On any given afternoon in one of the eight operatories at USC’s Special Patients Clinic, you might find a woman with Down’s syndrome listening to her favorite Hannah Montana song, a man with congenital heart disease with his wife and oxygen tank in tow or a patient who’s been living with AIDS since the ’80s.
“Patients may come in with caregivers, service dogs, using wheelchairs or barreling in at 100 miles per hour,” said Janet Lent, assistant professor of clinical dentistry at the Herman Ostrow School of Dentistry of USC, who has worked in the Special Patients Clinic for a decade.
For 30 years now, the clinic has provided the highest care for patients with physical, psychological or medical disabilities, as well as the frail elderly. Considered medically compromised and complex, these patients often have been turned away by multiple private practitioners.
“People with special needs often have difficulty maintaining their oral health or finding dentists who understand their disabilities and know how to modify a typical treatment to effectively provide care,” said Roseann Mulligan, Charles M. Goldstein Professor of Community Dentistry and founder of the clinic. “A number of years ago, it was clear to me that not everyone was receiving care, and I set about creating a clinic where people with disabilities could get that care and were welcome.”
The practice has grown
The clinic, which started out treating about 100 patients a year, now provides comprehensive care to more than 700 patients annually, in addition to providing routine preventive services to a larger patient pool.
“We see many patients with HIV/AIDS, older adults with significant multiple morbidities, patients with dementia, patients who are pre- or post-organ transplant or going through chemotherapy,” said Mulligan, who also serves as USC’s associate dean for community health programs and hospital affairs.
The clinical staff is also adept at treating patients with multiple chronic and rare diseases.
We’re not shy about studying a condition and considering how we might modify care.
“We’re not shy about studying a condition and considering how we might modify care,” Mulligan said.
Piedad Suarez, associate professor of clinical dentistry and co-director of the clinic, recalls such a case. She supervised the care of a patient with an extremely rare skeletal disorder.
“At the beginning, he was afraid because he didn’t have a lot of exposure to dentists, but little by little he allowed us to work with him,” she said of the patient, who stood about 3-feet tall. “We learn with some of these patients because there’s not a lot of literature written about their conditions.”
More than treating patients, during the past 30 years, the clinic has provided a training ground for 6,000 dental and dental hygiene students. Every student at the dental school must complete a week-long clinic rotation peppered with quizzes and comprehensive exams. Subsequent to that required week, students may volunteer to return to the clinic for more opportunities to treat special needs patients.
“We offer a rigorous experience so that students really understand how to deal with this population because there are usually huge consequences to patients if precautions and modifications are not taken,” Lent said. “When you’re 100 years old or medically compromised, the consequences tend to be worse.”
Before and after seeing patients, students present a medical or behavioral patient workup, as well as any modifications needed for treatment.
“A student might not be assigned to directly care for the ALS patient, but during their clinical exposure they will observe the treatment modifications that another student in the same rotation will be utilizing with this patient,” Lent said. “In this sense, we are training dentists for the 21st century in a very important way.”
By 2030, 20 percent of Americans will be over 65, and unlike generations before, these baby boomers “are going to come with teeth and chronic medical problems that are happening to obese America,” Lent said. “When you become a dentist in this society at this time, you’re going to see a lot of older patients, and you have to know who’s sitting in your chair and know the modifications necessary to deliver care safely and effectively.”
Additionally, 12 percent of Americans or 38 million people have a severe disability, according to the 2012 U.S. census.
“Many dental students get experience with [patients with disabilities] only through lecture classes,” Lent said. “Ostrow is deliberately educating every student with a framework of how to manage medically complex and geriatric patients.”
Taking appropriate measures
During their rotation, students learn modifications to care for special needs patients, including how to minimize stimuli for cognitively impaired patients, and behavior modification tools and sedation modalities for patents with developmental disabilities.
“We’re trying to create an awareness of these issues and help students to take appropriate measures,” Mulligan said.
Additionally, students learn the protocols for researching medically compromised patients, including interpretation of necessary laboratory results or requesting specific medical information via a consultation with the patient’s treating physicians.
“When [students] enter private practice, they’re better trained and more competent to treat any patient who walks in the door,” Suarez said.
Students reap other rewards from their time in the clinic. “If you like people and stories and courage, oh, what a place to be,” Lent said. “It’s daily inspiration.”
For Mulligan, serving this population is also personal.
“As a child, I spent lots of time as a patient. The people who took care of me made quite an impression,” she said. “My goal has always been to be one of the caring people … like those who had cared for me.”