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Dental clinic provides much more than dental care to patients with autism, cancer and other complex health-care needs

 
Two members of the dental clinic standing in a dental exam room at The Ottawa Hospital.

Jean-Marc Lang hasn’t always liked going to the dentist’s office.  The 27-year-old has autism, epilepsy, a severe developmental delay and ritualistic behaviours that mimic obsessive compulsive disorder (OCD).  For him, sitting in a dentist’s chair for a cleaning seemed next to impossible.

Jean-Marc Lang watching a baseball game

“Jean-Marc has destructive rituals,” explained his mother, Hélène. “So when things are not perfect, or not the same, he tends to want to damage them or get rid of them completely. He also has debilitating rituals where he will pick at his skin until it bleeds, or remove a nail.”

As Jean-Marc’s behaviour intensified over the past decade, Hélène has become increasingly concerned with keeping Jean-Marc’s teeth and gums healthy. 

“He has poor communication skills and is not able to say clearly if he’s in pain or not, so that has always been a huge concern for us,” she said. “He is sensitive to touch and noise, so any dental procedure—an  examination, cleaning or tooth repair—has to be done very carefully to make the experience as comfortable as possible.”

When Jean-Marc was young, he first went to theCHEO dental clinic. Over time, thanks to skilled and caring staff, Jean-Marc began to feel more comfortable and eventually developed complete trust in the staff. Once he became an adult, he was referred to another excellent clinic in the community before being referred to the dental clinic at The Ottawa Hospital. 

A dental clinic like no other

The Ottawa Hospital Dental Clinic is unique in the region and provides specialized care to adult patients in hospital, as well as those who require care and resources that community dental clinics aren’t able to provide.

A staff of highly-trained oral surgeons, dentists, hygienists and support staff work closely together at the clinic to provide care to up to 40 patients per day who meet the eligibility criteria and are referred by their doctor. 

“Consider someone who has an uncontrolled seizure disorder, someone who is recovering from a heart transplant, or someone who has had a portion of their jaw removed as part of their cancer treatment,” said Siobhan Little, Supervisor of The Ottawa Hospital Dental Clinic.  “These patients require specialized care and resources that we can provide at our clinic. We can even go up to their room in the ICU if they have a concern.”

Dr. Howard Weld
Dr. Howard Weld and the staff at The Ottawa Hospital Dental Clinic provide important dental care to people who have been referred by their doctor and need extra support.

Many of the patients the clinic sees are either preparing for or recovering from radiation treatment for cancer.

“We see patients who have head or neck cancer before and after their radiation,” explained Dr. Weld, who has been an associate dentist at The Ottawa Hospital Dental Clinic since 2017.  “Radiation kills cancer, but it tends to also damage saliva glands, so mouths are very dry and teeth are prone to decay. We have to ensure that all the teeth that are left in a person’s mouth are healthy and well cared for.”

The clinic also receives referrals for patients undergoing heart surgery who need to clear up an infection that could compromise the results of the surgery.

 “The reality is that we only have one bloodstream,” he explained. “If there is infection in the mouth, there is infection in your body. Antibiotic drugs help, but until the source of infection is eliminated, it can return.”

Special resources also exist for patients with behaviour or anxiety issues.  As part of their Dental Assist Program, hygienists are accompanied by an assistant, an extra layer of support for the patient.  In some cases, patients can be gently wrapped in a “papoose” during a procedure if it makes them feel more at ease. Every patient is different, and every patient is treated as a unique individual.

Born out of necessity and generosity

The clinic opened in 2002 as a result of  generous donations from Ottawa’s dental community, including individual dentists, dental specialists, dental laboratories, dental supply companies and dental manufacturers.

“Part of the reason the dental community helped create the clinic was the recognition that there are patients out there who could not be served in a typical clinic,” said Dr. Weld.

Some members of the team volunteer their time to the clinic as a service to the community.  The money and fees that are generated go into a trust fund, which helps pay for services rendered to people who can not afford this specialized dental care.

Dental Clinic staff hold a large cheque.
In August 2020, The Ottawa Dental Society made a generous gift in support of The Ottawa Hospital. Funds will be used to purchase vital equipment for our dental clinic.

A customized approach for every patient

With a strong sense of purpose and community support, the team at The Ottawa Hospital’s Dental Clinic focuses on accommodating the needs of each patient.

Jean-Marc wearing sunglasses and sitting in a dentist’s chair at The Ottawa Hospital Dental Clinic
The staff at the dental clinic consult with patients like Jean-Marc and their families to learn how best to support each patient and make their experience as positive as possible

“With every patient, we start with a consultation, and the treatment plan is made from there,” explained Siobhan.  “If they are deemed Hygiene Assist patients, we make sure that the extra person is there for support.  If sedation is needed, we make sure all the proper consents are given and the paperwork is done.”

When Jean-Marc needed to come to the dental clinic to repair a chipped tooth, the clinic team met with his parents to discuss what it was like for him to go to the dentist in the past, and how he typically responds to certain situations, so that they could better anticipate what might happen during the appointment.

With that knowledge, the team was ready to do what they could to make him feel as comfortable as possible.

“They talked to him and tailored their approach as much as possible to meet his needs, making sure to build rapport and trust,” said Hélène. “They helped him understand what was being done and what was expected of him during each step of the procedure.”

They also helped to make sure that Jean-Marc was comfortable.

“When I asked if there was something we could put on his legs to keep him warm, they came back with a warm blanket,” said his mom. ”Their level of kindness and compassion was so heart-warming.”

Leveraging virtual dental care during the COVID-19 pandemic

When hospitals across Ontario were directed by the provincial government to pause non-urgent programs and services, the hospital’s dental clinic scaled back to provide in-person dental care for emergency appointments only. But in an effort to provide as many patients as possible with timely care, the clinic also leveraged virtual care technology in some cases, which they plan to continue into the foreseeable future.

“Virtual care has been good for our clinic and our patients,” said Siobhan.  “For example, if we have a patient with a developmental delay, and we know that person will eventually need to go into the operating room, we don’t need to have the patient and their two workers come to the clinic.  Instead we can call their caregiver, potentially prescribe antibiotics and send off the paperwork to the operating room. It’s a smoother process for the patient.”

As restrictions are lifted, the clinic is gradually increasing the number of services once again.

Grateful families, dedicated staff

Anyone who has been to a dental clinic knows that the staff can make the difference between a positive and a negative experience.  In addition to being at the top of their game professionally, Hélène is pleased to say that the staff at the hospital clinic show incredible compassion.

Two members of the dental clinic standing in a dental exam room at The Ottawa Hospital.

The team at the clinic work together to provide each patient with world-class, compassionate care.

“They were so kind and patient, so open-minded and flexible as well as efficient and professional,” she said. “We could see that the whole experience was very reassuring to Jean-Marc, which meant so much to us.  We greatly appreciate the excellent services that Dr. Weld and the team at the dental clinic has provided to our son.  It’s reassuring to us to have the team here at the hospital and know that they will do what they can to help.”

And for the staff, that’s part of what makes this clinic special.

“I think because we have such a different patient population within this clinic, there is a lot of compassion from the staff,” explained Siobhan.  “I’ve gone in the room myself to hold a patient’s hand because she was so anxious during an extraction. We  try and go above and beyond to make sure that they’re ok.”

‘Ok, I’m ready. Let’s get this done!’

What could have been a difficult or even dangerous appointment ended up being pleasant for everyone, thanks to the teamwork between the dental clinic staff, Jean-Marc and his family.

“Going to the dentist this time was so important to Jean-Marc,” Hélène said. “He forgot all his other behaviours and rituals.  Nothing else mattered to him at that point and he was so relieved to be getting his tooth fixed.  He just sat there with his sunglasses on and gave the thumbs up as if he were saying, ‘Ok, I’m ready, let’s get this done!’”

 
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