{"id":3538,"date":"2025-02-07T13:00:56","date_gmt":"2025-02-07T13:00:56","guid":{"rendered":"https:\/\/magazines.uthscsa.edu\/schools\/?p=3538"},"modified":"2025-02-18T17:56:01","modified_gmt":"2025-02-18T17:56:01","slug":"a-better-condition-of-care","status":"publish","type":"post","link":"https:\/\/magazines.uthscsa.edu\/schools\/2025\/02\/07\/a-better-condition-of-care\/","title":{"rendered":"A better condition of care"},"content":{"rendered":"

The new Phil and Karen Hunke Special Care Clinic is making dentistry accessible and approachable for special care dental patients and students<\/strong><\/h2>\n

By Kristen Zapata<\/em><\/p>\n

\u201cHablo Espa\u00f1ol muy bien,\u201d said Jennifer Farrell, DDS, DABSCD<\/a>, with a satisfied smile. As a middle schooler growing up in Massachusetts, Farrell\u2019s parents were told she would struggle in school, never be capable of attending college and certainly never learn a foreign language, which she desperately wanted to do.<\/p>\n

\u201cI am the product of special education,\u201d Farrell announced proudly. As a child, she had a hearing condition that doctors didn\u2019t believe required hearing aids. At school, she was given the accommodation of sitting in the middle of the classroom so the sound of her teacher\u2019s voice could bounce off the walls to amplify it.<\/p>\n

\u201cEven then, I just wasn\u2019t doing so well in school,\u201d she said. \u201cI would always look at my classmates and think, I want to be smart like them.\u201d<\/p>\n

To keep up with her peers, Farrell would attend tutoring and be assigned double the work. She was finally given clearance to enroll in a Spanish course.<\/p>\n

\u201cThey didn\u2019t think I could handle it, but my mother was always in my corner,\u201d Farrell said.<\/p>\n

As it turned out, she handled the course quite well, went on to graduate from college and then earned a dental degree from Northwestern University Dental School.<\/p>\n

She did a preceptorship in special patient care dentistry and completed a residency program in dental anesthesiology at Advocate Illinois Masonic Medical Center in Chicago, where she subsequently directed the Special Patient Care Dental Program for 13 years.<\/p>\n

\u201cI had to work really, really hard, but I\u2019m always up for a good challenge, so here I am,\u201d said Farrell, who today is the founding director of the Phil and Karen Hunke Special Care Clinic<\/a> at UT Health San Antonio\u2019s School of Dentistry.<\/p>\n

Indeed, with over 28 years of special patient care experience, Farrell is ready to make a difference in South Texas. \u201cSpeaking Spanish comes in handy in these parts,\u201d she said.<\/p>\n

\"A
Sebastian Tamez (far left) is flanked by his parents as he greets Jennifer Farrell, DDS, for his appointment. Tamez, who is on the autism spectrum, had never experienced dental care that fully accommodated his needs until he met Farrell.<\/figcaption><\/figure>\n

The challenge<\/strong><\/h3>\n

The School of Dentistry<\/a> celebrated the opening of its special care clinic with a ribbon-cutting ceremony on Feb. 7, 2024. The clinic, named for the San Antonio-area philanthropists who provided seed money for the space renovation, provides comprehensive dental care or adults and children with intellectual, developmental, cognitive or physical disabilities and those with complex medical conditions.<\/p>\n

\u201cThere really isn\u2019t a whole lot of difference between treating these folks and the general population,\u201d Farrell said. \u201cThe biggest differentiator would be chairside manner, 100%.\u201d<\/p>\n

Farrell should know. She has the unique perspective of being a dental provider and mother to four children, each with unique challenges.<\/p>\n

\u201cI\u2019m facing the exact same challenge that my patients face. It\u2019s not just with dental care but all health care,\u201d she said.<\/p>\n

The challenge Farrell and other caregivers face is access to health providers experienced and willing to treat their loved ones in need of accommodations for care.<\/p>\n

According to a report by the National Council on Disability, due to a lack of training, \u201cdental care is often more difficult to find than any other type of service for people with [intellectual and developmental disabilities].\u201d Because of this, the council stated that this patient population is less likely to have had their teeth cleaned in the past five years or at all compared to those who are not considered disabled.<\/p>\n

These findings resulted in the council making a recommendation to the Commission on Dental Accreditation (CODA) to require all U.S. dental schools to ensure their students receive proper training to manage the treatment of patients with intellectual and developmental disabilities.<\/p>\n

In 2019, CODA passed the decision to require schools to update their curricula to be inclusive of special care patients in the predoctoral dental, orthodontics, dental hygiene and dental assistant programs. The American Dental Association likewise updated its Code of Professional Conduct to read, \u201cdentists shall not refuse to accept patients into their practice or deny dental service to patients because of the patient\u2019s\u2026 disability.\u201d<\/p>\n

\u201cDentists will no longer be able to refer these patients out without first attempting to treat them,\u201d Farrell said.<\/p>\n

The reason<\/strong><\/h3>\n

Martin Nutt is already a regular in Farrell\u2019s dental chair, with a plan for a full dental restoration \u2014 from fillings to extractions to a lower partial denture. During his visits, he enjoys watching NASCAR races as the dental team does its work.<\/p>\n

\u201cI love it here,\u201d he said. \u201cIt\u2019s like Cheers. You walk in, and it\u2019s like, \u2018Hey, Norm!\u2019 Everyone knows your name,\u201d he said, referencing the 1980s sitcom by the same name.<\/p>\n

Nutt has a complex medical history that includes a brain tumor at the tender age of nine, a malignant jaw mass at age 14 and a stroke at 40. In speaking with him, one might wonder why he would need care at a special patient clinic. Besides some irregularity in the shape of his jawline and a slight speech impediment, Nutt doesn\u2019t seem like a patient who would have trouble being seen at any dental office.<\/p>\n

For Farrell, this is exactly why dental students need exposure to the special patient population.<\/p>\n

\u201cHonestly, there are many patients who have disabilities who can be seen in the regular dental office. Unfortunately, many clinicians make assumptions about these individuals based on the way that they present rather than attempting care to see if they can tolerate it,\u201d she said.<\/p>\n

\u201cTo the defense of referring clinicians, I can understand their trepidation, as very few, including myself, were trained to provide care to these folks while in dental school,\u201d Farrell added.<\/p>\n

The solution<\/strong><\/h3>\n

Third-year dental student Gabby Ward has begun the<\/p>\n

clinical portion of her dental curriculum in earnest. As an aspiring pediatric dentist, Ward values the opportunity she has to interact with patients like Martin Nutt.<\/p>\n

\u201cPediatric and special needs dentistry work hand in hand,\u201d she said. \u201cMore often than not, kids with special needs are sent to a specialist because their general dentist is just not equipped to treat them.\u201d<\/p>\n

In addition to a didactic course introducing them to special care dentistry, Ward and her classmates will each be assigned a one-week rotation through the special needs clinic. Each day starts and ends with a clinic huddle to discuss the patients, their conditions and treatment.<\/p>\n

\u201cWe talk about what they may encounter or things they should think of in terms of developing a treatment plan for a particular person,\u201d Farrell said. \u201cWe also anticipate challenges we might have during an appointment and discuss how we would navigate those.\u201d<\/p>\n

The students are then ready to interact with their patients. Working in groups of three or four, Farrell has her students alternate tasks such as charting and assisting with or conducting the dental treatment.<\/p>\n

\"Jennifer
Jennifer Farrell, DDS, DABSCD<\/figcaption><\/figure>\n

\u201cI\u2019m facing the exact same challenge that my patients face. It\u2019s not just with dental care but all health care.\u201d<\/p><\/blockquote>\n

\u2014 Jennifer Farrell, DDS, DABSCD<\/em><\/p>\n

 <\/p>\n

 <\/p>\n

Ward will officially rotate through the clinic later this term and again in her fourth year, but she has been volunteering in the clinic in her free time since it opened. She shadows Farrell, charts, helps with X-rays or with more important tasks for patients, such as blowing up balloons, hitting the skip button on YouTube video ads or bringing them popsicles.<\/p>\n

Since spending time in the clinic, Ward said she came to an important conclusion about special patient dentistry.<\/p>\n

\u201cIt runs just like any dental visit would,\u201d she said. \u201cIt may run a bit slower. You need a little patience to explain everything and make the patient comfortable, but Dr. Farrell treats it just like any other dental visit.\u201d One particular visit made quite an impression on Ward.<\/p>\n

\u201cWe had one patient who was so scared when he arrived. His mom said that he hadn\u2019t sat for a cleaning in 10 or 15 years,\u201d Ward said. \u201cThe mom was ready to give up on finding a dentist, but she knew her son had cavities and other things wrong. By the end of it, we got X-rays, he sat for a cleaning and we\u2019ve even done extractions on him! His mom was crying because she was so happy.\u201d<\/p>\n

The trick, according to Ward, is finding a way to make dentistry approachable by taking the time to explain every step along the way. \u201cEveryone deserves access to care,\u201d she said. \u201cI\u2019m glad I get exposure to these patients now, so when I graduate, I feel confident with any patient.\u201d<\/p>\n

The future<\/strong><\/h3>\n
\"Sebastian
\u201cI was so surprised I was in tears,\u201d said Tamez\u2019s mother, Andrea Pastrano-Tamez, about her son being treated without sedation for the first time. Tamez happily complied with Farrell\u2019s instructions for X-rays and treatment during his first appointment.<\/figcaption><\/figure>\n

Farrell is passionate about sharing her expertise with her students but is just as eager to share it with dental professionals who need strategies for treating special care patients.<\/p>\n

\u201cWe are developing continuing education courses aimed at educating practicing providers because we\u2019re a collaborative team, we should all be working together,\u201d she said.<\/p>\n

She is also looking forward to working more collaboratively with local community partners, like The Arc, a national community-based organization that advocates for people with intellectual and developmental disabilities, which held a desensitization event at the clinic in September 2024 to help take some of the mystery out of the dental office.<\/p>\n

\u201cPotential patients and their families were invited to come see, touch and feel the dental equipment. They could sit and try out the dental chair and talk with me and some of our students,\u201d Farrell said.<\/p>\n

The School of Dentistry will, in the future, explore areas of research or scholarship within the special care clinic, such as treatment models that are seen as being most effective. Before that type of work begins, Farrell is solely focused on building relationships and trust with her patients and their families.<\/p>\n

\u2018A huge bite\u2019<\/strong><\/h3>\n

\u201cI like to tell my students that if every dentist in the U.S. saw even one patient with a disability, we could take a huge bite out of the access to care issue for that population,\u201d Farrell said.<\/p>\n

\n

Accommodating patients with autism<\/strong><\/h2>\n

By understanding the way in which an individual with autism experiences the world, dental providers can easily adapt their approach to care<\/p>\n

Autism spectrum disorder is a complex neurodevelopmental condition that presents unique challenges, particularly in settings like dental offices, where a patient\u2019s normal routines are disrupted and sensory inputs are heightened. For dental professionals, understanding the needs of autistic patients is crucial for providing effective care and a positive experience.<\/p>\n

\"AWhat is autism?<\/strong><\/h3>\n

Autism is characterized by persistent challenges with social communication, restricted interests and repetitive behaviors. The disorder is a spectrum, meaning the degree of impairment varies greatly between individuals. According to the U.S. Centers for Disease Control and Prevention\u2019s Autism and Developmental Disabilities Monitoring Network, approximately 1 in 36 children have been identified with autism, and adults with the disorder often struggle to access dental care due to a lack of training among providers and their general uneasiness in treating this population.<\/p>\n

Tips for treatment<\/strong><\/h3>\n

1. Emphasize routine.<\/strong> Patients with autism thrive on routine. Changes to their daily schedule, such as dental appointments, can cause significant distress. Be aware that their discomfort may stem from the disruption of their routine rather than fear of dental procedures.<\/p>\n

2. Use visual aids.<\/strong> Visual aids like pictograms can help autistic patients understand what to expect during their visit. These tools make communication clearer and more consistent, which can reduce anxiety and improve cooperation.<\/p>\n

3. Create a comfortable environment.<\/strong> Sensory overload is a common issue for autistic patients. Dimming the lights, providing noise-canceling headphones and minimizing sudden changes in the environment can help make the experience less overwhelming.<\/p>\n

4. Incorporate breaks.<\/strong> Frequent, fun breaks can alleviate stress for both the patient and the provider. Consider activities like dancing or playing with a foam ball to lighten the mood and provide a welcome distraction.<\/p>\n

5. Offer positive reinforcement.<\/strong> Reward positive behavior during the visit, but only when it\u2019s genuinely earned. Consistent and meaningful rewards encourage good behavior in future visits.<\/p>\n

6. Communicate simply and gently.<\/strong> When a patient is distressed, verbalize what you believe they might be feeling in simple terms. This acknowledgment can make them feel understood and help de-escalate intense emotions. Offer to let them rip up a piece of paper if it will help them express their emotions.<\/p>\n

7. Be flexible.<\/strong> Some autistic patients may be more comfortable being treated outside the traditional dental chair. If they prefer a different location in the office, accommodate them to the best of your ability.<\/p>\n

8. Understand behavior as communication.<\/strong> Many autistic individuals may lack the verbal skills to express discomfort, so their behavior often serves as their primary mode of communication. Recognize that what might appear as resistance is often a form of expressing an unmet need.<\/p>\n

By adopting these strategies, dental professionals can create a more welcoming and effective environment for those with neurodevelopmental conditions, ultimately improving their access to quality dental care and their overall experience at the dentist\u2019s office.<\/p>\n

This information was presented during the Dental Education Network for Texas ECHO session on March 21, 2024, by Jennifer Farrell, DDS, DABSCD. Watch the entire lecture and a case study by visiting the network’s website<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Jennifer Farrell, DDS, and the Phil and Karen Hunke Special Care Clinic are changing lives by providing compassionate dental care for patients with disabilities and complex conditions. Through her own inspiring journey in special education, Farrell is supporting families and addressing a critical need for access to care. <\/p>\n","protected":false},"author":653,"featured_media":3540,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,11],"magazine":[23],"issue-year":[59],"featured-story":[36,37],"class_list":["post-3538","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-academics","category-patient-care","magazine-salute","issue-year-59","featured-story-homepage","featured-story-landing-page"],"yoast_head":"\nA better condition of care - Magazines of the Schools at UT Health San Antonio<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/magazines.uthscsa.edu\/schools\/2025\/02\/07\/a-better-condition-of-care\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"A better condition of care - Magazines of the Schools at UT Health San Antonio\" \/>\n<meta property=\"og:description\" content=\"Jennifer Farrell, DDS, and the Phil and Karen Hunke Special Care Clinic are changing lives by providing compassionate dental care for patients with disabilities and complex conditions. 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