John Koch couldn’t tolerate going to the dentist, and his family didn’t know what to do about it.
Koch, 54, has Down syndrome and lives in a group home in Commerce Township. He had been making regular visits to the dentist without incident since he was a toddler, but in his 40s, he suddenly became apprehensive and no longer wanted to go. His family couldn’t figure out why, and, like many adults with special needs, Koch was unable to clearly articulate what was on his mind. Even valium couldn’t soothe him sufficiently, says his sister, Barbara Hoffman.
Then, one day, the group home called Hoffman to tell her one of Koch’s teeth had fallen out.
“That’s when we realized we needed to really step up,” Hoffman says. She and Koch’s two other sisters began searching for a dentist who treated adult patients with special needs. Eventually they found the Mercy Dental Center at St. Joseph Mercy Oakland in Pontiac, run by Drs. Craig Spangler and Nisha Yusaf.
Koch wasn’t the only person with special needs who struggled with visits to the dentist; when Hoffman called for an appointment, she was met with a 13-month waiting list.
St. Joseph Mercy Oakland is a nonprofit hospital with a mission to treat the underserved. The dental program got its start in 2011 as a response to community demand for greater access to dental care, both for low-income and special-needs populations. It is the only private hospital in the state with a dental program that provides care for adults with special needs, and it is the only one with a dental residency program.
“We started with two residents and a 700-square-foot clinic in the old physicians’ mailroom,” says Spangler, chair of the division of dentistry and oral and maxillofacial surgery. Spangler, who is director of St. Joseph Mercy’s general dental residency program, also has a private practice in Bloomfield Hills. “From there, we just started to work. Along the way we’ve had many generous and wonderful donors for operations and for construction. People realized no one else was doing what we were doing.”
Many people with developmental disabilities can’t sit still in a chair or understand what’s happening to them during a dental exam, and dentists can’t make much headway with uncooperative patients. The result is that many adults with special needs receive little to no dental care, which can wreak havoc on their overall health and well-being.
“If I have cerebral palsy and can’t communicate, does anybody know if I have dental pain or not?” Spangler asks. “I’ve had [patients] banging their head against the wall, and they’re being put on Haldol [an antipsychotic medication that improves manic moods and behaviors]. Did anyone do a dental exam on [them]? Maybe [they’re] in a huge amount of pain.”
When a new patient arrives at the Mercy Dental Center, the staff assess if they can be treated with special accommodations.
“I took John to the first appointment with Dr. Spangler, who pretty much walks on water in my opinion,” Hoffman says. “He was incredibly kind and gentle and open. He talks to John, not at him or around him. That’s really important; John may be developmentally disabled, but he’s not stupid. He’s pretty keen on picking up on people’s behaviors. Dr. Spangler really treated John as an equal.”
For patients the center can’t treat safely and adequately while conscious, the recommendation is treatment in an operating room under general anesthesia, where the staff starts by taking X-rays and then immediately tackles the most urgent issues within the four-hour window that protocol allows for the patients’ anesthesia.
“For most of those patients, we can’t even get a good look in their mouth, because they can’t sit still or are combative,” Yusaf says. “The most difficult part is the lag in care that they’ve had. If I see someone in their 50s who hasn’t had dental care ever, or since their 20s, we’re in defense mode. We see a lot of periodontal disease; we do cancer screenings. We do what we can in a four-hour window: ‘What are the things we really need to get done today?’ ”
Koch required general anesthesia, and the Mercy team discovered seven more loose teeth that had to be removed. (Anatomical and soft-tissue developmental anomalies commonly seen in people with Down syndrome can lead to dental problems.) He now returns every six months for checkups and no longer requires general anesthesia each time.
“It has changed so dramatically for John, who hated to go to the dentist,” Hoffman says. “Now, he walks in and hugs Dr. Spangler. The kindness is a really key thing.”
“You’d be surprised how many patients we can treat just by changing our approach,” Yusaf says. “We treat a whole variety of patients with Asperger’s and autism. We can dim lights, we can talk slowly. We often can get through the less invasive procedures.”
David Loeffler, of Oak Park, took his son, Zev, to Mercy four years ago after they were referred by Dr. Murray Baruch, whose practice is in West Bloomfield. Zev, now 38, has autism and epilepsy and communicates at the equivalent of a typical 3-year-old’s level. Over the years, he became less and less able to tolerate dental visits.
“Dental work is really important, and it’s one of many big problems that people with disabilities encounter,” Loeffler says. “Most dentists are not able to work successfully with this population. For people with autism, you need something like the situation at St. Joe’s. Everybody there, even the intake staff, they’re very helpful. We really appreciated that they brought us in ahead of time and explained what’s going on. We weren’t just rushed through; we felt confidence, and that’s really important.”
The center is expanding its space and will nearly triple in size this year, with additions including a fifth treatment room. The expansion extends to the residency program; the center will host four dental residents, up from two.
Dental students are not obligated to complete a residency. Mercy’s one-year program is intended, in part, to increase the number of dentists who are trained to treat adults with special needs.
“That has been really important to me and to my family, because they’re bringing people in who, in most cases, I don’t believe have had much experience with the developmentally disabled population,” Hoffman says. “Dr. Spangler is so good about teaching them: ‘If you cradle their head this way, it limits the movement and it’s more comforting.’ The technique just knocks my socks off.”
Spangler, who credits the hospital’s administration for its enthusiastic support of the residency program, says the hope is that residents will take their skills into the communities in which they ultimately practice.
“I hope we develop a spirit and philosophy for them of inclusivity,” Spangler says. “I want to be able to treat everyone. My hope is not only will they be able to see [special-needs] patients in their offices, but can do this at hospitals around the country.”
Where to Seek Special Care
Michigan is home to a small number of dentists trained to treat adults with special needs. If you are seeking care for someone, you can request they be placed on the waiting list at the Mercy Dental Center, or contact one of the following referral sources to connect with a dentist who is able to provide services in their office. (Patients who need general anesthesia require specialized treatment in a hospital.)
Tri-County Dental Health, part of Jewish Vocational Services, serves as a clearinghouse for patients seeking care. Visit dentalhealthcouncil.org for more information.
The Special Care Dentistry Association maintains a list of trained providers at scdaonline.org; as does the Oakland County Dental Society, at oaklanddentalsociety.com.