When I was a dental student, a 5-year-old child with special needs started coming to the clinic for dental care. I remember him as inquisitive but lacking the ability to focus or respond correctly to some verbal prompts. He would sit quietly in his mom’s lap on the dental chair, but when we approached him holding any instruments—including a toothbrush—he would fight so much that once he even vomited. Three years later, he was still a patient when I returned to the school as a Touro University Special Needs Dental Care fellow. Like before, he needed to sit on his mother’s lap, and the process was touch and go, but, by now, having received the proper training to help patients with special needs, I eventually convinced him to sit on his own, and from that point on, treatment had never been so smooth.
When an anesthesiologist I had worked with during my regular dentistry rotations told me that Touro was launching, through NYSADC, a Fellowship to Address Oral Health Disparities, I signed on without even knowing that it is difficult for people with special needs to receive proper dental care or the scope of the issue.
And it is significant: There are approximately 15,000 New Yorkers with severe to profound intellectual disabilities. These individuals have more complex oral health care needs than others and are prone to poor oral health. 11 percent of those with intellectual and developmental disabilities (IDD) don’t have any teeth, compared to 2 percent for the general population. Yet no region in the state can accommodate the access to the dental care they require. Only 10 percent of dentists surveyed by the American Academy of Pediatric Dentistry said they treat this subsection of the community “often.” At the same time, 70 percent reported they rarely or never treat such special needs patients. The scarcity of dentists available to the special needs community is understandable, considering that treating a person with special needs requires one to work harder than for other patients. The additional time it takes to treat those with IDD reduces a dentist’s earning power.
My perspective is probably a little different than most, most likely a result of my unconventional background. By the time I graduated from high school, my family had moved 11 times, six of which were across international borders. I also volunteered for two years as a full-time church service representative in Brisbane, Australia, with a focus on the Asian community, so from an early age, I needed to learn how to adjust to different ways of living and thinking to make friends.
Through my exposure to various lifestyles and cultures throughout the world, I’ve found that a strong basic human desire, whether young or old, is to be understood. This is especially true for patients who don’t have the capacity to express themselves as completely as they may desire. During my time abroad, I learned the basics of Chinese, Japanese, Cantonese, Samoan, and Korean to connect with people, but more important were the interpersonal skills I developed and took advantage of throughout dental school and my residency, and now in my fellowship. My goal is to use these communication skills to help every patient I encounter feel important while meeting individual dental needs.
When I first moved to Shanghai as a boy, my early view of dentistry was that of a man on the street who would cut hair and also extract teeth. Though, thankfully, times have changed, I feel a deep concern for the needs of people who live in poverty and a desire to provide access to quality dental care to people of every socioeconomic level. My multicultural life experience and commitment to the needs of the underserved motivate me to become the type of dentist that can make a positive impact not only in the United States but throughout the world.
This is what’s so rewarding about treating patients with special needs. Each comes in at a different level of cooperation and has a different dental history. Some will allow me to treat them without them batting an eye, and some will fight and scream the whole time. What matters is that whenever my patients come in, I try and improve their experience just a little bit in an effort to earn their trust so that by the next appointment, I can clean one more tooth than I did before.
There have been countless times when an assistant will tell me that so-and-so is here, that last time we couldn’t take X-rays, or couldn’t clean their teeth, or they wouldn’t even open their mouth. But having had the proper training, when I work with patients with special needs, they are more cooperative than before. My assistants have long since stopped prefacing our patients because people will surprise you with the right attitude and patience.
Someone recently asked whether I had an epiphany that made me want to treat the special needs community. I responded that I have one weekly: days where I think this is the kind of work I want to do for the rest of my career. Monetarily, I’m making pennies next to my colleagues that graduated at the same time as I did, but I’ve never been more at peace with myself and felt as deserving to be as blessed as I am in my life.
Alexander Dorrough is a dentist.