Patients with Special Needs and Complex Conditions: Addressing the Need and Provider Shortage

Apr. 5, 2024
man with IDD smiling in dental chair
EIOH patient David Goodnough

For the many people in New York state living with a developmental disability or a chronic health condition, accessing dental care can be a huge struggle. Many dentists lack the training and facilities to treat these patients effectively.

Since 2021, there have been three Upstate New York oral health safety net provider closures resulting in a dramatic decrease in services for patients with intellectual and developmental disabilities and medically complex conditions. This means fewer resources for patients and fewer dental residents training across New York.

In the late 1970s, Eastman Institute for Oral Health alum Dr. Jorge Davila developed several innovative techniques for managing patients with developmental disabilities that are still used today. These include desensitization, acclimation, gradual exposure therapy, lotion for touch therapy, aroma therapy, music and low light for relaxation.

More recently, EIOH formed a taskforce of experts in 2012 with the Golisano Foundation to identify gaps and barriers that explain why dental care is the number one unmet healthcare need. One of the main recommendations was to increase the number of providers and their skills when treating patients with special needs. 

professional portrait of Dr. Planerova
Dr. Adela Planerova

A five-year, $3.5 million Health Resources and Services Administration grant awarded in 2015 allowed EIOH to train more than 100 pediatric and general dentists, hygienists, dental assistants and staff to provide dental treatment to adults with intellectual and developmental disabilities and other childhood-onset conditions such as, but not limited to, Type 1 diabetes, cystic fibrosis, sickle-cell anemia, childhood cancers, and autism.

A year later, the University of Rochester Medical Center established Rochester’s first primary care practice dedicated to caring for this patient population, where medical and oral health teams work side by side. The maximum capacity of patients was reached in just six months and the waiting list continues to grow rapidly.

“Working side-by-side with the medical team at UR Medicine’s Transitional Care Medicine [formerly Complex Care Center] allows us to provide comprehensive care for this patient population,” said Dr. Adela Planerova, director of Dental Services there. Dental patients at this clinic are numbered more than 2,700. “Having medical and dental providers side by side greatly improves clinical and functional outcomes, improves patient safety and satisfaction, and it reduces costs.” 

Dr. Nadia Stephens, EIOH Specialty Care

With the help of a generous donor, EIOH put a wheelchair-accessible SMILEmobile on the road, bringing dental treatment to children with special needs, refugee centers, nursing homes and other patients with limited access. 

EIOH further expanded its services by building a Specialty Care Clinic in its main building. With a priority on accessibility, the dental treatment rooms are large enough to accommodate specialized patient equipment. Air glide dental chairs are easily moved to allow for wheelchair access or to accommodate a stretcher. Special lifts are available to safely transfer wheelchair users into a dental chair, and bariatric chairs can accommodate patients who don’t fit in a standard dental chair. The close proximity and affiliation to Strong Memorial Hospital is another important feature, as patients with severe medical conditions may be at increased risk of complications during dental care, even when all precautions are taken.

Currently, patients with special needs and severe medical conditions are treated at EIOH in five clinics: Transitional/Complex Care, where physicians and dentists work side by side, Specialty Care, where dentist from all specialties treat patients with complex medical conditions, its mobile units, its hospital dentistry clinic, and under general anesthesia in the operating room.

For example, Brenda Bidwell is a patient who suffers from diabetes and is a double amputee. She is also prone to blood clots and has lymphedema. Eastman

Institute for Oral Health is the closest such facility to help her, despite the three-hour one-way ambulance ride to transport her.

Dr. Lipschitz standing next to Janelle, who is seated in wheelchair
Dr. Wayne Lipschitz with his patient Janelle

“Not every dentist can accommodate or are comfortable treating high-risk patients. Most don’t have the special training and equipment or know how to handle medical emergencies if they arise,” said Dr. Nadejda Stephens, the Specialty Care Clinic’s associate director. “We see patients from throughout the region who have very challenging medical conditions. It’s an honor and privilege to help people when other dentists aren’t able to help them.”

EIOH Pediatric Dentistry Chair Dr. Cynthia Wong received grant funding to develop online training modules for medical and dental professionals about treating individuals with intellectual and developmental disabilities.

“The academic institutions in New York State play an important role in addressing these disparities by training residents to competently and confidently provide quality care for patients with special needs,” said EIOH Director

portrait of Dr. Eliav
EIOH Director Dr. Eli Eliav

Eli Eliav, DMD, PhD. “And we must work more closely with our medical colleagues, because as the population ages, we will see many more patients with medically complex conditions.”

A local student chapter of the American Academy of Developmental Medicine and Dentistry is very active at URMC, where medical students and EIOH residents host many events to promote awareness, education and respect, as well as contribute posters at the national meeting. They work with Special Olympics for medical and dental screening at athletic and community events.

EIOH faculty and residents each year participate in URMC’s Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program, which offers collaborative interdisciplinary training focused on improving the health of children with neurodevelopmental disabilities and special healthcare needs.

Like our colleagues throughout New York, EIOH participates with NYSADC’s Fellowship to Address Oral Health Disparities, an important initiative funded by New York State. Qualified Fellows advance their training and expertise in special needs dentistry, while gaining teaching and research experience. After they finish the one-year program, they commit to providing care for people with special needs for at least one year in New York.