Access for All
Both close to home and far afield, Penn Dental Medicine spearheads multiple initiatives to deliver the highest-quality dental care to people with disabilities.
While comprehensive oral care should be available to anyone who needs it, not everyone shares the same privilege. Many adults with physical or intellectual disabilities face significant barriers to high-quality dentistry, beginning with the fact that many general dentists do not feel comfortable or prepared to manage care for these patients.
Penn Dental Medicine has taken strides to remove many of those barriers through a plan put in place by Mark S. Wolff, D.D.S., Ph.D., who became Penn Dental Medicine’s Morton Amsterdam Dean in 2018. Dean Wolff’s vision for the future includes one in which students graduate from dental school in full possession of the tools and the hands-on experience needed to effectively assess and manage dental care for all patients, regardless of a patient’s ability.
“Our mantra is that the vast majority of people with disabilities can be treated by a caring general dentist who looks for the accommodation that can make care possible for that patient,” says Dean Wolff. “That’s what we’re working toward.”
Perhaps the most tangible example of this inclusive vision is the Care Center for Persons with Disabilities, a 3,500-square-foot facility within the school’s Robert Schattner Center in University City. The center opened in 2021.
“Traditionally there has been a huge access-to-care problem for patients with disabilities,” says Miriam R. Robbins, D.D.S., M.S., the director of the Care Center for Persons with Disabilities and a professor of clinical oral medicine and clinical restorative dentistry in Penn Dental Medicine’s Department of Oral Medicine. “Most dental students have limited exposure clinically to patients who may need accommodations and don’t receive training in how to deliver oral health care to this population. The traditional approach has been to treat them surgically under general anesthesia, but that’s not a sustainable model. I’d say 75 percent of these patients can be seen in general practice with minor modifications.”
A dental student’s introduction to the Care Center for Persons with Disabilities begins with observation and assistance in their third year of dental school. By their fourth year, dental students spend as much as 10 percent of their clinical time treating patients with disabilities under the supervision of dentists, public health hygienists, and other faculty, all with the specific expertise to work with these patients.
“Students work in pairs, and there is almost always a faculty member with them chairside,” Dr. Robbins adds. “A nonverbal patient who may be yelling because that is their way of communicating can be intimidating to a student who has never treated someone like that, but we’re there to support them.
“Some of the greatest experiences I’ve had in my career happen when a student ‘gets’ it,” she continues. “I don’t expect 100 percent of our students to go out and devote their careers to treating patients with disabilities, but a lot of them will incorporate some level of special needs into their practices because it has been normalized for them; it’s not special, it’s normal.”
The center’s patient-care area, known as the Personalized Care Suite, includes wide corridors and entryways for ease of accessibility. Each of its 12 operatories can accommodate wheelchairs and other assistive devices, while four operatories are outfitted with wheelchair lifts that can support and recline patients in their chairs while clinicians deliver care. Each operatory is equipped with nitrous oxide to keep patients calm and comfortable during treatment. A low-stimulation room caters to patients who are sensitive to bright lights and loud noises.
“We call it the Personalized Care Suite because it’s personalized care for each patient,” Dr. Robbins adds. “If a patient wants to receive care in a regular chair, we can do that. If they want to sit on the floor, we’ll do that with them. If they can receive care for only 15 minutes at a time and then they want to get up and walk around for a bit, we let them do that, too.”
The Care Center for Persons with Disabilities also provides a medical home for medically complex patients, such as those who have bleeding or lung disorders, cancer, infectious diseases, or other medical conditions that can complicate the management of their dental care. As of early December, the center had seen approximately 9,000 patient visits and more than 2,000 unique patients; some patients have traveled two hours or more to receive care at the center.
Penn Dental Medicine’s commitment to treating patients from vulnerable and underserved populations extends to its Advanced Education in General Dentistry (AEGD) program. As part of the program, students will treat patients in community-based care centers such as the clinic at Woods Services, a Langhorne-based nonprofit that supports children and adults with disabilities. By July 2023, the AEGD program will have a new team of 10 dental residents who will be treating patients at the newly renovated and expanded Woods clinic.
“There has always been a tremendous need, and that need is only going to grow,” says Marc Henschel, D.D.S., director of Penn Dental Medicine’s AEGD program. He cites data from the U.S. Centers for Disease Control and Prevention suggesting that by the year 2030 approximately 61 million American adults—one in four—will have some sort of disability. “Lack of accessibility has been a problem in medicine as a whole, not just in dentistry.”
Dr. Henschel previously directed the Special Patient Care Clinic at New York University College of Dentistry. He also had a private practice in Forest Hills, New York, where he welcomed patients with disabilities. In his current role with Penn Dental Medicine, Dr. Henschel works closely with AEGD residents who rotate through the Care Center for Persons with Disabilities and the Vulnerable Populations Clinic, balancing clinical instruction with real-life examples from his professional career.
“General dentistry is general dentistry, no matter who the patient is,” he says. “An electric wheelchair can recline the same way a dental chair does, so you can easily learn to treat a patient within their wheelchair. It’s a matter of taking the extra time needed to modify treatment to apply to a population with special needs.”
Penn Dental Medicine at Woods Mikey Faulkner Dental Care Center, which was renovated and expanded from Woods’ existing dental care center, is due to open in January. The space will include five spacious operatories equipped with “all the bells and whistles,” as Dr. Henschel puts it. Residents enrolled in the AEGD program will devote part of their time to treating Woods’ more than 600 residents, as well as patients with disabilities from the surrounding community.
“Woods has been one of the most accommodating organizations I’ve worked with so far, and their goal is the same as ours: to provide the best possible patient care to this population,” says Bruce A. Brandolin, D.D.S., who joined Penn Dental Medicine in October 2021 after 17 years on faculty at New York University College of Dentistry. “Any patient with a disability from the surrounding community can be seen at Woods, so they don’t have to trek to New Jersey, Philadelphia, or somewhere else farther from home.”
In his role as Assistant Dean of Intramural Practice and Extramural Partnerships with Penn Dental Medicine, Dr. Brandolin facilitates arrangements to help Penn Dental Medicine “branch out” in ways both large and small. The partnership with Woods is just one example.
“We’re trying to change the paradigm, so when these students graduate, treating patients with disabilities is second nature,” he adds. “Providers used to be taught that these were challenged individuals who could be treated only through sedation, but that couldn’t be further from the truth. It’s rare that we have to intervene with narcotics. You can do an unbelievable level of dentistry through proper interaction with the patient.”
Drs. Brandolin, Henschel, and Robbins are happy to see other dental schools beginning to follow Penn Dental Medicine’s lead. Likewise, they applaud efforts by organizations such as the Commission on Dental Accreditation, which now requires dental schools to train their students in managing treatment of patients with intellectual and developmental disabilities.
Penn Dental Medicine intends to further its efforts to “change the paradigm” locally, regionally, and nationally—even globally. Penn Dental Medicine has collaborated with other esteemed dental schools across the country to develop a national curriculum for delivering care to the vulnerable and underserved. Internationally, Dean Wolff and Dr. Robbins, along with other leaders from Penn Dental Medicine, have traveled to Israel and France to share their learnings with peers.
“We’re trying to spread the word,” Dr. Robbins adds. “We’re doing everything we can to normalize treating patients with disabilities, for the benefit of our students, for the benefit of the profession, and for the benefit of people who have faced too many barriers to care for far too long.”
For more information about Penn Dental Medicine’s Care Center for Persons with Disabilities, its partnership with Woods, and other efforts to provide care to patients with disabilities, call (215) 898-8180 or visit penndentalmedicine.org.
Photo by Alison Dunlap
Published (and copyrighted) in Suburban Life, December 2022.
