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Barriers to care

When Dr. John Morgan left Seattle to interview for the job of Tufts Dental Facilities program director in 2000, he was leaving behind an office in a brand new building that overlooked Puget Sound and operatories with a view of Mt. Rainier. The dated and dilapidated Tufts Dental Facility at the Walter E. Fernald Developmental Center, which serves as the special needs program headquarters, was a stark contrast, its Waltham, Mass., campus dotted with boarded-up buildings. Most of the dental equipment was close to 30 years old. Yet when Dean Lonnie H. Norris, DG80, offered Morgan the job, he immediately accepted.

"One of the reasons I said yes that day was that when I talked with the staff, many of them had been here 20 or 25 years," he says. "I thought if these people are staying in the program that long, maybe it's a good thing to come here."

Disabilities are only one barrier to care. The TDF patients are mostly unemployed or hold entry-level jobs and are almost exclusively participants in MassHealth, the state insurance program for low- or moderate-income residents. Many dentists simply don't feel qualified to handle special needs patients.

The TDF patients are some of the most complicated dental cases a dentist can face. Some of the patients are physically or mentally unable to accept care in a traditional dental operatory, so the program averages about 400 operating room cases per year, completed through the Lemuel Shattuck Hospital, Salem Hospital, Franciscan Children's Hospitals and Baystate Medical Center.

Funding is always an issue, especially when oral health is competing with so many other health-care issues for dollars. "Very often the mentally retarded and the developmentally disabled get pushed down the ladder just by nature of the voicelessness of that group," Morgan says.

"Very often the mentally retarded and the developmentally disabled get pushed down the ladder just by nature of the voicelessness of that group."

— John Morgan

In many ways, the Delta Dental endowment will not only help the program in the short-term, but help raise awareness of the state's special needs population and their oral health care needs simply by culling accurate statistics. "We have an incredible amount of patient data which we can't really access" without a computerized system, Morgan says. "We have this opportunity to really learn the best ways to improve the care for the patients and discover the most cost-effective, efficient models that can be developed from the dental program."

Morgan says that the program's atypical structure, which draws support from hospital, university, community, institutional and private health-care programs, has contributed to its longevity.

"I think the model we have is a great model," he says. "It has existed for 30 years. It has survived the trials and tribulations of economic problems and other issues."

Over the years, the dental program has had to adapt to the state's changing approach to caring for the developmentally disabled. Where the Fernald School campus was once the full-time residence for thousands, all but a couple hundred of the most severely disabled clients have been moved into group homes in their communities, and now return to the facilities for their dental care.

Dentists wanted

The TDF at the Wrentham Developmental Center is now housed in one of the newer buildings on the campus. But as he walks around the grounds, Dr. André St. Germain, D63, points out the now-boarded-up building where the clinic was first housed 30 years ago, and then a low red building that, on closer inspection, is actually a trailer. Designed to house the clinic temporarily; the trailer ended up as the clinic's home for more than 22 years. "It wasn't a pretty sight," St. Germain says, "but it did a lot of work."

St. Germain is known to his patients and colleagues as "the saint"—not necessarily because of his angelic demeanor. Feisty and opinionated, he said he enjoys working with the special needs population, in part, because they accept him as he is.

"We call him saint, but he's a little devil," says Farragher, the clinic coordinator. "Saint has his own way, but he gets the job done."

Tufts Dental Facilities

Twin sisters Susan and Stacey Caffrey are given a ride around the grounds of the Wrentham Developmental Center.

Point being, a dentist doesn't need to be an obvious bleeding heart to be cut out for this kind of work. Asked why he decided to work with special needs patients, Richard Miller says, "I'm not even sure I knew what special needs was." But when Joel Pearlman, D74, a key founder of the program, offered him a job as an associate in his private practice—as well as a post at the new Tufts Dental Facility in Wrentham where Pearlman was director—he signed on. Pearlman, Miller and St. Germain have been working together at the Wrentham TDF for close to three decades.

Although retired from private practice, St. Germain continues to work at the Wrentham clinic three days a week. But there are big questions about the future. "Our replacements are not out there," St. Germain says. "Their indebtedness prevents them from taking a job at this place."

Pearlman agrees that it is hard for young dentists to consider public health as a career. "It's a rare person you are going to find who wants to do that coming out of school with substantial loans," he says.

Then again, sometimes all it takes is a little exposure. As a senior at Tufts dental school, Dr. Anastasia Foufas, D04, chose to do her five-week externship at Wrentham, not because she was particularly interested in special needs, but because she didn't have a car. "It truly was chance," she says. "This was one of only a handful of externships you could get to by train." But the experience was a powerful one. She returned to the facility last year and has been seeing patients at the clinic for more than a year now. "It changed my perspective," she says of the externship. "Unless you're exposed to it, you assume it's something that's not up your alley."

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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.