuse to sit up or open their mouths. They can bite instruments. Other physical impairments make it difficult to sit still or swallow.

To receive treatment, patients must be “put to sleep” under general anesthesia, which the dental center was not equipped to provide.

The only program the center could refer them to was at University Health Lakewood Medical Center, nearly a four-hour drive from Kansas City.

McLeod didn’t want to keep turning away patients.

“We want the St. Louis Dental Center to be home to everyone who needs treatment under our care,” he said.

So he approached the leaders of Barnes-Jewish Hospital with the big request.

It took more than three years to set up the program. The COVID-19 pandemic stalled progress, but they remained committed, Martin said.

Barnes purchased the necessary dental equipment. The hospital, along with the University of Washington School of Medicine, also provides the nurses, anesthesiologist, radiologist, laboratory and pharmacy supplies and services.

AT Still’s dental faculty has established hospital privileges through collaboration with the hospital’s Ear, Nose, and Throat department.

What convinced everyone at the hospital, Martin said, was the idea of ​​patients being neglected for years, with enormous need and no place to go.

“Our position, quite frankly, was: if not us, then who?” said Martin. “Who else is going to be able to provide this care?”

McLeod said there are many reasons why most dentists don’t provide care for people with disabilities, especially adults.

Patients may be difficult to manage due to their weight or large wheelchairs. They can be very loud in the waiting room or scream, scaring others.

Sallye Holland searched for years to find dental care for her adult daughter, Cassandra, who has cerebral palsy. Thanks to a St. Louis-based collaboration involving AT Still University-Missouri School of Dentistry and Oral Health, Affinia Healthcare, Barnes-Jewish Hospital, and Washington University School of Medicine, Cassandra finally received the comprehensive dental care she needed. – in an operating room – carried out by a team of caregivers.

Video by Huy Mach / Washington University School of Medicine in St. Louis

It’s also more expensive — dentists being able to see four or five patients in the time it takes to care for one disabled patient.

“The majority of dentists are not competent, nor do they feel comfortable, nor is it a good return on investment or economic advantage for them to treat people with intellectual disabilities or of development,” McLeod said.

For dental offices able to provide sedation, staff often lack the expertise to do so on high-risk patients, he said. Adults with intellectual or developmental disabilities also tend to have other comorbidities such as hypertension, diabetes, or heart or neurological disease.

“It’s best if these people are managed in a hospital where they have the full extent of a medical team,” McLeod said.

The medical team often does not know the extent of the care required until the patient is asleep and able to look into the mouth, he added. Sometimes the job can take three or four hours, which is why only a few patients are scheduled at a time.

Nearly 80 patients are waiting to be seen at the hospital, McLeod said, and the list is growing week by week. The partners hope to add more days to the schedule and also create dental student rotations.

“I want all of our graduates to feel very comfortable treating these patients, and the only way to do that is to provide first-hand experience while they’re in dental school,” he said. -he declares.

Sallye said her daughter had to have several teeth pulled and a dozen cavities filled. Cassandra was sedated for 3.5 hours, she said.

Unique collaboration brings dental aid to people with disabilities, affinia, AT Still University, program, medical Christian Gooden, Post-Dispatch

Sallye Holland finishes brushing her daughter Cassandra’s teeth Friday, Sept. 30, 2022 at her home in St. Louis before taking her to adult daycare.

When told Cassandra was lucky to have her as a mother, Sallye said she was the lucky one.

“I’m happy to have it because it opened my heart and my eyes to things that I probably would have been blind to if I hadn’t had to deal with certain things,” she said. said, “and that’s good because then I can help other people to open their eyes and their hearts to things that we sometimes take for granted and overlook.

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