A Focus on the Institutionalized Aged and Special Care Patient for Today’s Practice

Dentists must understand the growing institutionalized-aged and special-needs population, the places wherein they reside, and the unique challenges of access that confront both the patient and dentist. This article discusses governmental regulation and legislation of long-term-care facilities and outlines professional duties and requirements of dentists who care for residents of such facilities. It will also cover the treatment needs of this population and the venues available to the hospital-trained dentist.It is Monday morning, and Dr. Treatall arrives early to prepare himself for the day ahead. Unlike the other days of the week, this is the day Dr. Treatall begins practice in his private office but completes his workday at the community hospital treating one of his “special” patients in an operating room setting. The rich aroma of Starbucks’ flavor of the day momentarily causes Dr. Treatall to think about his good fortune to be a dentist on such a magnificent day. A crisp knock on the door, however, refocuses the doctor’s eyes upon today’s rather long patient list.The receptionist half whispers, “Dr. Treatall, your first two patients have been seated.” Obediently, Dr. Treatall dons his OSHA-compliant white lab coat, grabs his loupes, opens the door, and heads toward operatory 1.Though the waiting area is not in his line of sight, Dr. Treatall has sensed more than the usual motion and conversation emanating from that part of the office.The receptionist advises, “Dr. Treatall, there was a problem with transportation. Your 9:30 and 10:15 appointments have arrived early, but not to worry, the nursing home attendant will wait with them.”Dr. Treatall nods his head in acknowledgment, as he begins to weigh the effect of voicing dissatisfaction. He thinks to himself “Is it purposeful to test the natural impatience of two octogenarians in the waiting room, or should daily production be sacrificed to a ‘humanitarian’ reschedule?” Indecisive, Dr. Treatall greets Mrs. Jones in operatory 1. Mrs. Jones has also noticed the congestion in the waiting area as she recounts her passage through it, employing the colorful phrase “wheelchair gauntlet.” Dr. Treatall understands that Mrs. Jones means no harm, and he silently administers local anesthesia for tooth No. 30’s replacement alloy.Next, Dr. Treatall slips into operatory 2 to examine a new patient, as Peggy the hygienist stands by. He is greeted by the warm smile and wide eyes of a young man named Johnny. Johnny is a high-functioning, developmentally delayed patient with a seizure disorder, who is not at all self-conscious. Johnny is extremely friendly, eager to cooperate, though maybe a little loud. Dr. Treatall has always been committed to providing access for all patients. Having negotiated the examination, he clears Peggy to begin the scaling.Returning to check on Mrs. Jones, Dr. Treatall inquires about the profoundness of her anesthesia. He ends up asking twice so he can be heard over Johnny’s excitement of working with the hygienist next door. (If ever the annoying sound of the high-speed handpiece is welcome, it’s now.) No longer aware of the loud banter from the adjacent operatory, Dr. Treatall becomes immersed in the technical bliss of operative dentistry. Suddenly, like an alarm clock that jolts one from a restful slumber, Peggy declares her patient to be in a state of seizure, grand mal to be specific. As Dr. Treatall provides the needed emergency support, Mrs. Jones bites on an oversoaked cotton roll. As Mrs. Jones waits, she overhears the receptionist telling the doctor that one of the nursing home patients had become disruptive in the waiting room, so both were returned to the facility. “Dr. Treatall, you will now have plenty of time to complete Mrs. Jones.” Mrs. Jones is silently overjoyed.Thirty minutes later, Dr. Treatall dismisses Mrs. Jones. She asks if the coast is clear as she plans her exit from the operatory; there is no answer from Dr. Treatall. With a bit less bounce in his step, Dr. Treatall retreats to his small private office only to find a note confirming his scheduled in-service at Sleepy Haven Nursing Home today at noon. Recognizing the doctor’s difficult morning, the receptionist delivers a fresh cup of coffee, while praising her employer’s willingness to treat long-term-care patients. Departing, the receptionist adds, “I get so many calls from care homes and nursing homes, you must be everybody’s favorite dentist.”Somewhat worn from the morning’s events, Dr. Treatall smiles as he is satisfied with the coffee’s fine aroma.