Treating Patients with Developmental Disabilities: A Win-Win for Patient and Practice

Typically, for most people, finding the right dentist that they're totally comfortable with doesn't always come that easy. But for individuals that have developmental and intellectual disabilities, it's much more challenging. However, there are dental practices that open their doors to patients with these disabilities. And what they typically find is not only a high level of career satisfaction and an immense fulfillment in their work, but also a rapid expansion of their patient base through the powerful network of word of mouth marketing. That's right. They end up treating the entire family of the patient with a disability, as well as their friends, relatives, and so forth. So there's no doubt it's a fantastic way to grow your practice and really feel good about yourself. To tell us more about opening your doors to treating patients with developmental and intellectual disabilities, is our guest, Jeannette Diaz. She is really an incredible person, very passionate, motivated, and it's one of the reasons why I really like being a podcaster because I get to meet people like Jeannette. She just believes in doing good for the community and she's just an amazing person and it was really a pleasure to meet her before this podcast and we're excited about doing this. She's a public speaker. She is an independent dental hygienist in California. She's an educator. She has her own portable dental hygiene practice. serving older adults and individuals with developmental disabilities. And Jeannette actually did a webinar on VivaLearning .com, which is available now as a recorded webinar for self-study credit. The title of that webinar is The Value of Being Seen, Elevating Care for Individuals with Intellectual and Developmental Disabilities. So I highly recommend everybody to take a look at that webinar just to get an idea of what this is all about. Jeannette , it's a pleasure to have you on the show. Thank you, Dr. Klein. So happy to be here. Yeah, and I've been reading a lot about you. It's really impressive the things you're doing for the profession, for our patients. Hats off to you for making that effort to really be a healthcare provider that's looking after patients that oftentimes they get ignored to some extent. And having that access to care is really phenomenal. So before we delve into the deep parts of this podcast, let's begin. if you would, to define the difference between developmental and intellectual disabilities? Thanks for that question. I think developmental disabilities is often used as a very broad term. And the way I like to explain it is developmental disabilities is a big umbrella. And within that umbrella, a person may have a... intellectual disability so something affecting you know cognition someone may have a physical disability or a combination of of both so think of developmental disabilities as that broad term and an intellectual disability is really just focused on IQ, and a person may also have some areas such as learning, memory, that are affected, as well as adaptive skills, like daily living skills. So would ADHD, for instance, autism, even cerebral palsy, would they fall under developmental? Yes, absolutely. So things like autism, ADHD, you've got genetic conditions like Fragile X, Down syndrome, even traumatic brain injuries are included in that developmental disabilities umbrella. One that I always like to point out is cerebral palsy, because that even though it's under that developmental disabilities umbrella, a person may also have an intellectual disability. But it's estimated about 30 to 50% of individuals with cerebral palsy, you know, have an intellectual disability. So that's one that can go either or. So under this big umbrella, What percentage or how many of these patients are floating around the typical GP's community where they would have the opportunity to treat these patients? Do you have a percentage on that? You know, the Centers for Disease Control and Prevention estimates that one in six children ages 3 to 17 will have either one or more developmental disabilities. And it's estimated that over 7 million people, so that includes children and adults, have a developmental disability. Now, even though we say that, I think it's important to highlight that there are many individuals who may have never, you know, gotten a diagnosis. And particularly for conditions like autism or learning disability, sometimes those are not diagnosed until a little bit later or never diagnosed, depending on how a person is impacted. So it's very likely that we will be seeing these patients in our practices. And typically as dentists, when we see patients in our practice, children, for instance, that... they may not be reaching the milestones that's expected of them based on their age. I assume it's important to talk to the parents about it or the caregiver. Yes, absolutely. This is something that, you know, that bridging that gap in, you know, increasing awareness, not only for our healthcare providers or other, you know, providers that are working with our community members is, you know, ensuring that they know that we should. be tested or screened but also on the flip side of that is really empowering parents to say you know if your child hasn't crawled um you know isn't speaking i mean there are these these milestones and sure there are some that might be a little bit delayed and not necessarily be you know, have a diagnosis for a developmental disability, but it is important for us to just bring awareness to that. And I think as dental professionals, we often will hear these stories from our patients or they will say, oh, you know, my child isn't, you know, crawling yet or isn't. sitting up or, you know, we can also be those connectors in our community to those resources that are available. So either, you know, recommending that they go to their pediatrician. Here in California, we have what are called regional centers and they do free assessments there. So it's really important that the dental professional at least have a basic understanding of developmental disabilities, how they're diagnosed. I'm sure the American Academy of Pediatrics, for instance, has some sort of guidelines that should be probably kept handy in a dental practice. So unfortunately, these patients that have developmental disabilities not only have inherent and genetic oral conditions that make it more difficult for... patient to maintain oral hygiene, but also they kind of get lost in the shuffle at times when it comes to going to the dentist. The priority is not there. And of course, we know that many dentists don't feel they're equipped to treat these kinds of patients. So there's a lot of challenges all mixed into one. So tell us in your experience what these patients are facing and how they manage these challenges. That's a great question. It's a really big, that's a big answer. So I'll give you some examples. You know, some of the the automatic that you know we all probably are familiar with is that individuals with developmental disability may have genetic oral malformations so you know maybe we'll see more crowding and that's going to make it a little bit you know difficult to perform good daily oral hygiene we also see a lot of dental anomalies that are related to developmental disabilities but i think that the biggest problem is accessing dental care so You know, an individual may have many other competing priorities that are going on, you know, maybe going to the doctor appointments. specialist, the therapist appointments. And sometimes medical, excuse me, dental will kind of fall by the wayside or we don't think about it. If it gets skipped by the time that an individual seeks dental care, it might be challenging, you know, because it's a brand new experience. And so providers on the dental side, not just dental, but even our medical colleagues will say, you know, we haven't had a lot of training and experience, clinical experience working with this population. And so there are some hesitations, I think, on the provider side sometimes. And then on the patient side, right? So those are some of the obvious. Some of the not so obvious may include transportation. You know, maybe an individual really isn't used to traveling. If there's health professional shortages, they can't find a dentist in the community. And if they can't find one that is comfortable or skilled enough to work with the population, then they might have to just prolong care. And so as you can see, this gets to be quite challenging. On top of that, you know, there's a lot of trauma that some of these individuals have experienced, which can also make it really difficult to accept care. So, you know, there's a lot of things. And navigating services, I think, is also really challenging. So in your experience, Jeannette , and what you've seen in the area of dental care for patients that fall under developmental disabilities, Do you think it's more on the provider side that these patients are struggling to get good care? Yes. You know, I hear the stories from families, and a lot of times they say it's just they can't find someone that's willing or able to. You know, maybe that first appointment. a meltdown happens, you know, and automatically as a provider, you know, you worry about patient safety, right? And so you think that, you know, perhaps someone else that's got a little more experience would be a better fit. But this happens quite a bit. And I think, you know, there are some cases where individuals may have to go under sedation or general anesthesia. But we know that a lot can be done to accommodate individuals with developmental disabilities. And I think that Once providers are aware of this, I think the more that they work with families... I believe they become a little more willing, more comfortable. It's also important to acknowledge the financial piece. It does require a little extra time for some individuals. And so it's difficult because our schedules in the dental office, we are getting people in and out. Even though we're providing individualized care, it may take another assistant to help out. Things don't always go as planned. And I think that is also what makes it a little hard for providers to go ahead and say yes. But what's interesting is, Jeanette, even with all these challenges for the provider, what I've heard from other dentists is that opening the door to these kinds of patients with these disabilities can be a huge practice builder. And it just comes from word of mouth because the families that have kids that are involved with this are so happy that this office... is helping their child. They end up getting their treatment there. They recommend their friends and it just goes on and on and on. Is this something that you've seen as well? Yes, absolutely. That was my experience in one of the first offices that I worked in, which is why I think I had so much experience working with our autistic community because everyone told everyone. And so you had families that would refer other families and then they said, well, you know, I need to come in too. And so it's definitely a great practice builder. And, you know, when you hear of a colleague that is seeing patients with developmental disabilities, you know, I would say rather than sending your patients over there, maybe have a conversation. And, you know, they do, these dentists who are taking care of this population, you know, they're amazing. But a lot of times they're also overworked and they want a little bit of help. A lot of them are willing to have those conversations with you and share the wealth of patients because they can't do it alone. So, yes, I would say I encourage you to, you know, reach out to those colleagues in the community that you know are treating this population. And then, you know, maybe try out that having that open house so that families can come and you can get to know them and their needs and, you know, they can get to know you and your office. So where did your interest get piqued? with treating patients with disabilities like this. When and how did it all start? Well, I'll tell you that as a dental hygiene student, my school didn't have a dental clinic on campus. So we often went out into the community, county facilities, veterans hospitals. And so I became really, I guess, comfortable with packing up my equipment and, you know, going on to the next place. And we also had a project during during our senior year where we worked with, again, in California, we have what are called regional centers. And so this is a place where people can go once they're in the system, we call it the system, they provide resources and supports. And so we went into a group home and we taught oral hygiene instruction. And that was really my first interaction. And then eventually, I went on to receive my additional license here in California as an RDHAP. It's RDH, an alternative practice. And I think I just kind of fell into it. I was seeing a lot of older adults. One of my mentors decided to retire, and she was also seeing people with developmental disabilities. I think that's how it happened. I also got to work in an office that had a lot of patients with autism or, you know, served a huge autistic population. And I learned a lot just from working there with families and with patients. And so I don't know. It just happened. And I really, I enjoy it. It's rewarding. And I see the need. So I'd love to see others go ahead and say yes. Let's try this. Yeah, no, it's a fantastic story. So do you think you've gleaned a whole nother level of career satisfaction out of treating patients like this? Is it different? Absolutely. Yeah, it must be a completely different experience than the typical path one would follow out of hygiene school. But there's a whole nother level of, I think, satisfaction and passion that you've shown through your career. How long have you been practicing? I've had my portable dental hygiene business a little over five years, so it hasn't been that long. But yes, it is satisfying. And I think, you know, I enjoyed my time working in private practice. But during my time there, I also saw, you know, I had patients who were in car accidents and lost the ability to, you know, walk. I had patients with traumatic brain injuries who were, you know, wasn't set up, you know. And so oftentimes I felt like, you know, I always wore loops with the light and I felt like that really helped me in the office to be able to, you know, if I can't get you in the chair, let's move some things around. And that really got me thinking, you know, if these are people that are coming to us, what about all of those individuals who, you know, our dentists have been caring for for such a long time and then they fall off the schedule and, you know, that they still want to receive care. They just, have a really difficult time coming to us. So you go to them. It's definitely another piece. Yeah, I go to them. You go to them. Yeah. And that works out financially where you still have a business, so it has to be profitable. You can maintain a profitable business by getting in the car with your equipment and going to these locations. Yes, I will say my business is a small business. So I do this. I don't do it full time. I do know colleagues who do this full time. I don't want to say I get bored easily, but I also I'm an educator. I work for a state agency on developmental disabilities. So I'm really kind of. Hitting this topic from all angles, I'm speaking about it because I'm really passionate and I feel like, you know, I hear my colleagues say, well, I don't know. I'm afraid. It's like, look, let me share what I have learned. Let me share the stories. And, you know, these are little things that you can do to be able to, you know, accommodate those patients. So it is profitable. I do have to say that physically it can be a little challenging, right? You're lugging. this heavy equipment and people are in their beds and their wheelchairs. I prefer to keep them where they're comfortable. And so, you know, if you do this day in and day out, it can be challenging, but I think you can incorporate an element of this into your practice. You know, maybe you go out one day a week or twice a week. hire someone that's willing to help you so that you can continue care for individuals. And I know different states have different dental practice acts, but I think that it is a really, really nice way to continue to take care of your patients. Now, do you also visit young people that are going through developmental disabilities? Yes, I have seen children. I would say children. Children seem to have a little more access to dental care. I feel like providers are a little more willing to try and work with children, or like you said, they send them to the pediatric dentist. So I would say the majority of my patients are older, but I have worked with kiddos. So let me ask you this. What are some strategies dental teams can implement to help improve care for people with intellectual and developmental disabilities? Thank you for that question. I think if we can focus on being more inclusive, you know, just being willing to try, that's a huge piece. I know some offices who are starting to have like an open house, maybe once a month or once a quarter. I mean, it really depends on how you want to do this, but they open up their doors so that families can come in and desensitize, you know, the family members that maybe are a little unsure about going to the dentist. And so you practice coming in, sitting down. I think this is one strategy that can be really helpful. It's a great practice builder as well, in my opinion. But really, it is starting to just ask, you know, ask how we can accommodate because there are little things that we can do. So, you know, things like communication, I think is really important once an individual is in the office, you know, making sure that we use very clear, concise language. Our nonverbal communication is also really important. And I think really stressing on prevention. So even if someone's not quite ready, we can still meet their needs by recommending prevention products. My go-to when I'm... to parents, caregivers, and, you know, my patients is to introduce them to a fluoride varnish. This is such an easy thing that we can do. And, you know, there's evidence to support it. And so my personal favorite is Bivoco. They have a pro fluoride varnish. It comes in seven different flavors. And I know sometimes I have patients that are a little picky and they will say, you know, appointment's over. I don't like this. And, you know, it might be just the flavors. So I love being able to offer options and offer choice. It really engages my patient. And so I love vocals fluoride. It goes on pretty clear. It's moisture tolerant. My patients love it. They say, well, what flavor am I going to pick today? You know, I show them the options and I've been very successful. I see some patients sometimes every two to three months. And so, you know, being able to focus on that prevention piece is key. With caregivers, you know, sometimes we have to kind of show them how to brush. And I like to... have them, you know, help me when I'm working with, you know, their loved one. And then also even, you know, having them try it on themselves so that they can kind of understand what a person is feeling. So when you're using the varnish, the profluorid varnish, that's not age specific, I assume, right? That's based on the patient's needs more than the age. This product is great for all ages. I also use it quite a bit for individuals who have, you know, recession, who are a little sensitive. And so it's a great option for, you know, kiddos who are in ortho, you know, they're pretty high risk for dental caries. I also, Boco has another product that I really love. It's called Riemann Pro and it's a dental cream. And so, you know, I think. There's so many options, but I personally use Vocal. I've had really good feedback from my patients. Now, when you're treating these patients, especially autism patients, for example, there's some sort of desensitization process. or desensitizing, I don't mean that in the terms of the pulpal desensitizing, I mean their whole sensory system, you know, the sound of the drill, just the sounds of the office that you don't even hear anymore, but they come in and they're all freaked out. Do you have to deal with that in a way where you desensitize them to the typical sounds that those kinds of patients are very sensitive to, and they kind of act in a frightened way, and that certainly isn't conducive to giving them treatment? Yes, you know, this dental desensitization is what we have been calling it, but really it comes from the psychology world. And what I have found is that... with autism or autistic population, they tend to have a lot of sensory processing differences. So some individuals might be really hypersensitive to the bright lights, you know, the sounds in the office, the smells. And then there are others who might be hyposensitive and they're sensory seeking. You know, they might need a fidget toy in their hand. Maybe they can't sit still. And so... With this population, if you have someone that checks off that box, autistic, autism, I think it's really important for us to ask if there are any sensory processing differences. They may refer to it as a sensory processing disorder, although it's not an actual medical condition. But I think knowing this ahead of time can help us to help them. If we know that loud sounds are an issue, then maybe encourage them to bring their headset. having those familiarization visits, you know, you're not going to schedule a treatment appointment for that. But I think as a team, we can provide the opportunity for them to come in and, you know, practice, you know, coming in, sitting down. And I think using some of those techniques that are real common with with our pediatrics, right? Like the show, tell, do approach. I like to add a feel. So oftentimes, you know, just polishing the teeth. I've had patients that will say, oh, you know, the noise or they're unsure. So I let them, you know, hold, hold it, you know, we'll test it out a little bit and we take breaks. we count. So I think eventually you can build up that trust and that confidence. And initially it might take a little bit of time, but it's doable. So those are some tips that I think when it comes to sensory processing that we can incorporate in the office is really asking first. That's really important. Jeannette , it's been a great conversation and it's so enlightening and really uplifting to hear someone like you who dedicates their time and passion towards helping patients that have challenges getting access to good dental care. You do it through your mobile program. The dental practices that you work in open their doors to patients that have disabilities, and you found a way to make that all work. And in the end, it's a win-win-win. It's great for you, for your career. It's great for the patient, and it's great for the practice, as we talked about with word of mouth. So what is the best way for our listeners to contact you if they have any questions? Of course, they can reach me by email. They can also reach me on social media, Jeannette Diaz on... at California RDHAP on Instagram. And, you know, I always appreciate hearing the stories. If, you know, you have tried one of these tips and they worked well, or you have additional, I'm always open to learning from you and sharing resources all the time. Wonderful. Jeannette , thank you so much. Have a great evening. And thanks for spending the time with us on this. Very important. Very important. Of course. Thank you so much, Dr. Klein. I appreciate it. If you're enjoying this podcast please leave a review or follow us on your favorite podcast platform. It's a great way to support our program and spread the word to others. Thanks so much for listening. See you in the next episode.