Breaking down barriers to care through portable dentistry

I started working with seniors and patients with special health care needs last year. This was a result of my general practice residency, during which I learned how to care for patients with more complex needs. Finding care for many of these patients is especially difficult. Some patients are restricted because of resources or their support systems; others are limited by a disability from leaving their home and getting the dental care they need. At Enable Dental, we are able to provide fully functional portable dental services to our patients in their homes, thereby eliminating frequently encountered barriers in accessing care.

I often get questions from friends, family and colleagues on what exactly I do in “portable dentistry.” To be completely clear, we do not have a dental van with chairs in it that patients get to use. We mobilize all dental equipment and take it into our patients’ homes or assisted/independent living centers.

Here are some of the highlights and challenges associated with working in portable dentistry:

1. We have long commutes.

Since we go see our patients at assisted living centers or their homes, we often have to drive long distances. Most of the time we drive together in a single vehicle and split driving among each other. Long commutes mean long days. I often get home after 6 p.m. on such days. Those are days I do not cook dinner.

2. We do dentistry standing up, bending or occasionally sitting down.

Recently I had a patient sitting in her arm chair and prepped for a few extractions. Unfortunately, I didn’t have the foresight to move her into a chair without thick arm rests beforehand. After a lot of changes to my positioning and sweating/sighing, I ultimately sat on the floor and extracted Nos. 12 and 13. Afterwards, my assistant said, “Congratulations, you just delivered two boys!” That cracked me up, and the whole room, including our patient, erupted in giggles.

3. I wear excellent loupes because I have to.

I recently made the decision to buy an ergonomic set of loupes. They have been a godsend. The loupes have prevented me from worsening my upper back and neck. Especially with the work I do, having a nonergonomic set of loupes would have made life miserable.

Ergonomic loupes have a slight bend in them, which means the loupes do the bending for you, instead of your neck. You can stand and look straight ahead and still see everything you need to in a patient’s mouth. The power at which I use my loupes gave me no headaches and did not require any time getting used to.

4. We provide a ‘good and better’ plan for patients.

Most of our patients are above the age of 75. It may not always be reasonable for us to plan extensive care for them. Many are looking for palliative care and regular hygiene appointments only. Most are looking for someone to talk to for an hour. It’s an honor for me to feel included in my patients’ lives and listen to their stories during these times. Our treatment plan is based on what is realistic for us to achieve given their medications and complex needs. This can be very different from what we are traditionally able to achieve in a regular dental clinic environment. We always provide one to two alternatives to all treatment plans.

5. We address complex medical histories.

I have to admit that after residency, complicated medications and medical histories do not scare me as much as they used to. My general practice residency prepared us for the most medically complex conditions. If you are a dental student and not considering a residency, let this post make you reconsider.

When it comes to our patients, it is important to put their diet, medications, preference and dental needs in a neat bow and come up with the right plan. There are several patients for whom I have to regularly contact physicians, endocrinologists or cardiologists to have an educated conversation about test results and next steps. A dentist can be an important person to alert the care team on things that are amiss. We need to remember that patients see their dentists more often than their physicians. I usually set aside a half day for these consultations. I’ve also found that having phone conversations about important topics is much better than requesting a standard medical clearance that comes back saying “patient cleared for dental treatment.”

There was a patient we saw in residency with an abnormally high blood sugar level that needed full-mouth extractions and dentures. We declined to do the extractions until his blood sugar is under better control because of postoperative healing considerations. This prompted his care team to start the patient on insulin. The patient may not have gotten the needed care and medications had it not been for our team creating this alert.

6. We have a committed, motivated team.

It is hard to be in a job like this and not be committed to our work. Our assistants lug heavy equipment to and from every patient’s home and then commit 100% to their treatment plan and care. The nature of our work and patients we see also makes it easy for us to love our jobs. Before I started doing this, I used to think pediatric dentists probably have the most fun jobs in the world. Seeing adorable small kids all day — how cute! However, now I think treating seniors is just as fun (or even more).

7. Our patients are amazing.

We are often the last resort for our patients, and that becomes very evident when we meet them. Most are very happy to see us and thankful for a dental team that can come to their doorstep to care for them. We also, of course, have patients who are less than overjoyed to see us. Those are the patients whose children are scheduling dental treatments for them. There are also patients who may be confused by our presence. This could be because of advancing dementia or other neurological conditions.

8. I was able to work longer while pregnant.

I worked through nearly 35 weeks of pregnancy in this job. Had it been a traditional brick-and-mortar space, the size of my belly would have probably impeded my ability to practice beyond 25 weeks, the way it does most clinicians. Since I stand while I do most treatments, I was able to perform dentistry much longer. My caring team also took extra steps to make sure I was more comfortable during this time, and my patients gave my child many, many blessings. The constant moving around also helped me stay active throughout pregnancy.

All patient interactions have taught me significant lessons about society, the aging process, the importance of family and support systems, patience, compassion, and different cultures. These are lessons I would not find in any other job. I hope this post inspires other new dentists to work with seniors and patients with special health care needs. Getting anxious about treating these populations is only natural; however, with time and proper education via residency or dedicated continuing education, it will become easier.

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