Visiting the dentist can be a stressful experience for many, but for individuals with intellectual or developmental disabilities (IDD), this anxiety can be magnified, often preventing them from receiving necessary dental care. At Tufts University School of Dental Medicine (TUSDM), a new pilot program is working to bridge this gap by offering tailored, family-centered care designed to improve both access to and the experience of dental visits for individuals with disabilities.
The program, which began in November 2023, integrates a combination of telehealth and in-home visits to better serve patients with IDD. Funded by a $175,000 grant from the CareQuest Institute for Oral Health, this initiative aims to make dental services more accessible and reduce the barriers that many patients face when seeking care.
Dr. Athanasios Zavras, a public health dentistry expert at Tufts, stresses that the current healthcare model tends to prioritize disease treatment over prevention, particularly for individuals with disabilities. He explains that understanding how social factors influence oral health is crucial to providing comprehensive care.
Redefining Success for Dental Visits
The pilot program is focused on addressing not just the dental needs of IDD patients, but also their emotional and practical challenges, many of which extend beyond traditional dental care. The initiative employs a unique dental hygienist/social worker team, who visit patients at home and communicate with caregivers via telehealth. Katie Walker, a hygienist, and Niurka DeJesus, a social worker, have already visited and provided care for 10 patients with various disabilities.
For these patients, a successful dental visit may not always look like a routine exam. According to Zavras, a visit might simply involve opening the patient’s mouth and assessing their oral health. “Even that small moment gives us an opportunity to build a care plan tailored to each patient’s specific needs,” he says.
Anxiety and Trust Building
Caregivers involved in the pilot have shared positive feedback about the program’s impact on reducing anxiety. For many patients, long car rides and past traumatic dental experiences create additional stress. However, through the pilot, dental hygienists and social workers are able to build rapport with patients in a familiar environment, which is less intimidating than a dental clinic.
Walker and DeJesus emphasize the importance of small, personalized strategies to make dental care more approachable. One parent, for example, shared that their child pulled people’s hair when distressed. Another noted that a specific hand gesture was effective in signaling when an exam should end. These seemingly small adjustments have made a significant difference in the patients’ comfort and cooperation during exams.
Training and Standardization for Better Care
Beyond patient care, the pilot program is also working to standardize how dental specialists approach patients with IDD. This initiative aims to educate faculty members at Tufts and extend the training to alumni and private practitioners to ensure more inclusive care across the board.
As part of this effort, Tufts has developed a new intake form that goes beyond the typical dental questionnaire. This comprehensive tool, known as the Tufts Functional Assessments For Oral Health, evaluates a patient’s ability to cooperate with dental care, their tolerance for dental procedures, and how their disabilities might affect their oral health care experience.
Tailored, Personalized Care
By leveraging the detailed intake forms, Walker and DeJesus are able to understand their patients before even meeting them. They connect with families and caregivers via telehealth, ensuring that they’re familiar with the patient’s needs and preferences. When they visit homes, they bring along dental tools, show patients what to expect, and offer oral hygiene guidance to caregivers. Being treated in a patient’s home also eliminates the stress associated with visiting a dental office, allowing for a more relaxed and effective experience.
Zavras also highlights the challenge that individuals with autism face when it comes to dental care. For those who require significant support, trips to the dentist may be nearly impossible. However, through the in-home visits, many of these patients have been able to receive dental exams in a familiar and less overwhelming setting.
In addition to dental care, DeJesus also screens families for any additional support needs, recognizing that caregivers often overlook their own well-being while focusing on their loved ones. Zavras points out that providing support to caregivers is an essential part of the program, as it extends beyond the typical responsibilities of a dentist.
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