Special needs dentistry is often life-saving care

By Kim Elmore, Corporate Communications Manager at Delta Dental of New Jersey

More than seven years ago, Delta Dental of New Jersey awarded grant funds to the Rutgers School of Dental Medicine (formerly known as UMDNJ) to renovate and build the Delta Dental of New Jersey Special Care Treatment Center. This Center provides vital dental services to those with developmental disabilities, ranging from autism to traumatic brain injury.

We recently spoke with Dr. Evan Spivack, Program Director of the Special Needs Center at the Rutgers School of Dental Medicine, to learn more about the Delta Dental of New Jersey Special Care Treatment Center and the often life-saving services it provides to a population who requires unique care. 

Q: Can you explain what the Delta Dental Special Care Treatment Center (SCTC) is, who it treats, and the services provided?

Dr. Spivack: The Center is the clinical facility for the care and outpatient treatment of patients of the Rutgers School of Dental Medicine with developmental and acquired disabilities. The SCTC has been in existence at the dental school since 1994, and the renovations to the renamed Delta Dental Center allowed reopening in 2014.

We treat patients with all disabilities, including autistic spectrum disorder, Down Syndrome, cerebral palsy, intellectual disabilities, dementia, psychiatric disorders, traumatic brain injuries and numerous physical disabilities. The care provided is comprehensive, including examinations, periodontal care, tooth restorations, prosthodontic tooth replacement, extractions, endodontic treatment and a broad variety of general dental services. We utilize the dental school specialty programs for services outside of the scope of general dentistry (implants, orthodontics, complex procedures, etc.).

Q: How does the Special Care Treatment Center address the healthcare issues and barriers to care that those with special needs face?

Dr. Spivack: Our patients are cared for in as much of a "private practice" mentality as we can arrange, with an emphasis on caring for the individual, both comprehensively and wholistically (in addressing their needs).

For those patients unable to tolerate care in the outpatient setting, we provide care in the same-day surgery operating room setting through University Hospital. We utilize large, chair-less operatories for those patients who are unable to transfer from wheelchairs or stretchers for care and meet ADA recommendations for facilities to allow easier and more comfortable care for our patients. Our doctors maintain close contact with physicians and other healthcare workers in assuring that our patients are treated safely.

Q: Why is the Special Care Treatment Center so vital to the communities it serves?

Dr. Spivack: Dentistry for persons with disabilities is consistently reported to be among the most unmet needs of this population. The care provided does not just account for esthetics, which is important in its own right, but addresses pain and infection for patients who often cannot access care and who often are nonverbal or of limited verbal ability and cannot even express their own needs. Dental care for these populations is often literally a life or death matter.

Q: Do you have a patient story you can share that highlights the importance of the work that you do?

Dr. Spivack: So many stories, so little time…these demonstrate less the concern over a tooth, and more the concern for our patients as individuals.

A 15-year old girl with cerebral palsy, seizures and extremely challenging behaviors who kept biting her lip to the point of ripping most of the lip tissue free and resulting in infections that spread to her lungs–we were able to save her teeth for years by fitting her with a custom-designed mouthguard to allow healing and restoration of function, and recovery of full pulmonary health.

A severely physically and cognitively disabled 32-year-old man who had been seen by several other dentists came for comprehensive care, brought by his 70-year-old mother. On evaluation, we noticed his severely labored breathing and compromised pulmonary function, malnutrition and poor medical follow-up. We talked his mother into allowing us to bring him to the ER, from where he was admitted to the hospital for a week of intense care and was discharged home with plans for proper follow-up, in-home therapy and social work support.

Q: What are the top three things you think we should know about dentistry for special needs populations and the relationship to overall health?

Dr. Spivack: Many of our patients are nonverbal or have limited verbal abilities. They often cannot express their needs for care, including the presence of infection or pain. Because of the many physical disabilities faced by our patients, including their often-precarious pulmonary status, dental care is not optional—it is, literally, in many cases, life or death.

It is critical to look at the overall patient when planning dental care, which includes physical and cognitive status, social factors (including their caregivers) and the complexity of their dental needs. 

Q: What motivates and inspires the dental teams that work at the Special Care Treatment Center?

Dr. Spivack: The staff of the SCTC has been together for a long time, and we all have many years of experience in caring for this complex population of patients. We take our responsibilities for the care of our patients very seriously and often find ourselves involved in issues beyond the scope of dentistry in caring for our patients. Having seen many of them for well over a decade, they and their caregivers have become part of our extended family. Knowing our patients and contributing to their heath and successes in life is a very rewarding experience. As faculty, too, we have the unique opportunity to pass on our knowledge, experience and enthusiasm to so many others who will care for this patient population for decades to come.

Q: Is there anything else you'd like to share about the work being done at the Special Care Treatment Center?

Dr. Spivack: The state of New Jersey has a huge population of patients requiring our care. Too often we are limited in what we can accomplish due to lack of manpower or the constraints of limited operating room time. Our patients face too many challenges and getting proper dental health care should not be one of them.