Celebrating Developmental Dentistry PART 1: Sydnee Chavis, DMD
By Helen Journal Staff
INTRODUCTION
For the past 50 years, access to, and the ability to receive oral healthcare services has been the number one health problem faced by people with disabilities. Most studies cite the lack of didactic and clinical training of dental professionals, inadequate levels of reimbursement for treatment, time, complex needs and behavioral problems as the most significant barriers they face. Stigma, communication, ownership, culture, and the changing the face of healthcare are additional barriers to care. The numerous comorbid and secondary conditions also contribute to the high burden of disease faced by patients with disabilities.
There is clearly a need to bring more attention to the barriers faced by people with disabilities when it comes to receiving competent, timely oral healthcare and early intervention. Who would better provide us with valuable insight into this issue than oral healthcare professionals having purposefully committed to treating people with disabilities?
With this series, Celebrating Developmental Dentistry, HELEN Journal and PAOH (People Advocating for Optimal Health) shine a spotlight on oral health professionals who are passionate about treating people with disabilities. We thank these professionals for their passion and commitment.
SYDNEE CHAVIS, DMD:
“Every dentist and healthcare provider should be able to use their humanity to treat any patient with kindness and with care.”
Sydnee with sisters, Brandi (her sister with cerebral palsy) and Jillian.
Syndee Chavis, DMD knew from the start that she wanted to treat adults with disabilities. Her sister, Brandi, has profound disabilities (cerebral palsy, ID and is nonverbal). “Having her as a big sister absolutely colored my worldview and my perspective of people with disability,” said Sydnee. “I knew that she was different from a very young age, but that was such a gift and a blessing to my family, because of the unique abilities she did have.”
Sydnee, who has been in practice for 10 years, graduated from the Harvard School of Dental Medicine. She is currently Clinical Associate Professor at the University of Maryland School of Dentistry, Special Care & Geriatrics (Oral & Maxillofacial Surgery Department). While attending dental school, she was purposeful in seeking out opportunities to solidify her experience in treating patients with disabilities. She instigated clinic involvement as well as research projects that focused on the care of people with disabilities.
“I remember distinctly, I had a patient who happened to come to the student clinics and was assigned to me because my faculty knew that I wanted to take care of patients with disabilities.” Sydnee recalled. “She had some intellectual disability but could walk and was verbal. Her disability wasn't so profound that actually providing her dental care was straightforward. It merely required a little more patience, a bit of understanding and TLC to forge a relationship with her.
“Having her as a big sister absolutely colored my worldview and my perspective of people with disability…I knew that she was different from a very young age, but that was such a gift and a blessing to my family, because of the unique abilities she did have.” -Sydnee on sister, Brandi
Other people commented at the time on how much they appreciated Sydnee for taking care of the patient. “To me, that was a sign that other people thought what I was doing was something special or different,” said Sydnee. “But it shouldn't be seen that way. Every dentist and healthcare provider should be able to use their humanity to treat any patient with kindness and care. It was a real ‘aha moment’ that I realized everybody should be able to do this. ”
The Training Gap
Dentistry is the number one unmet healthcare need among people with IDD, both for children and adults, but especially adults. One of the main reasons, Sydnee explained, is that dentists (“...physicians as well.”) do not receive significant training, whether didactic or clinically, to treat patients with different types of disabilities. “It is more challenging, generally speaking, for dentists to guide patients with disabilities, as dentistry is an invasive and sensitive profession.” This involves being in the oral cavity, being able to keep the patient’s mouth open, and to have them tolerate the noises and feelings of vibration.
“It takes some different behavioral guidance techniques and awareness, as well as just methodologies to provide care to patients who might have different behavioral tolerances or different capacities to sit still and keep their mouth open for treatment.”
Sydnee believes that there's a long way to go in improving training, comfort levels and competencies for dental students and dentists to be able to treat patients with disabilities.
Giving Control to the Patients
Autism is perhaps the most prevalent disability of patients that Sydnee treats. Her preparation for treating people with autism is not much different from that of any other patient. “If I haven't met a patient before, but I know they have a history of autism, I start off by trying to find something to connect with them: understanding what are their interests, hobbies, what's something that I can talk to them about to help gain trust and start to build a relationship and rapport so they'll be comfortable with me. That's the most important thing.”
Sydnee gathers sufficient information about the patient before beginning treatment –what generally has worked and hasn’t worked for the patient. For example, if the patient likes to listen to a particular type of music, Sydnee will play that music prior to starting treatment. If they prefer the room to be darker, she will try to dim or turn off some of the lights. If they don't like being touched in a certain place in their head or neck, Sydnee makes sure to explain what she’s doing. She tries to avoid doing what makes them uncomfortable.
She explains everything she does. “Part of the experience of dentistry is not knowing exactly what your provider is doing; and we use a lot of sharp instruments that we put in the mouth. So, I'll show patients the instruments, explain what they are, what they're used for, or let patients hold them, feel them, and explain and demonstrate everything that I'm about to do before I do it.”
What Sydnee finds most helpful, no matter what their specific disability is, is giving control to the patient. She gives them a way to signal if they need a break, or if anything is uncomfortable. If they want her to stop for a minute, she gives them an opportunity let her know. If needed, she gives them a break. “I kind of put them in the driver's seat, to have the autonomy to control the flow of the appointment, so that they can feel more comfortable.”
What Sydnee finds most fulfilling is being a resource to sit and listen to a patient, their family or their caregiver, or all three—”to say that I am here to help you, and I will do everything I can.”
The Referral
The American with Disabilities with Act and Title IX prohibit discriminating against people on the basis of sex, race, or disability status. In the field of oral healthcare, providers cannot turn anyone away nor decline to treat them on the basis of their disability—but Sydnee explained that, should a dentist not feel comfortable or confident in their ability to treat a patient because they don't have the skills or knowledge, then that dentist may refer the patient elsewhere.
The problem with referrals is there are very few dentists that are willing, able and comfortable in treating patients with disabilities, so those few end up being inundated with referrals. Sometimes, they're also not necessarily located geographically close to where the patient lives. So typically, people with disabilities have to wait months, or even years, to receive care.
Sydnee herself receives a good number of referrals in her role as faculty at the dental school. It is widely known within her community in Baltimore, that the dental school offers services for patients with disabilities. They also have a dedicated clinic, the Special Care and Geriatrics Clinic, providing care for patients with disabilities and older adults. Sydnee talked about one of the patients she recently saw, who has Down syndrome. He was very cooperative, independent, and aware his own healthcare needs. He's seen a dentist every six months for his whole adult life and generally has healthy teeth.
About a year ago when the dentist took x-rays, it was revealed that the patient had a deep cavity and would need a root canal on that tooth. His primary dentist who has been seeing him for cleanings referred him to an endodontist who is a root canal specialist. That specialist referred him to a surgery center to get a treatment plan and estimate for having the care done under general anesthesia because he has Down syndrome.
Eventually, Sydnee received a call from the patient's father through a common connection who sent her an email and sought her input for his son’s case; they were getting estimates for full mouth treatment and care under general anesthesia which could add up to tens of thousands of dollars and a long treatment process.
“We thought he was healthy and he was very up to date on his care,” Sydnee said. “Long story short, I wound up seeing him. He needed a root canal and a crown on this one tooth, but he didn't need to have it done under general anesthesia, and he didn't need all of the other care that was recommended.”
Because he had Down syndrome, it was assumed he would not be able to tolerate the root canal in the clinic setting like anybody else would. Nobody gave him that chance. Sydnee was able to see him and perform the root canal, the crown and, in the end, “he did spectacularly… So people need, and particularly those with disabilities, they need to be given the opportunity to participate in their care without somebody dictating that they need to be asleep in order to have treatment.”
Sense of Fulfillment
For recent graduates, Sydnee recommends that they don’t look at patients with disabilities needing to be treated any differently than neurotypical patients. She tells her students to look at every patient as an individual; they need to have that same checklist of all that’s needed for every patient and every appointment. That list might have to be modified from person to person based on anybody's particular likes, dislikes and comfort level.
“You want to meet the person, understand who they are, what their needs are, and then modify any treatment that you do based on their needs,” said Sydnee. “And don't assume that because they have a disability, they may need additional treatment above and beyond what you would provide for the neurotypical population. Don't assume that they won't be able to tolerate it.”
By the time a patient with a disability sees Sydnee, it’s highly likely they’ve gone to several other dentists who have not been able to treat them; or they've gone through many years without receiving dental care. Sydnee’s hope and goal, especially by being in the academic setting, is that she can help encourage more dentists to treat more patients with disabilities.
What Sydnee finds most fulfilling is being a resource to sit and listen to a patient, their family or their caregiver, or all three— “to say that I am here to help you, and I will do everything I can.”
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HELEN: The Journal of Human Exceptionality and PAOH (People Advocating for Optimal Health) thank the Colgate-Palmolive Company for their unrestricted educational grant and helping celebrate Developmental Dentistry.