When Asheville dentist Katherine Jowers sees a child with special needs, a little make-believe goes a long way. She calls the dental chair a beach chair, the bright overhead light the sun, and the sharp dentistry tools funny-looking silverware.
“You’ve got to make it familiar or else it will be scary,” Jowers explains, even if it means sitting on the floor with a coloring book or letting patients wear her dental assistant’s shoes. “If that makes them happy and they’ll smile for me, I’ll do it.”
Jowers, who’s worked in Mission Hospital’s children’s dental program for 15 years, sees about 25 special-needs patients per week — some of whom might not otherwise get dental care at all.
“The tricky thing about being special needs in North Carolina is that you’re automatically Medicaid. Then, you have to find a dentist who will see kids and take Medicaid — a very big challenge if you live in a rural area,” she notes.
But the challenges don’t necessarily end there. Sometimes even these dentists can’t allocate enough time for a full oral exam. “If they’re taking three times as long to see a child with special needs … frankly, time is money for them,” says Shawn Henderson, manager of Mission Children's Hospital.
Jowers says she allows at least 15 minutes more per special-needs child. But appointment times vary because of the broad range of people involved, each with unique challenges.
“Special needs is a huge term,” she explains. “You’re talking about children who may just have a little bit of Asperger’s syndrome, who may just not be socially as connected, all the way to someone who can’t feed themself, can’t bathe themself, can’t do anything for themself.”
In terms of dental care, Jowers says special-needs kids face the same problems as any other child, only more so.
“Depending on what your situation is, you may look different from other people — your mouth may have a different shape, you might have more crowded teeth — which makes those teeth harder to clean.”
Meanwhile, fear and uncertainty about what’s happening during a dental appointment can make it hard to persuade a child even to open his or her mouth, Jowers notes. “It’s a natural tendency not to want things in your mouth, which is a tough thing to overcome for a parent trying to help a special-needs child.”
To combat this, she advises all parents (but particularly those with special-needs kids) to begin cleaning their child’s teeth from day one. “Start that first week cleaning their mouth, getting in their mouth, getting them accustomed to that, because as they grow, the defensiveness will get worse.”
And sometimes, despite Jowers’ best efforts to make the appointment as familiar, fun and relaxed as possible, she still won’t be able to complete an oral exam.
When all else fails, Jowers resorts to seeing her patients in an operating room setting under general anesthesia. “You don’t do general anesthesia without good reason,” she explains. “It’s not that it isn’t a safe thing to do, but I can’t sit here and tell you that it’s without risk.”
And though Jowers concedes that it sounds like an extreme measure, she prefers it to sedation. “If you sedate a kid, you’re usually doing it with something they already take regularly,” she says. “But you don’t want over sedate them, so you kind of under-sedate them. Sometimes that works; sometimes it doesn’t work. Sometimes it works a little too well.”
General anesthesia, on the other hand, is a controlled environment. “You don’t have to risk harming the patient, and you don’t have to risk harming yourself,” she explains. It also enables the dentist to take care of everything at once, avoiding the need for additional appointments.
Finding a dental home
Still, Jowers says the greatest challenge for special-needs patients is finding a way they can continue getting dental care later in life.
“The thing with special needs is that you don’t grow out of it,” she explains. “Even though you’re trained to see children, you also have to be trained to see adults.” Accordingly, Jowers did her residency (at Charlotte’s Carolinas Medical Center) in hospital, not pediatric, dentistry.
And even though a lot of the resources available to special-needs patients are oriented toward children, she concludes, “We really want to find you a dental home, if there is one.”
— Send your local health-and-wellness news and tips to Caitlin Byrd at firstname.lastname@example.org, or call 251-1333, ext. 140.