Special Care Clinic fills dental health care gap

Dental students Christy Kopasz and Bob Johnson replace a filling on patient Harold Fowler as his mother, Reather, watches at the CU School of Dental Medicine's Special Care Clinic. (Photos: Eric Bellamy)

Harold Fowler, a 62-year-old Denver resident with cerebral palsy, sits calmly as gauze gets packed around his teeth and the high-pitched whir of a drill fills the room.

Outside the state-of-the-art clinic in the CU School of Dental Medicine Building sits Harold's mother, Reather Fowler. Reather and her husband have been taking Harold to regular checkups at the dental school's Special Care Clinic for 28 years, making him one of the clinic's longest-standing patients.

On this March afternoon, Harold is getting a filling replaced. This is the first time he's been treated by dental students Christy Kopasz and Bob Johnson, but that's normal. Third-year dental students and second-year international dental students are rotated through the Special Care Clinic to give them hands-on experience treating patients with developmental and physical disabilities.

'They take good care of Harold'

"The students are always really pleasant," Reather says. "They take good care of Harold."

The soon-to-be dentists don't mind being taken out of their comfort zone to treat patients like Harold.

"I love it," Kopasz said after treating Harold. "We had a class on (caring for patients with special needs). It prepares us so we can treat special needs patients when we go into our private practices."

Besides rounding out students' skills, the Special Care Clinic has filled an important health care gap in Colorado since 1979. When it was difficult to find a private-practice dentist who would take Harold as a patient in the mid-‘80s, one of his physicians told Reather about the Special Care Clinic at CU.

The clinic originated in the JFK Building on CU's former Health Sciences Center at Ninth Avenue and Colorado Boulevard. In 1986, when Harold started coming to the clinic, it moved inside the School of Dental Medicine Building at the Health Sciences Center.

The constant through the years, besides Harold Fowler, has been JoAnn LeClaire, RDH, MS, who started working in the Special Care Clinic in 1994 and became clinic director in 1997. LeClaire said dental students are generally apprehensive when they first treat a patient with physical or developmental disabilities, but "they're glad they were trained in it (in school) so they know what to expect the next time."

Tailoring treatments to patients' needs

LeClaire said the clinic currently serves about 150 patients, most of whom are adults who have disabilities such as Down syndrome, Autism Spectrum Disorder and cerebral palsy. Many other patients have Sturge-Weber syndrome or seizure disorder.

While the clinic provides needed health care service to the local community, some patients—typically those requiring more complex dental procedures—travel from Nebraska, Wyoming, Kansas and other regional states. "If some of them need to be put under general anesthesia, they often come from out of state because that is a pretty rare treatment," LeClaire said.

Dental students learn to use equipment, such as restraint boards and mouth props, that are often required in special-needs care. "We'll do everything we can to see the patients in a traditional setting rather than refer them to an operating room," LeClaire said.

She refers patients whose dental care needs are too difficult to handle in a traditional setting to a conscious-sedation room in the dental school, or to the operating room at the University of Colorado Hospital Anschutz Outpatient Pavilion for general anesthesia.

When it's easier for patients to obtain care, they get better care

Along with LeClaire, Sheila Stille, DMD, an associate professor in surgical dentistry, has a special needs background and oversees the students' work. James Woolum, DDS, MS, an associate professor, and Karen Foster, DDS, who is a volunteer pediatric dentist, also help oversee students in the clinic. The Special Care Clinic currently serves patients on Mondays, but the possibility of adding clinic hours is being studied.

"This is the only dental school in the state, so it's really our job to train dental students so they'll be comfortable treating special needs patients when they go into private practice," Stille said. "And when it's easier for these patients to obtain care, they'll get better health care."

Stille said it's fascinating to see how quickly the students become more empathetic to patients who have disabilities. LeClaire notices this, too. She surveys the students after each clinic rotation. "The majority of the time they give positive feedback," she said. "They're glad they went through the hands-on clinic."

'Lowers the apprehension'

Johnson said he enjoys providing a service to patients who really need it and may not have easy access to dental care elsewhere. "It's good that the school does this training for us. It lowers the apprehension because you've been there. You've treated patients with special needs."

As Johnson and Kopasz finish up the filling work, Johnson gets ready to flip the switch to bring the chair back up. "How are you doing Harold? I'm going to bring you up, OK?"

Harold nods. Despite having undergone two surgeries on his legs when he was younger, he can walk fine, and he lifts himself out of the chair. Harold doesn't talk very much, but his mother can tell he enjoys the trips—about every three months—to the dentist.

"He is so good," Reather said. "He always has been a good, steady kid. And he likes coming out here."

The person he's seen most through the years is LeClaire. In many ways—as Dr. Stille will tell you—LeClaire is the special needs program in the School of Dental Medicine. She's had the chance to pursue other career opportunities, but she's always decided to stay with the clinic.

"It's been really gratifying," LeClaire said. "There have been a few times where I've thought I could do other things, but then I say, 'Oh, my gosh, I'm not going to be able to see this patient or that patient.' It's been really rewarding for me."