Tufts University

Special Work

Tufts Dental FacilitiesFor 30 years, the Tufts Dental Facilities have been helping patients few others can.

One day not long ago, Dr. Richard Miller, D78, stepped out of an operatory at the Tufts Dental Facility in Wrentham, Mass., and called to Colette Farragher, the clinic coordinator. "Would you like to see how we clean teeth around here?" She looked up to see Miller standing with a patient wrapped around his neck and torso, the patient contentedly holding on while the dentist gently brushed his teeth. Some of the special needs patients who come to the facility refuse to be touched; others only feel secure with human contact. Clearly this patient was one of the latter.

"To me, they are my heroes," Farragher says of Miller, the other dentists and hygienists who have staffed the clinic almost since it opened 30 years ago. "They do things that no one else can accomplish, and I hear it from parents who are almost in tears they are so happy. People say, 'I can't believe my son opened his mouth for that dentist.' They do special work."

The clinic, located at the Wrentham Developmental Center, is one of eight Tufts Dental Facilities Serving Persons with Special Needs located throughout Massachusetts. For almost all of the patients—whose disabilities range from autism to blindness to cerebral palsy to Down syndrome—these clinics are the only places where they can get the dental care they need.

The program dates to 1976, when the state departments of Public Health and Mental Retardation contracted with the Tufts University School of Dental Medicine to provide dental services for the state's developmentally disabled population. An estimated 17,000 patients make 25,000 visits to the facilities each year, which prompted the Boston Center for Independent Living to bestow the Marie Feltin Award on the program this year. Yet because of limited resources, many of the facilities are often unable to accept new patients, and waiting lists are long.

"They do things that no one else can accomplish, and I hear it from parents who are almost in tears they are so happy."

— Colette Farragher

Earlier this year, the dental school received a special boost for its long-time efforts to help bring dental care to the underserved. Delta Dental of Massachusetts, the largest provider of dental benefits in the state, awarded a $5 million endowment to the dental school—the largest gift in the school's 107-year history—aimed at improving care and access to care for underserved populations, including people with special needs. Part of the award will fund an endowed professorship in public health and community service; the rest will be used to convert the Tufts Dental Facilities (TDF) paper files to a computerized system, creating a clinical database of information that will help form best practices for dental treatment guidelines for persons with special needs.

All together, the gift will help advance a program rooted in active citizenship. It is a cornerstone of the school's community outreach and public service endeavors, which also include extensive work with people with HIV/AIDS and survivors of domestic violence, preventive care for students at area schools and humanitarian missions in the United States and abroad.

Sleepy juice and small bribes

Often when a dentist in the community encounters a patient with developmental disabilities, he or she directs the patient to one of the Tufts Dental Facilities, sometimes labeling the case as "too difficult."

"Their idea of a difficult patient is much different than ours," says JoAnn Kosiorek, the office manager who has worked at the TDF in Amherst, Mass., for 28 years. She and the long-time hygienists and dental assistants at the clinic have learned countless ways to coax reluctant or frightened patients who otherwise would have to go to a hospital operating room for oral health care. Sedatives are called "sleepy juice." A sealant is likened to nail polish. Sometimes hygienists ask patients to count with them while they clean each tooth, helping take their minds off the procedure.

One parent told Kosiorek that her son only comes to the dentist because he knows he will find a favorite book—one Kosiorek's own children had outgrown—in the waiting room. Another patient always keeps her appointments because she knows the dental staff will have a bag of soda can flip-tops for her. (The patient collects them for a charity.)

Many of these tricks are familiar to pediatric dentists, but patients with developmental disabilities can be far less predictable than children. "The next day it's a totally different person, depending on the mood," says Sandy Crowner, who has been a hygienist at the Amherst TDF for most of the last 20 years. Looking at a patient's chart can tell you something about the patient's medical history, but not his or her idiosyncrasies. "You kind of have a game plan in mind, but you can't always count on it," Crowner says.

Medical factors often compromise the patients' oral hygiene. Medications contribute to dry mouth and cavities. Many do not have the motor skills to brush their own teeth. If they do, they may fixate on a certain spot in their mouth or not exert enough pressure to clean properly. Sadly, Crowner says, "Sometimes I know I'm the only one cleaning this person's teeth."

Tufts Dental Facilities

Joel Perlman (D'74), director of the Wrentham Tufts Dental Facility

The successes make the extra time and effort worthwhile. Annette Hightower, a certified dental assistant, recalls one patient who at first was so apprehensive that she would not even come into the operatory. After Hightower worked with her for years, she slowly came to trust the staff completely, even as she was losing her sight. "When we eventually had to do a root canal, she didn't even need the nitrous oxide," Hightower says.

Because of their oral care issues, special needs patients may need cleanings twice as often as the typical patient. The schedule is packed tight. Still, every day brings one or two cancellations, usually because a caregiver is too busy to bring the patient in. For the staff, educating the caregivers about the importance of oral health and advocating for the patients' care is part of the job. When a caregiver recently called to cancel an appointment, Kosiorek pointed out that the next available one wasn't until September and persuaded the caregiver that the patient should not wait that long. The patient showed up on time.

As competent and dedicated as the staff is, Amherst recently lost its two half-time dentists. The clinic currently relies on dentists from Tufts' General Practice Residency Program, who travel to Amherst for two days every six weeks, staying overnight nearby. Thankfully, two local dentists recently contacted the program, offering to help out, and one has made a commitment. Dr. R. Scott Smith, D76, an orthodontist, also sees Amherst patients once a month at his office.

In addition to her work in the Amherst clinic, Linda Johnson is one of seven hygienists with the TDF Special Needs Community Dental Health Program. With a portable compressor, light, stand and a chair that folds up into a suitcase, she travels throughout the area to clean the teeth of people who otherwise do not go a dentist. For many years the program was dedicated to helping developmentally disabled patients, and Johnson has known some of the patients since they were children. "With one child, it took three years to get inside his mouth. I had to start by brushing his cheek," she says. Fifteen years later, she sees him for a fluoride varnish every three months.

Why have these employees stayed with the program so long? For some, it is the hugs, kisses and unabashed declarations of love they receive from patients they have helped. If they run into a patient in the grocery store, there are never any awkward glances or averted eyes.

"They'll tell everyone, 'I know you! You cleaned my teeth!' " Crowner says. (continued)

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Profile written by Julie Flaherty, a senior health sciences writer in Tufts' Office of Publications.

Photos by Melody Ko, University Photographer

This article originally appeared in the Summer 2006 issue of Tufts Dental Medicine, the magazine of Tufts University School of Dental Medicine. This story originally ran online on Nov. 27, 2006.