Bulletin of Dental Education

Collaboration Provides In-hospital Dental Care for Adults With Disabilities

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A.T. Still University Missouri School of Dentistry & Oral Health, Affinia Healthcare, Barnes-Jewish Hospital, Washington University Team Up to Provide Groundbreaking Services

Some people with severe physical, mental or developmental disabilities are only able to undergo dental procedures while under general anesthesia, but such specialized care is expensive and hard to find. As a result, many people with special needs are unable to access routine—or even emergency—dental care and end up with rotting teeth, inflamed gums and chronic dental pain making it difficult to eat, talk and function comfortably and confidently in daily life.

A program to provide dental care to patients with severe disabilities in the St. Louis area has been established by A.T. Still University Missouri School of Dentistry & Oral Health (ATSU-MOSDOH), Affinia Healthcare (a federally qualified health center), Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis. Patients in the program need specialized care for severe dental problems that may only be provided under general anesthesia in a hospital. 

“Half a million people in the St. Louis area are living with disabilities, but few dentist offices accept people with special needs as patients, and even fewer accept Medicaid,” said Robert J. Schmidt, D.D.S., M.S., Assistant Professor and the former Specialty Care Unit Director of Special Needs Dentistry at the St. Louis Dental Center. The St. Louis Dental Center is a partnership with ATSU-MOSDOH and Affinia Healthcare. “This program is a way for adult patients with difficulty and higher acuity who have severe dental problems and have been unable to undergo treatment in a general dental setting to receive comprehensive dental care under general anesthesia. This collaboration among four exceptional institutions—Barnes-Jewish Hospital, the highest ranked hospital in Missouri; ATSU-MOSDOH, a socially responsible dental school; Washington University School of Medicine; and Affinia Healthcare, a stellar community health center—provides immediate benefits to vulnerable people with disabilities.” 

The program was piloted in the fall 2021 and launched in 2022 with the help of Affinia Healthcare, a nonprofit dedicated to providing care to underserved populations in the St. Louis area. From the Affinia Healthcare diverse patient pool, ATSU-MOSDOH dental faculty members and students identify people who have special needs and arrange for them to receive dental care at Barnes-Jewish Hospital. Twice a month, one operating room at the hospital is dedicated to such patients, and care is provided by a team of ATSU-MOSDOH dentists, Washington University physicians and Barnes-Jewish clinical staff. The hospital purchased specialized equipment for dental surgery that includes a portable dental cart and a portable radiograph machine. Washington University and Barnes-Jewish Hospital are providing their services at no charge to the patients. Affinia Healthcare patients are generally covered by MO Healthnet for these services, or they are encouraged to and assisted with applying for coverage. Those not eligible for coverage are charged in accordance with a deeply discounted fee schedule for services.

“All parties worked diligently to achieve this pioneering agreement, making it possible to provide a higher level of dental care for patients with special needs,” said Dwight McLeod, D.D.S., ATSU-MOSDOH Dean and Professor. “We are the only such public-private partnership in eastern Missouri dedicated to special needs dental care for underserved populations. Our experienced team of highly skilled providers deliver compassionate dental care, at an affordable cost, close to home. This is the kind of access to dental care that families, loved ones and advocates for people with severe mental and developmental disabilities have wanted and have been asking to receive for many years.”

This collaboration is part of a broader effort to ensure access to quality emergency and comprehensive dental care for all residents of St. Louis led by Affinia Healthcare and ATSU-MOSDOH. In 2015, the two established the St. Louis Dental Center to address the paucity of oral health services for underserved vulnerable populations in St. Louis and provide comprehensive, affordable oral health care services to patients of all ages. The center started providing special needs dentistry in 2017 and has since treated 230 patients with special needs. But some patients’ needs surpass the capabilities of even the special care unit at the center. 

“People with special needs sometimes seek care for acute dental pain in our emergency department, but because of the severity of other patients’ illnesses and injuries, patients with a tooth problem may find themselves waiting for a long time to be seen by our care team,” said Jackie Martin Jr., M.D., the Vice President of Perioperative Services at Barnes-Jewish Hospital. “We would try to refer special needs dental patients to a clinic, but the nearest one that provides this kind of specialized care is in Kansas City, and patients often do not have the means to travel there. These patients were not getting care in the community, and if we didn’t find a way to provide it, who would?”

The reasons people need to receive dental care under general anesthesia in a hospital vary widely. Many have intellectual or developmental disabilities preventing them from effectively communicating with dentists, or which make the experience of undergoing a dental exam while awake unbearably confusing and frightening. Some have movement or muscular disorders interfering with opening the mouth, swallowing or holding still. Certain existing medical conditions such as brain injuries, spinal cord injuries and obesity also may indicate a need for general anesthesia. 

Such patients require the services of a fully staffed hospital, including anesthesiologists to care for patients before, during and after administering anesthesia; radiologists to perform and interpret imaging; hospitalists to care for patients who need to be admitted; ear, nose and throat physicians to consult with dentists on complicated cases; and clinical lab scientists to perform blood work and other tests.

“These are patients who, unfortunately, have hurdles to obtaining treatment,” said Ivan Kangrga, M.D., Ph.D., a Professor of Anesthesiology at Washington University and the Director of Quality and Safety For Perioperative Services at Barnes-Jewish Hospital. “I am happy and proud to be part of a team that is providing top-level care to this underserved population of dental patients with special needs.”

Repairing years of neglect takes hours, so only two patients with special needs may be treated a day. There are 80 people on the waiting list, and the number is growing as more people learn of the program. 

“We add one to two new patients to our list every week,” Dr. Schmidt said. “These are often people in a lot of pain. Before this program, we would have to tell parents there was no one around to take care of their son or daughter. It was really discouraging. Everyone deserves respect and care. I am grateful that we can provide this service for some of the most vulnerable members of our community.”

Curiosus Magazine, published by Barnes-Jewish Hospital and Washington University Physicians, also features this story. Watch the story of Sallye Holland with her daughter Cassandra, who received needed extensive dental care here

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A.T. Still University Missouri School of Dentistry & Oral Health

Established in 2013, A.T. Still University’s Missouri School of Dentistry & Oral Health (ATSU-MOSDOH) offers an innovative curriculum with an emphasis on public health, leadership and practice. ATSU-MOSDOH addresses the oral healthcare disparities in Missouri and across the nation. In addition to the issues of oral health and skills of dentistry, students learn from and are encouraged to become caring, community-minded healthcare providers.

Affinia Healthcare

Established in 1906, Affinia Healthcare is a dynamic and transformative health system, providing affordable primary and preventive healthcare, including medical, dental, and behavioral health services across 12 locations in St. Louis. Affinia Healthcare is a community health center, 501 (c) (3) nonprofit organization, and is accredited through the Joint Commission and National Committee for Quality Assurance organizations.

St. Louis Dental Center

The St. Louis Dental Center is a state-of-the-art 79,000-square-foot clinical education facility with 93 dental chairs. Dental care is provided by A.T. Still University Missouri School of Dentistry & Oral Health faculty and dental students and by Affinia Healthcare dentists and staff. To learn more about St. Louis Dental Center services, visit stldentalcenter.org or Facebook.com/stldental.center .

About the Partnership

In 2015, A.T. Still University’s Missouri School of Dentistry & Oral Health (ATSU-MOSDOH) and Affinia Healthcare established a unique partnership to address the critical shortage of dentists, and paucity of oral health services for underserved, vulnerable populations in St. Louis, who lack access to high quality oral healthcare. Through this innovative partnership, ATSU-MOSDOH’s third- and fourth-year dental students complete their hands-on clinical education curriculum at the St. Louis Dental Center in a community health center learning environment, providing dental care to Affinia Healthcare’s patients. 

Affinia Healthcare’s experienced clinical operations and skilled oral healthcare teams are essential to the partnership because of its comprehensive primary medical, dental, and behavioral health services provided to over 43,000 patients per year, of which 90% have incomes under 100% of the federal poverty line. Collaboratively, ATSU-MOSDOH and Affinia Healthcare help dental students develop a comprehensive understanding of the negative determinants of health on the dental and overall health of patients at the St. Louis Dental Center, while improving access to dental care for otherwise underserved individuals in our community. 

About Washington University School of Medicine
Washington University School of Medicine (WashU Medicine)   is a global leader in academic medicine, including biomedical research, patient care and educational programs with 2,700 faculty. Its National Institutes of Health (NIH) research funding portfolio is the fourth largest among U.S. medical schools, has grown 54% in the last five years, and, together with institutional investment, WashU Medicine commits well over $1 billion annually to basic and clinical research innovation and training. Its faculty practice is consistently within the top five in the country, with more than 1,790 faculty physicians practicing at over 60 locations and who are also the medical staffs of Barnes-Jewish and St. Louis Children’s hospitals of BJC HealthCare . WashU Medicine has a storied history in M.D./Ph.D. training, recently dedicated $100 million to scholarships and curriculum renewal for its medical students and is home to top-notch training programs in every medical subspecialty as well as physical therapy, occupational therapy and audiology and communications sciences.

About BJC HealthCare
BJC HealthCare (BJC) is one of the largest nonprofit health care organizations in the United States, delivering services to residents primarily in the greater St. Louis, southern Illinois and southeast Missouri regions. Serving the health care needs of urban, suburban and rural communities, BJC includes 14 hospitals and multiple health service organizations. Services provided by BJC include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care, and hospice. BJC’s nationally recognized academic hospitals, Barnes-Jewish and St. Louis Children’s hospitals, are affiliated with Washington University School of Medicine.

Media Contact

Judy R. Goodman, Lents Mazur & Associates, 314-795-8264, jgoodman@lentsmazur.com

Courtesy of Dwight McLeod, D.D.S., M.S., Professor of Periodontics and Dean, A.T. Still University Missouri School of Dentistry and Oral Health and Paul Bigg, D.M.D., Assistant Professor, Director Special Care Unit, Special Needs Dentistry, A.T. Still University Missouri School of Dentistry and Oral Health, St. Louis Dental Center

Published on January 11, 2023

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