TEACHING ROUNDS
BY MINDY DOGMANITS
When I was offered the opportunity to visit the Lee Specialty Clinic in Louisville, I was excited to spend time in a facility that fulfills one my career goals – specializing in treating individuals with intellectual and developmental disabilities (IDD). Grateful for the opportunity, I told my husband, "I'm going to Kentucky!" I booked my flights from Buffalo to Louisville, with only one week left of summer break, before I would have to return to the University at Buffalo School of Dental Medicine for my fourth and final year of dental school.
On the first day of my week-long trip, I observed the Dental Department at the Lee Specialty Clinic, which appeared just like any other dental clinic. During the daily morning meeting, Dr. Kristin Compton, the Developmental Dentistry Director, discussed important details about patients and procedures, particularly regarding the root canal treatment that the dental resident would be performing that morning.
I learned that root canal treatment is routinely performed at their clinic, and I am embarrassed to admit that I was somewhat surprised. We are often advised that tedious treatment, such as a root canal, is often too difficult to accomplish in patients with neurodevelopmental disabilities. Some providers are more inclined to take patients with disabilities to the operating room for dental work, a setting in which time does not permit for such procedures. Other providers may, instead, offer alternatives to treatment or temporary solutions that can be performed in the office more easily. The spe cial challenges pertaining to the dental treatment for this population requires both a particular skill set, as well as a philosophy about the best course of treatment.
I was exposed to both at the Lee Specialty Clinic, where the providers do not hesitate to offer a vast array of procedures, while considering patients' personal needs. I watched them treat patients that need more time, more breaks, sensory toys, a mechanical lift out of their wheelchair, medical immobilization/protective stabilization, or simply compassionate reassurance. My admiration for Dr. Compton and the entire dental team grew exponentially throughout the week.
When Dr. Compton asked me about my post-graduate plans, I confessed that originally, I expected to attend a residency program in Pediatric Dentistry. I explained that I wanted to work with adults with special needs, but also with children. Pediatric dentists may be more equipped to deal with difficult or defiant behaviors, but this is not the only reason why many adults with special needs still visit a pediatric dentist. There is a widespread shortage of general dentists willing or competent to see these patients in their practice.
I explained to Dr. Compton that I did not want to be a general dentist, because I didn't want to do extensive "esthetic work," implying cosmetic elective cases. She responded, informing me that they do a lot of esthetic work at the Lee Specialty Clinic. Patients with IDD may need dental work on their front teeth, which would be considered "esthetic."
It may sound cliché to have had a "life-altering moment," but I had one. I realized that my top priority is the patient. Personally, the most rewarding aspect of dental care is establishing and maintaining a good rapport with patients. As a dental student, I have been trained to perfect my abilities in procedures and techniques. However, as I move closer to my residency, I recognize the value in selecting the best procedure for each patient's unique needs.
Therefore, I plan to focus my practice of dentistry by specializing in treating individuals that require additional attention or behavioral guidance during treatment. This refers to both individuals with intellectual and developmental disabilities (IDD) and children. It was during this epiphany that I was able to put Pediatric Dentistry into perspective. If I intend to treat adults, I need to be a dentist for adults. I have since applied to General Practice Residency programs for next year, which will allow me to enhance my skills in general dentistry and provide higher quality care to my adult patients, before proceeding with the pediatric specialty.
Throughout the week, I also had the opportunity to engage with Dr. Henry Hood, Director of the Lee Specialty Clinic, and cofounder of the American Academy of Developmental Medicine and Dentistry (AADMD). Dr. Hood developed a series of five one-on-one lectures, during which I learned more about neurodevelopmental disorders and the history of disabilities. Though I've learned about intellectual and neurodevelopmental disabilities throughout my education, this information was given in a different cultural context with unique perspectives, teaching me something completely new.
Aside from enhancing my formal education and dental knowledge, and dental knowledge, I also explored other areas of healthcare. The observation of a multidisciplinary integrative approach to care was the most outstanding aspect of this experience. Moreover, some of the most memorable moments occurred while I ventured into these new territories.
I was also given the opportunity to participate in a session of integrative physical therapy and speech therapy. Truthfully, this was one of the most enjoyable hours of my entire week. The session began with the patient reading "knock-knock" jokes aloud to practice his speech, and we all shared laughs at the punchlines. His shirt and pants pockets were stuffed with snacks that he took with him from the group home, just before his sister picked him up for the appointment. With each lively chuckle, he had to adjust the jiggling crackers. Throughout the session, he taught me how to do wall push-ups and showed off as his skills tossing balls into a barrel and riding the stationary bike. At the end of the appointment, the physical and speech therapists remarked how impressed they were with his progress. His sister also mentioned that he did more at that appointment than ever before! Then she whispered to me, "He was showing off for you." I was not only flattered, but also inspired by his motivation to work hard.
I am so grateful to have had this rare and meaningful opportunity. All of the people I met, the moments I shared with patients, and the striking revelations I had, will forever be impressed upon my heart and soul. The Lee Specialty Clinic feels like one of a kind, but I hope to discover more wonderful facilities like this one, and certainly emulate their establishment throughout my career •
"Funding for the Lee Specialty Clinic is provided by the Centers for Medicare and Medicaid Services and the Kentucky Cabinet Health and Family Services — Department for Behavioral Health, Developmental and Intellectual Disabilities"
ABOUT THE AUTHOR: Mindy Dogmanits is a fourth-year dental student at the University of Buffalo School of Dental Medicine and an active member in the student chapter of the American Academy of Developmental Medicine and Dentistry (AADMD). After graduation, she intends to provide oral health care to children, as well as individuals with intellectual and developmental disabilities. Her clerkship at the Lee Specialty Clinic cemented her interest in special care dentistry.
INTEGRATIVE APPROACH: At the Lee Specialty Clinic, the providers do not hesitate to offer a vast array of procedures while considering patients' personal needs. My admiration for Dr. Compton and the entire dental team grew exponentially throughout the week.