UTHSC College of Dentistry Alumna Addressing Unmet Need in Dentistry

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Dentistry student Nadareh Naseri ’18, Dr. Misha Garey ’07, and a dental assistant provide treatment to a patient at the Orange Grove Dental Clinic in Chattanooga. (Photo Courtesy of Misha Garey/Orange Grove Center)

Misha Garey, DDS, stepped right in when Orange Grove Center in Chattanooga needed a full-time dentist for its clients with intellectual and developmental disabilities.

The 2007 University of Tennessee Health Science Center College of Dentistry alumna, who moved to Portland, Oregon, shortly after graduating, did not initially realize the impact she would have by serving the number one unmet health care need for those with intellectual and developmental disabilities when she returned to Tennessee.

“I’m a general dentist and I didn’t have any special training and I was hesitant to come at first,” Dr. Garey said. “Orange Grove told me they had a different philosophy here.”

That philosophy is to provide dental services to adults and children with special needs, including autism, Down syndrome, cerebral palsy, Angelman syndrome, and Prader-Willi syndrome, in an open and inviting environment using the “desensitization model.” This means that patients are given the opportunity to become comfortable and familiar with the senses, such as the sight, sounds and smells that go along with visiting the dentist. Patients are scheduled for multiple visits prior to receiving any treatment, until they become comfortable.

Recently, Orange Grove has started a partnership with the UTHSC College of Dentistry to allow fourth-year dental students to visit their clinic as part of their clinical rotations in Chattanooga.

Dr. Garey initiated the idea. She said she was shopping at Whole Foods one day, and saw a group of UTHSC dentistry students in their scrubs and thought, “Why are they here?”

She found out they were doing rotations at the Dodson Avenue Community Health Center, which was half a mile from Orange Grove Center.

“I knew that I’d learned so much here and have been able to do so much that I could apply in my private practice,” said Dr. Garey. She maintains a private dentistry practice in the evenings. “I wanted them to come over here to just observe for a day to see some techniques to help them be more confident and say yes to more people.”

The students spend the day with Dr. Garey observing ways to manage treatment for people with special needs and how they can become successful in providing treatment.

One of those students was Nadareh Naseri, who will graduate in May. She spent a day with Dr. Garey and a dental hygienist. “I was very impressed with the interactions that Dr. Garey and Daphne had with the patients,” Naseri said. “Disabilities were not seen as their defining trait and each patient was treated as family.”

Students are allowed to be hands on with the patients, since Dr. Garey is a credentialed UTHSC faculty member.

“My goal is to treat a majority of my patients without sedation,” Dr. Garey said.

She takes time and care to ensure her patients are comfortable and at ease. Allowing them and their families to visit weekly, if needed, to get used to the space and get to know her and the staff and to familiarize themselves with the equipment that will be used.

“We have built into our business model an opportunity to desensitize people so they come into our clinic with no expectation of them ever getting into the chair,” said Rick Rader, MD, FAAIDD, DHL (Hon.), director of the Morton J. Kent Habilitation Center at Orange Grove. “It’s not unusual for someone to make five or six trips to the dental office before they get into the chair. We feel that it’s worth it.”

Although it costs more on the front end, Orange Grove believes it’s worth it so that patients are not being sent to the operating room under general anesthesia for a routine dental visit such as a cleaning. “Not having to send someone to the operating room makes sense not only for economic reasons, but for health reasons, particularly for this population because airway management is difficult and therefore they don’t always do well on the general anesthesia,” Dr. Rader said.

Orange Grove started in 1953 in Chattanooga and quickly set out to dispel the misconceptions the public had about individuals with developmental and intellectual disabilities. For more than 60 years, it has expanded the services offered, including educational and vocational training opportunities, health care services, residential living, and community integration.

Dr. Rader said providing dental services to individuals with special needs and training future dentists in how to provide treatment to the special needs population is vital, because something like a cavity or abscess could go unnoticed if an individual does not have the vocal or language skills to communicate pain. Behaviors, such as head banging or other abusive coping mechanisms from the pain experienced from the cavity or abscess, are often treated through psychiatric medications, when all the individual needed was to go see a dentist. “All this time, the infection from the mouth has migrated to the brain and very often someone will die of a brain infection, when an $80 extraction could have saved their lives,” Dr. Rader said.

Based on her experience at Orange Grove, Naseri couldn’t agree more. “I learned that in my future practice, I shouldn’t see a person’s disability as an obstacle to treatment and immediately refer,” she said. “But that I should try to help provide appropriate treatment whenever possible to avoid patients’ having to undergo sedation for a simple procedure.”

In the future, the UTHSC College of Dentistry plans to have a special needs clinic in Memphis. A long-term goal is to also have a graduate program in special needs dentistry. “This rotation has prompted my desire to learn more about patient management in the special needs patient communities,” Naseri said. “I hope one day to be performing similar treatment.”

Dr. Garey is continuing to educate UTHSC students on how they can best provide treatment for this patient population.

“I hope that they have an awareness and an awakening that those things we didn’t think we could do, because we weren’t trained in school, they will have the confidence to try. And they will help someone with special needs,” Dr. Garey said. “Also, to show them that if they can’t treat someone, then that is OK. I teach them and walk them through treatment, but also how to help the patients to the next place.”

“When a parent is so excited that someone says yes, and they watch their child or their adult children succeed in getting health care, I love that,” Dr. Garey said. “Some will say, this is the first time they’ve sat in a dental chair without sedation. That’s exciting.”