Tufts Dental Facilities serve the underserved
by Janet Walzer

Fred Holway, 54, has had multiple sclerosis for 25 years. It is not easy for Holway to get around, but that does not deter him or his caregivers when it is time to see the dentist. Via an ambulance and on a stretcher, Holway is brought to the Tufts Dental Facility (TDF) Serving Persons with Special Needs in Waltham, Mass.

Dr. John Morgan oversees the TDF clinics.© Mark Morelli

What makes this situation even more unique is that a dentist, hygienist and assistant, all of whom have been specifically trained to treat patients with special needs, will see Holway.

The number of dental professionals who are appropriately trained to treat this population is alarmingly low. According to surveys by the Academy of Dentistry for Persons with Disabilities in 1994 and 1995, dental schools average 12.9 hours of lecture time on the subject, but 65 percent of these schools report 10 or fewer hours of clinical experience. This dearth of training, coupled with the low rate of dentists who accept MassHealth, the Medicaid equivalent for dental care in Massachusetts, make it difficult for these patients to receive care.

ÒWhat the statistics show is a definite need for more training,Ó observes Dr. John Morgan, administrative director of TDF, which is headquartered at the Walter E. Fernald State School in Waltham. ÒTufts is in a better situation than most of the country,Ó he adds. As a result of a partnership that goes back to 1976 between the School of Dental Medicine and the Massachusetts departments of Public Health and Mental Retardation, Tufts dental residents and students have the opportunity to learn how to treat patients with special needs.

When Morgan became TDF director a year ago, one of his first items of business was to apply for a grant that would enhance the existing general practice residency program at Tufts. The $314,000 grant was awarded by the University of Massachusetts Medical School MassHealth Access Program to expand resident training to two residents at the Springfield TDF clinic, facilitate equipment upgrades for the various sites and augment patient care and education throughout the TDF system.

The program currently consists of five residents who are trained to diagnose and treat oral disease in patients with multiple disabilities and limitations at the TDF clinics in Waltham and Taunton, Mass. In this one-year postdoctoral program, residents work on becoming technically proficient in addition to becoming emotionally sensitive to their patientsÕ needs.

With eight TDF clinics throughout the state, more than 14,000 developmentally disabled persons are served annually through approximately 24,000 clinic visits. Because TDF clinics address a need not being met elsewhere in Massachusetts, ÒitÕs important to improve the comprehensive care delivery system that TDF clinics provide throughout the state,Ó comments Morgan.

Improvements to the delivery system are also critical because this group of patients continues to grow. It is estimated that 2 percent of the population in Massachusetts has developmental disabilities.

Statistics show that the number of decayed, missing and filled teeth is greater in people with disabilities than in the general population. So why is this population the most underserved in the state? According to Morgan, the problem lies not just with adequate training but with advocacy and access. ÒOur patients are not a vocal group,Ó Morgan points out. ÒPatients with disabilities require special treatment protocols. The number of dentists, dental hygienists and support staff members available to treat patients with special needs is limited, and often it is difficult for patients and their caregivers to locate those dental practitioners who are able to provide the required care.Ó

Dr. Gina Terenzi, patient Fred Holway and dental student Darren Drag.© Mark Morelli

Spend a morning at the TDF site in Waltham, and it is clear that more is going on than just maintaining teeth. The atmosphere is professional, yet laid back, and the camaraderie of the staff underscores their dedication to the patients. ÒPeople slowly begin to realize that this population is like any other population,Ó reflects Morgan. ÒMany of these disabilities can happen to any of us.Ó

Tufts dental students can choose to become familiar with this patient population by opting to do their clinical externships at Fernald. Throughout the year, two Tufts dental students do five-week rotations at Fernald. Included in the residency curriculum is a series of seminars that directly addresses the treatment of special needs.

Morgan says that TDFÕs relationship with Tufts is crucial in terms of its success. ÒItÕs important in the treatment of special needs patients to have these liaisons.

ÒMany people who first come here are not sure they want to be involved with the dental treatment of this group of patients,Ó Morgan acknowledges. ÒOne of the things that may frighten them, [they come to realize] is simply the patientsÕ means of communication.Ó

However, once practitioners take the plunge, they become involved in a professional activity that goes beyond expectation. As Morgan says, ÒItÕs a grounding experience that makes your [own] life better.Ó