The Demand for Special Needs Dentists
John Barnosky became an advocate for expanding programs like the one at Rutgers School of Dental Medicine after a delay in finding care for his son
It was a routine check-up for Peter Barnosky and his dentist found a few cavities. But because Barnosky is on the autism spectrum, his provider didn’t have the skills or resources to help.
Barnosky, 28, can be combative during dental procedures and often needs general anesthesia, which many dentist offices aren’t equipped to provide.
His father, John Barnosky made an appointment at the Rutgers School of Dental Medicine’s Delta Dental of New Jersey Special Care Treatment Center, one of the only clinics in the region where dentists are trained to work with patients who have disabilities.
But Peter Barnosky, who lives with his parents in Trenton, had to wait months for an appointment. A severe shortage of special needs dentists, and a booming population of patients with physical disabilities and behavioral disorders, has left special needs dentists at RSDM and beyond struggling to meet the demand. Because Peter’s case wasn’t urgent, an appointment couldn’t be booked any sooner.
“There are many barriers to receiving dental care for special needs patients,’’ says Glenn Rosivack, interim chair of the Department of Pediatrics, which oversees the school’s special needs clinic. “Some are physical: a lack of ramps, doorways that aren’t wide enough for gurneys to fit through. Some are due to the fact that many dentists aren’t trained and willing to treat special needs patients.”
The delay turned Peter Barnosky’s father, John, into an advocate to expand the availability of programs to help patients like his son.
“I want to get the word out, and I’m passionate about this. This is about my kid. What breaks my heart is that there are patients in group homes who have no voice at all,’’ he declares. “We have to expose this lack of care for what it is. It’s not acceptable.’’
The dental school, the largest oral health care provider in the state, logged 7,757special needs patient visits in 2017. But in New Jersey, more than 10 percent of the population has at least one disability, a figure that totals 911,300. Nationwide, 48 percent of patients with disabilities had no dental check-up within a year, compared to 35 percent without disabilities, according to a 2016 study published in the Journal of Public Health Dentistry.
“There is a huge need,’’ says Dean Cecile A. Feldman.
Inadequate care can have dire consequences, including infections that spread throughout the body. When patients can’t verbalize their needs, self-injury from pain they’re unable to describe is also a risk, say RSDM providers. For some, dental problems are part of their condition or disability. Patients with Down syndrome, for instance, are at high risk for periodontal disease, which can cause painful infections and early loss of teeth. Down syndrome patients also have anatomical differences, including larger tongues, smaller teeth and narrow upper jaws, which can make it more difficult for dentists to treat them.
John Barnosky is hoping the state legislature will appropriate funds for RSDM to expand its capacity since it has the only clinic in the state devoted to special care dentistry. It is also one of few dental schools nationwide that provides intensive special needs dentistry education for all students as part of the curriculum.
Assemblyman Dan Benson (D-14) agrees that New Jersey’s special needs dental patients require greater access to care and that support for the dental school would help. “The Rutgers School of Dental Medicine Special Care Treatment Center is critical for serving the needs of the developmentally disabled community in our state. We must ensure that it be prioritized and given the resources it needs to continue to work with patients that would not be able to get dental services otherwise,’’ stated Benson, who represents Barnosky’s district and is a member of the Assembly Health and Senior Services Committee.
“These services help not only special needs patients, but ease the burden on families who support them,’’ he added.
According to Feldman, extra staffing and additional surgical resources to treat the many special care patients who need general anesthesia would greatly bolster the school’s clinical and educational mission.
“It can be a struggle to provide care without more support,’’ Feldman said. “The patients here are mostly severely disabled and that can be very challenging. They take longer to treat. It can take two or three visits just to get the patient comfortable enough to open their mouth. And if providers can’t complete the exam, we don’t get reimbursed through Medicaid, which covers a majority of our patients. The need is greater than we can accommodate.’’
Training the next generation of dentists to be better prepared to treat special care patients will help, says Chelsea Fosse, a 2017 RSDM graduate who works with special care patients. “There’s great potential to focus on dental students to help with the shortage,’’ says Fosse, who received an RSDM scholarship to pursue education in special needs dentistry and completed a residency at Helen Hayes Hospital in New York for patients with disabilities.
“If the next generation of dentists is more equipped to handle less severe special needs cases in their private practices, it will be easier for specialized centers like RSDM to handle more advanced cases,’’ Feldman said.