Bailey says many private dental practices have turned away her residents. Ellen acknowledges that too few providers are willing and trained to treat patients with special needs. According to the American Dental Association (ADA), which does not recognize special care dentistry as an official specialty, pediatric dentists help fill the void, but most do not continue seeing patients into adulthood.
In general, dentists eschew special care treatment because of the low profit margin of a Medicaid clientele that requires more staff time and longer appointments. Only a small proportion of Nova’s general dentistry students opt for a special care residency because, unlike competitive residencies that offer salaries, it is unpaid. “If you have $200,000 in dental school debt, that stipend can be pretty important,” says Ede-Nichols, who replaced Tabak as the school’s community dentistry chair.
On the plus side, the special care residency allows dentists from foreign countries to take national boards after two years, saving a year’s tuition.
Eselle Lemus, a second-year resident from Cuba, was a periodontist in her country. The two-year residency will enable her to practice in the United States, provided she passes national exams.
“We know it’s an immigration lift for some people,” says Ede-Nichols, “but we try to instill an interest in special needs.”
A tall, slender autistic woman arrives at the clinic for a cleaning. Nervously she settles into the dentist chair, her stomach distended from hyperventilating and swallowing air. Flanked by second-year resident Arwa Alwehaib and dental assistant Pia Velasquez, Ellen reassures her. When the suction sound of the water device upsets her, they switch to a hand tool. They coax her to continue with toys. Finally, the patient reaches her limit. The doctors show her a soft blanket-like restraint called a papoose. They ask her permission to use it. Warily, the patient nods yes. Wrapped in the papoose, she relaxes.
“It simplifies things for her. It gives her a secure space,’’ Ellen says. “The papoose should never be used for the dentist’s convenience, only to protect the patient from hurting herself.”
Her cleaning finished, the patient embraces Velasquez for several minutes.
“It’s so difficult, but it’s a blessing for me to help her,’’ says the dental assistant. “My goal is to help people who really, really need it.”