Janiece Hardieway-Muhammed has been caring for her non-verbal autistic cousin, Carla Hardieway, for many years. Her adult cousin’s condition makes everyday care like dental hygiene a challenge.
During dental visits, Hardieway-Muhammad rubs her cousin’s hand to make her feel comfortable and remind her that she is safe. This type of assistance is not only a priority for Hardieway-Muhammad but also the St. Louis Dental Center.
The Center, operated by A.T. Still University-Missouri School of Dentistry Oral Health, caters to patients with special needs like Hardieway, 47. The federally funded center offers a full range of oral healthcare services, but the waiting list can be extensive.
Before Hardieway-Muhammad became her cousin’s primary caregiver, she said Carla’s oral health had been neglected, and nearly all of her teeth had cavities. She has 27 dental fillings and two extractions.
The Centers for Disease Control and Prevention (CDC) lists developmental disabilities as impairments in physical, learning, language, or behavior areas, and includes Autism spectrum disorders, cerebral palsy, attention-deficit/hyperactivity disorder, learning or intellectual disabilities, hearing loss, vision impairment, and other developmental delays.
Dr. Paul Bigg, assistant professor and director at Special Care Unit-Special Needs Dentistry, is ensuring patients with disabilities and special needs receive dental care. Dr. Bigg faces significant challenges, especially with patients who are reluctant to open their mouths. Dr. Bigg uses adaptive care for his patients and their specific care plan.
“Adaptive care is the crux of it all. With the care I give to patients with disabilities, it’s fascinating,” said Bigg. Adaptive care allows doctors to connect with the family and patient to discuss what’s best for the patient.
“Carla had to be surgically sedated to get to the root of all of her cavities and for the doctor to perform the rest of the dental care she needed,” said Hardieway-Muhammed. “It took about five of us to manage her to get her sedated.”
Hardieway-Muhammed says Dr. Bigg and his team were sensitive to her cousin’s specific needs.
For example, Dr. Bigg has to give Hardieway a heads up about the loud machinery being used, why it was being used, and how he was going to use it before he turned it on. He has been applying adaptive care since 2019.
“The caregiver or the patient is the PHD of their care; I’m the PHD of dentistry,” Dr. Bigg said when talking about Hardieway’s care plan.
He plans to continue to help Hardieway become increasingly comfortable with going to the dentist. The mouthpress he describes as “A great tool to use for patients with disabilities.” It allows him to get a closer look inside her mouth. For each successful visit, Dr. Bigg rewards Hardieway with a surprise. Since Hardieway is non-verbal, he has to watch for her facial expressions to see where the pain is coming from.
He believes that together they can take care of the patient to a great extent. Dr. Bigg also volunteers for the Special Smiles Special Olympics, where he serves as clinical director, providing dental screenings for athletes with special needs.
According to the World Health Organization (WHO), about 1.3 billion people in the world with disabilities have twice the risk of developing conditions such as depression, asthma, diabetes, stroke, obesity, or poor oral health.
On May 26, 2024, the Global Strategy and Action Plan on Oral Health 2023–2030 was released to define WHO’s global oral health agenda towards 2030.
ATSU services in special care suites are equipped with a wheelchair lift and include exams, cleanings, sealants, fillings, crowns, bridges, periodontal therapy, oral surgery, and digital X-ray. Medicaid and most dental insurance plans are accepted.
In partnership with area hospitals, Dr. Bigg can provide a higher level of dental care for patients with special needs by accessing a hospital operating room if a patient needs to be sedated for the required care.
He has also developed a comprehensive oral health curriculum to teach the next generation of dentists to care for patients with special needs.
“This has been a dream come true to help these patients,” said Dr. Bigg. “It’s been really rewarding.”
This is great to know. My son could really use the service after becoming increasingly hard to manage and often eloping during dental visits.