By Jasmine E. Crenshaw

Lack of Dental Access for Patients with Disabilities

Patients with disabilities across the state can often deal with many factors that hinder their access to adequate dental care. These factors include proximity to dentists, costs of care, and the lack of knowledgeable health care providers with expertise working with this population. “Dentists receive far too little training to care for individuals with developmental disabilities. This frequently leads to a feeling of inadequacy providing care for this population. While the Americans with Disabilities Act has helped ensure wheelchair ramps and doorways give special patients access to offices, few offices provide sensory rooms or safe spaces for patients on the autism spectrum. Finally, most dental offices are very busy while patients with developmental disabilities need extra time and patience during their care,” Dr. Stephen C. Mitchell, the Director of the UAB Sparks Clinic, explaining the compounding reasons that care for patients with special health care needs is needed. Proximity to care also remains an issue in Alabama, where 21% of its 67 counties, all identified as rural, were documented in 2019 by the Alabama Department of Public Health to have access to only 9.8% of the state’s dentists. Because of these issues and others, many patients, including pediatric ones, may deal with an increased level of periodontal disease.

2021-22 Alabama Schweitzer Fellows Jenai Bostic and Carolyn Grace Griffin first learned about this issue in their Special Patient Care course at the UAB School of Dentistry (SOD), which inspired them to focus on it as their Fellowship project. “We were also interested in servicing this population because access to dental care and delivery of quality dental services are important with patients with special needs”, the partners said. Jenai and Carolyn Grace aim to create a connection between these patients seeking care and practitioners wanting to provide care. The Fellows noted that general dentists are more likely to see individuals with disabilities in their patient population for a multitude of reasons, including availability where they live and Medicaid acceptance, so it would be best for them to be knowledgeable about serving these patients. 

Bridging the Divide Between Patient and Provider

Jenai and Carolyn Grace’s first step to start bridging the divide between patient and dentist was to identify a community site partner, and they found one in the UAB Sparks Dental Clinic. The only of its kind in Alabama, the Sparks Dental Clinic specializes in dental care for patients with disabilities and additional special health care needs across Alabama. “We take time with patients and work to desensitize them to dental care. We are willing to work with patients who cannot cooperate and know how to manage them safely and effectively,” Dr. Mitchell, the Director of the Clinic noted.” Our residents and students get direct, hands-on experience providing care and also get to see how those with more experience manage the patients.” The Fellows chose this partner so they can witness and learn from them about properly treating this population. With the expertise and assistance of the UAB Sparks Dental Clinic, Jenai and Carolyn Grace’s project focuses on two elements: creating and disseminating both a story video for patients and their caregivers to view pre-treatment and training modules for second-year UAB School of Dentistry students. Currently, they have begun filming clips for their dental story and collaborating with SOD staff and students to outline the training modules. Dental social stories are commonly included in the dental services, including at the Sparks Dental Clinic, for this patient population to provide them with a sense of ease and comfort prior to or during their appointment. “Many times, families and patients don’t know what to expect at dental visits. Some have had bad past experiences and don’t want to face the same thing again. This project provides families videos they can watch before coming to an appointment to help prepare them for what to expect. The hope is this will relieve some anxiety and help us more quickly become a team, doctors and family members, providing the best oral health for the patient,” Dr. Mitchell explained. By creating the social story, the Fellows hope to provide an accessible visual overview about what to expect at their dental visit, decreasing feelings of stress.

Six Months Into Being Alabama Schweitzer Fellows

Having started their Fellowship journey six months ago, Jenai and Carolyn Grace have encountered many experiences and lessons so far, including the joy and excitement received from patients at their visit. “[The patients] are the sweetest individuals. They come in with the biggest smiles, the warmest hugs, and the most optimistic personality. It excites me to see them come in nervous, but with the wonderful training by the current pediatric residents, the patients are calm and leave happy with a sticker on their shirt,” Jenai reflected. As Fellows, they have learned about data collection methods and using those skills to build the learning modules for their fellow School of Dentistry students. Jenai and Carolyn Grace are one of three collaborative partnerships within the 2021-22 class of Alabama Schweitzer Fellows, which was not by accident. Their friendship is the genesis of their Fellowship experience. “We both work very hard and it has been nice to have someone who equally wants to initiate change in the same way you do. We were friends before the project and we are happy that this fellowship has strengthened our friendship.” Carolyn Grace noted. Through their friendship has blossomed a project to make improvements for patients with disabilities seeking dental care.