PAGD Keystone Explorer Fall 2019

Keystone Explorer |  Fall 2019  1 from the editor’s desk | Imagine the following scene involving me with a seven-year-old patient. Dr. G: Ok, let’s fix your tooth. We have to clean the cavity bugs out of the tooth with this toothbrush that whistles. Patient: How many seconds before a break? Dr. G: We will do 10 seconds before the break. Patient: Fast 10? Slow 10? Regular 10? Dr. G: Slow 10. Patient: Okay, do a regular countdown from 5, then I’ll open and you can do the slow 10. Dr. G: Okay, five, four, three, two, one. (patient opens mouth and I start prepping tooth while counting) one…two…three…etc. I was so thrilled to be able to say those numbers for him. Why was this so exciting for me? This particular patient had been diagnosed with Asperger’s Syndrome. The counting and its pace were what he relied on to cope with the stress of having dental work completed. Up to this point, I was NOT allowed to be the person counting. The only people provided that honor were his mom or his twin sister. The privilege to count told me that he trusted that I would not betray him by changing the pace. By this time I had learned that “slow 10” really meant 30 seconds. Fast 10 was about 2 seconds in reality. I probably earned less than $100 on all the fillings I did on this patient in three appointments, but at that third appointment when he let me do the counting, it was priceless. His mom could relax, his sister could play with her tablet, and the appointment was like any other of my day. I attended dental school at University of Pittsburgh, where there is a Center for Patients with Special Needs. It was fun, it was different, and it was efficient in that clinic, so I spent a lot of time there. I did my residency at The Ohio State University where the GPR clinic is where patients with special needs were treated, so this young boy with Asperger’s was something that I knew I could manage. I had the confidence to treat him because of my exposure, but so many practitioners don’t have this available and it causes a crisis when a patient shows up in their office who needs accommodations. The average dental patient presents obstacles for everyone involved in treatment: tongue, saliva, anxiety, financial restrictions, value for service. Patients who have special needs have different obstacles that we aren’t used to managing every day. Their caregivers have even more responsibility in managing those obstacles. Understandably, dental visits are often low on the list of priorities for the caregivers and it only goes further unresolved when the visits do not go smoothly or successfully. There is often a chain of referrals involved, ultimately leading to substandard care with the waste of a lot of time and resources. In highlighting our special needs population in this edition of Keystone Explorer, the PAGD wants to encourage you to evaluate your protocol when it comes to these patients. What accommodations is your office capable of making? What kind of accommodations can you learn to make? Take the time to evaluate if what this patient needs is something you can provide and get educated on the local places where you can refer. Establish a connection to a dentist who has the capability to treat patients with advanced special needs. If we can’t be the person who treats the patients with special needs, we can help remove the obstacles that can get these patients the quality care that they require. MariaGarubba, DMD, FAGD Editor, PAGD Keystone Explorer Removing Obstacles MariaGarubba, DMD, FAGD “Patients who have special needs have different obstacles that we aren’t used to managing every day. Their care- givers have even more responsibility in managing those obstacles.”