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ATSU-MOSDOH, Affinia Healthcare, Barnes-Jewish Hospital, Washington University team up

Sallye (CQ) Holland says her daughter, Cassandra Holland is now pain-free and proud of her smile after undergoing oral surgery provided Special Needs Dental Surgery Program. The collaboration between AT Still University Missouri School of Dentistry and Oral Health, Affinia Healthcare, Washington University School of Medicine and Barnes-Jewish Hospital. Community partnership enables special needs individuals to receive full anesthesia for dental services. Cassandra, 42, had been unable to get dental care due to cerebral palsy and a couple of other co-morbidities, including seizures. Both were photographed in their home in north St. Louis, on June 2, 2022. MATT MILLER/WASHINGTON UNIVERSITY SCHOOL OF MEDICINE

Some people with severe physical, mental, or developmental disabilities are only able to undergo dental procedures while under general anesthesia, but such specialized care is expensive and hard to find. As a result, many people with special needs are unable to access routine – or even emergency – dental care and end up with rotting teeth, inflamed gums, and chronic dental pain making it difficult to eat, talk, and function comfortably and confidently in daily life.

A program to provide dental care to patients with severe disabilities in the St. Louis area has been established by A.T. Still University-Missouri School of Dentistry & Oral Health (ATSU-MOSDOH), Affinia Healthcare – a federally qualified health center, Barnes-Jewish Hospital, and Washington University School of Medicine in St. Louis. Patients in the program need specialized care for severe dental problems that may only be provided under general anesthesia in a hospital.

“Half a million people in the St. Louis area are living with disabilities, but few dentist offices accept special-needs patients, and even fewer accept Medicaid,” said Robert J. Schmidt, DDS, MS. Dr. Schmidt is an assistant professor and the former specialty care unit director of special needs dentistry at the St. Louis Dental Center. The St. Louis Dental Center is a partnership with ATSU-MOSDOH and Affinia Healthcare. “This program is a way for adult patients with difficulty and higher acuity who have severe dental problems and have been unable to undergo treatment in a general dental setting to receive comprehensive dental care under general anesthesia. This collaboration among four exceptional institutions – Barnes-Jewish Hospital, the highest ranked hospital in Missouri; ATSU-MOSDOH, a socially responsible dental school; Washington University School of Medicine, and Affinia Healthcare, a stellar community health center – provides immediate benefits to vulnerable people with disabilities.”

The program was piloted in the fall 2021 and launched this year, with the help of Affinia Healthcare, a nonprofit dedicated to providing care to underserved populations in the St. Louis area. From the Affinia Healthcare diverse patient pool, ATSU-MOSDOH dental faculty members and students identify people who have special needs and arrange for them to receive dental care at Barnes-Jewish Hospital. Twice a month, one operating room at the hospital is dedicated to such patients, and care is provided by a team of ATSU-MOSDOH dentists, Washington University physicians, and Barnes-Jewish clinical staff. The hospital purchased specialized equipment for dental surgery that includes a portable dental cart and a portable X-ray machine. Washington University and Barnes-Jewish Hospital are providing their services at no charge to the patients. Affinia Healthcare patients are generally covered by MO Healthnet for these services, or they are encouraged and assisted to apply for coverage. Those not eligible for coverage are charged in accordance with a deeply discounted fee schedule for services.

“All parties worked diligently to achieve this pioneering agreement, making it possible to provide a higher level of dental care for patients with special needs,” said Dwight McLeod, DDS, ATSU-MOSDOH dean. “We are the only such public-private partnership in eastern Missouri dedicated to special needs dental care for underserved populations. Our experienced team of highly skilled providers deliver compassionate dental care, at an affordable cost, close to home. This is the kind of access to dental care that families, loved ones, and advocates for people with severe mental and developmental disabilities have wanted and have been asking to receive for many years.”

This collaboration is part of a broader effort to ensure access to quality emergency and comprehensive dental care for all residents of St. Louis led by Affinia Healthcare and ATSU-MOSDOH. In 2015, the two established the St. Louis Dental Center to address the paucity of oral health services for underserved, vulnerable populations in St. Louis and provide comprehensive, affordable oral health-care services to patients of all ages. The center started providing special-needs dentistry in 2017 and has since treated 230 patients with special needs. But, some patients’ needs surpass the capabilities of even the special-care unit at the center.

“People with special needs sometimes seek care for acute dental pain in our emergency department, but because of the severity of other patients’ illnesses and injuries, patients with a tooth problem may find themselves waiting for a long time to be seen by our care team,” said Jackie Martin Jr., MD, the vice president of perioperative services at Barnes-Jewish Hospital. “We would try to refer special needs dental patients to a clinic, but the nearest one that provides this kind of specialized care is in Kansas City, and patients often don’t have the means to travel there. These patients were not getting care in the community, and if we didn’t find a way to provide it, who would?”

Added Dr. Alan Freeman, president and CEO of Affinia Healthcare: “We consider this to be a landmark achievement in our ability to provide comprehensive care to our particularly vulnerable and underrepresented patient populations.”

The reasons people need to receive dental care under general anesthesia in a hospital vary widely.  Many have intellectual or developmental disabilities preventing them from effectively communicating with dentists, or which make the experience of undergoing a dental exam while awake unbearably confusing and frightening. Some have movement or muscular disorders interfering with opening the mouth, swallowing, or holding still. Certain co-existing medical conditions such as brain injuries, spinal cord injuries, and obesity also may indicate a need for general anesthesia.

Such patients require the services of a fully staffed hospital, including anesthesiologists to care for patients before, during, and after administering anesthesia; radiologists to perform and interpret imaging; hospitalists to care for patients who need to be admitted; ear, nose, and throat physicians to consult with dentists on complicated cases; and clinical lab scientists to perform blood work and other tests.

“These are patients who, unfortunately, have hurdles to obtaining treatment,” said Ivan Kangrga, MD, PhD, a professor of anesthesiology at Washington University and the director of quality and safety for perioperative services at Barnes-Jewish Hospital. “I’m happy and proud to be part of a team that is providing top-level care to this underserved population of dental patients with special needs.”

Repairing years of neglect takes hours, so only two patients with special needs may be treated a day. There are 80 people on the waiting list, and the number is growing as more people learn of the program.

“We add one to two new patients to our list every week,” Dr. Schmidt said. “These are often people in a lot of pain. Before this program, we would have to tell parents that there was no one around to take care of their son or daughter. It was really discouraging. Everyone deserves respect and care. I am grateful that we can provide this service for some of the most vulnerable members of our community.”


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