NYU Dentistry Oral Health Center for People With Disabilities

Ronald W. Kosinski, DMD, is the clinical director at the NYU Dentistry Oral Health Center for People With Disabilities and a clinical associate professor and director of pediatric sedation and anesthesia at the New York University College of Dentistry. Conflict of Interest Disclosure: None reported.

ABSTRACT

In February 2019, the NYU Dentistry Oral Health Center for People With Disabilities (OHCPD), an 8,000-square-foot center designed to provide dental care for people with physical, cognitive and developmental disabilities, opened its doors. The OHCPD provides much-needed comprehensive care for patients whose disabilities or medical conditions prevent them from receiving care in a conventional dental setting.

Keywords: People with disabilities, vulnerable patients, training dentists

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The purpose of this paper is to share the vision of the NYU Dentistry Oral Health Center for People With Disabilities and to encourage other dental schools to embrace this vision.

NYU Dentistry has been committed to the goal of increasing access to oral health care for people with a range of disabilities for more than 50 years. Since 1971, the college has conducted a successful Special Patient Care Program, an honors program for a small group of exceptional dental students to gain experience caring for people with disabilities.

About six years ago, the NYU Dentistry leadership made the decision to vastly expand the care offered to people with disabilities and the education and training provided for future practitioners, preparing them to provide compassionate, comprehensive oral health care for these patients across the lifespan.

This decision was motivated by an experience NYU Dean Charles N. Bertolami, DDS, DMedSc, had while preparing to cross East 24th Street in Manhattan, just outside the college’s main clinical building. Dr. Bertolami saw a disabled man in a wheelchair waiting for an Access-A-Ride van to pick him up, and he realized that the person’s disabilities were preventing him from holding his head steady. At that moment he became acutely aware that, “We can do better, we must do better.”

Motivated by this vision, Dr. Bertolami wrote a white paper describing in detail the kind of treatment and educational facility he had in mind, and he asked Executive Vice Dean Michael O’Connor EdD, MPA, to explore the concept of an oral health center for people with disabilities that areas who met weekly for approximately two years, during which they created a detailed plan to build a facility designed specifically for people whose disabilities or medical conditions prevented them from receiving care in a conventional dental setting. The team also visited a number of facilities in the northeastern United States that provide dental care for the disabled population. None of the facilities they visited offered the physical resources and the comprehensiveness and timeliness of care that reflected Dr. Bertolami’s vision.

After completing this fact-finding phase of the project, the decision was made to create a facility that would go beyond what already existed — one that would incorporate the most advanced design and technology available to meet the specific needs of people with a full range of physical, cognitive, acquired and developmental disabilities.

To that end, the college collaborated with a number of health care and advocacy groups that provide general health care and support for people with disabilities, including the Cerebral Palsy Associations of New York State, Metro Community Health Centers, Family Health Centers at NYU Langone, New York State Office for People with Disabilities, NYU Langone Health and the Viscardi Center. In addition, focus groups made up of people with disabilities were conducted in cooperation with the NYU Ability Project. An architectural firm that was able to implement all the unique design requirements for the center was hired, and the center was completed through a $12 million renovation and of an existing space.

The NYU Dentistry Oral Health Center for People With Disabilities (OHCPD) opened in February 2019. The 8,000-square-foot center addresses a major public health challenge by providing comprehensive, compassionate dental care for people with a full range of disabilities who experience significant barriers to accessing care. Equally important, care at the center is ongoing with preventive continuity. By providing dental care across each patient’s lifespan, the center aims to break the vicious cycle of neglect and repeated hospitalizations.

The Need

According to the U.S. Census Bureau, in New York City alone, an estimated 950,000 people — in a city of 8.5 million — have some form of disability, and more than 99,000 of those people use wheelchairs. Research shows that people with disabilities have worse oral health than the general population and are less likely to have access to dental care. [1]

People with disabilities face many barriers to dental care, including physically accessing dental offices that which may not be able to accommodate wheelchairs or other assistive devices. In addition, some dentists lack confidence in their ability to meet the needs of people with disabilities, so they may not be prepared or willing to welcome disabled patients.

As a result, patients with disabilities are often referred to hospitals for dental care because of the need for sedation, and they may wait as long as six months to get an appointment to be seen in a hospital OR. These visits are often one-off emergencies without follow-up or continuous preventive care, which can trigger a cycle of recurring dental problems.

Designed for People With Disabilities

A major objective of the design process was to create an environment that felt both spacious and soothing and that flowed naturally from room to room as the accompanying photos illustrate.

The center features nine spacious with disabilities include the following:

■ Wheelchair tilt: designed to accommodate patients receiving dental treatment in their own wheelchairs, without the need to transfer to a dental chair.

■ Multisensory room: designed to reduce patients’ agitation and anxiety, help them relax and engage their senses. Amenities include a bubble tube; noise-canceling headphones; soothing, adjustable, multicolored lighting; weighted blankets; body socks; and a projection screen.

■ Bariatric chairs: designed to accommodate patients up to 650 pounds.

■ Spacious, private treatment rooms: designed to offer privacy and comfort, with soothing, adjustable, multicolored lighting; noisecanceling headphones; and personal entertainment tablets.

■ Sedation: A nurse and a dental anesthesiologist conduct comprehensive exams to determine what level of sedation is most appropriate for a patient’s needs.

The center is staffed by multidisciplinary faculty representing all the dental specialties, a clinical director, two dental anesthesiologists, a nurse, three patient services representatives, two dental supply assistants, four dental assistants, an assistant director and the director of oral health advocacy and policy initiatives. In addition, since Jan. 1, 2022, two dental hygiene students have been rotating through the center each week.

Training the Next Generation of Dentists Specializing in Treating People With Disabilities

In addition to offering much-needed clinical services to patients, the OHCPD provides a unique training opportunity for NYU dental students, who will become the next generation of dentists with the skills to practice with competence, confidence and compassion in treating people with disabilities. To that end, students started full-day rotations at the center as soon as it opened. By investing in curriculum changes and in clinical rotations at the center, NYU Dentistry is educating students to embrace this patient population rather than resort to sending them to hospitals for care. Just as children are afraid of the unknown, dental students often have a fundamental fear of treating people with disabilities.

One important way in which NYU Dentistry is training future dentists to care for those with disablities is by scheduling longer appointment times so that students have extra time to understand the patients’ needs from a medical and a psychological perspective in addition to the dental perspective. The increased appointment duration also allows students time to collaborate with faculty with experience and expertise in treating individuals with disabilities — helping students to learn how to integrate that specialized information into their approach to the patient.

The biggest challenge was to create the right balance between care provided by dentists and care provided by students. Because of the complex needs of the majority of the center’s patients, the decision was made to have dental faculty from all the specialties, rather than students, provide care in complex cases.

Accordingly, patients are cared for by faculty at the NYU College of Dentistry with particular interest and expertise in treating people with disabilities. Senior dental students provide basic dental care not requiring sedation and learn from the faculty providers.

The results have been extraordinarily rewarding. Many of our providers have noted that the experience of seeing patients who have been met with resistance their entire lives, who have never before had an X-ray taken or had anyone try to take an X-ray, or even look in their mouths, is an exhilarating one — for the patient, their family and the provider. The center is beginning to remove the roadblocks people with disabilities have encountered their entire lives.

Going Forward

When the OHCPD opened in February 2019, 10 to 15 patients a day were being seen. When the COVID-19 pandemic forced NYU Dentistry to suspend clinical operations on March 13, 2020, the center was seeing 40 to 50 patients a day, ranging from newborns with recently diagnosed syndromes to the elderly, and was on target to provide 8,000 patient visits in 2020 and 10,000 visits in 2021.

Although that trajectory was interrupted, the center was able to resume patient care in mid-July 2021. Since then, the center has been ramping up its services in a gradual, phased-in manner consistent with health and safety guidelines, and the faculty and students are optimistic about the future. Notably, the department of pediatric dentistry at the NYU College of Dentistry recently received a grant of nearly $2 million from the Health Resources and Services Administration (HRSA) toward training dentists and other dental care professionals to provide care for people with disabilities and complex medical conditions — a development that bodes well for advancing the goal of achieving health equity. And because NYU Dentistry is the largest dental school in the U.S., educating nearly 10% of the nation’s dentists, the prospects for having an exponential effect on the oral health needs of people with disabilities across the nation are extremely strong. In fact, we anticipate that, over time, many fewer people with disabilities will be referred to hospital ORs and many more will be treated in a conventional way.

Clinical Implications for Dentists

While having an innovative comprehensive clinic and suite for providing dental care to those with disabilities and complex medical conditions is not possible for every dentist, there are accommodations and modifications that can be made in traditional dental offices to support these patients.

Patient Scheduling

When scheduling a patient with disabilities or special health care needs, the appointment scheduler should ask the patient, parent and/or caregiver if there is an ideal time to schedule the appointment. Some patients may have medical conditions or daily routines that make an appointment at a specific time of day preferable. Furthermore, patients with developmental disabilities such as autism spectrum disorder often find the waiting room of a dental office uncomfortable and/or overstimulating. Scheduling patients with developmental disabilities in a way that ensures that the patient is immediately seen for treatment and does not spend time in a waiting area can increase the patient’s ability to tolerate the appointment.

Sensory Modifications and Accommodations

The dental office includes many sensory experiences that can be unfamiliar and displeasing to patients with developmental disabilities. The dental setting has bright lights, unusual tastes and loud noises in an unfamiliar setting. Some simple accommodations for the patient can help with the sensory discomfort that may lead to uncooperative behavior from these patients.

Sensory Modification Items and Music

Patients can be offered sensory modification items to enable them to better tolerate the dental setting. Simple interventions like sunglasses, noisecanceling headphones and dimming operatory lights can decrease the patient’s exposure to the bright lights and loud noises of the dental office. Furthermore, to make the dental office more acoustically tolerable for the dental patient, music that is calming or pleasing to the patient can be played during the dental visit.

Toothpaste Options

Having multiple flavors of prophy paste and/or asking the patient to bring their preferred flavor of toothpaste from home can help to reduce the patient experiencing unfamiliar or displeasing tastes in the dental office. Additionally, for patients who have strong taste aversion, flavorless prophy paste and toothpaste can be used in the office and/or suggested for the patient to use at home. These modifications can make cleaning of teeth more tolerable for patients with restricted acceptance of new flavors.

Tactile Distractions

Some patients will respond better in the dental setting when they have tactile input that is calming or pleasing to them. A weighted blanket can increase comfort for some patients in the dental chair. If a dental office does not have a weighted blanket, the use of a radiograph lead apron can be used in a similar manner to provide a calming pressure sensation to patients in the dental chair. Additional tactile distraction can also aid patients in tolerating care in the dental clinic. Items such as fidget spinners, squishy toys and stress balls can provide an item for the patient to hold and use to reduce anxiety during a dental visit.

Desensitization

The dental office can be initially unfamiliar and uncomfortable to a patient with developmental disabilities. However, gradual exposure over time to the sights, sounds, smells, tastes and overall “feel” of the dental clinic can transform it into a safe and tolerable space for these patients. Pairing of the above-described modifications and accommodations with multiple, short desensitization visits over time can be highly effective — enabling individuals with disabilities to gain the skills they need to attend and complete routine dental visits in a traditional dental office.

Conclusion

Some patients will respond better in the dental setting when they have tactile input that is calming or pleasing to them.

As a pediatric dentist and dental anesthesiologist who has treated many disabled children, I have been extremely frustrated when I have been unable to provide care for my patients who have disabilities as they grew older. So, it makes me incredibly happy that NYU is offering lifelong access to comprehensive, compassionate dental care to people of all ages who have disabilities instead of referring them to hospitals, and that NYU is training the next generation of dentists to be able to treat this population. It’s also immensely gratifying to know that what NYU is doing to implement this paradigm shift in providing dental care to people with disabilities has spurred other dental schools to create their own facilities for the treatment of individuals with disabilities. Indeed, former NYU Dentistry faculty members who are now deans of other dental schools have built or are in the process of building centers of their own. My hope is that their actions will be replicated across the nation.

REFERENCE

1. Morgan JP, Minihan PM, Stark PC, et al. The oral health status of 4,732 adults with intellectual and developmental disabilities. J Am Dent Assoc 2012 Aug;143(8):838–46. doi: 10.14219/jada.archive.2012.0288. PMCID: PMC4527687.

THE AUTHOR, Ronald W. Kosinski, DMD, can be reached at rkosinski@nyu.edu.