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Ready, Set, Smile

Training helps dentists and students learn how to treat children with special needs

December 08, 2014

By Kelly Soderlund

Wheaton, Ill. — Six-year-old Yehya Azhar lay in the dental chair with tears streaming down his face as muffled crying sounds escaped his mouth.

His dad, Mohammed Azhar, knelt down next to the chair and rested his hands on Yehya’s legs to comfort him. His brow furrowed and he winced every time his son screamed.

“Daddy, we are done,” Yehya said, struggling to catch his breath in between sobs.

“It’s alright. We’re just going to get this done really quickly and then you get to go home with daddy,” said Kristina Zivrer, fourth-year dental student at Midwestern University College of Dental Medicine, who, under supervision, helped treat Yehya Oct. 29 at the DuPage County Health Department.

Thumbs up: Josh Tschetter, 9, poses with Midwestern University dental students Jacob Sonn, left, and Ryan Kuebler after his treatment at the DuPage County Health Department during its Ready, Set, Smile clinic. The program focuses on the criteria for behavioral and anesthesia management for children with special health care needs.

Third-year Midwestern student Andrei Ionescu stood behind Yehya and rubbed each side of his head in a soothing motion as a supervised Josh Cribbs, fourth-year dental student, restored a cavity on one of his teeth.

Yehya has cerebral palsy and visits to the dentist have been nearly impossible given his special needs. He doesn’t quite understand what’s going on, so he gets scared and acts out physically, making it an arduous task for a dentist to complete the treatment.

That’s where the Ready, Set, Smile program comes in. Ready, Set, Smile trains dental students and dentists to be better at treating special needs patients like Yehya.

The Ready, Set, Smile educational program focuses on the criteria for behavioral and anesthesia management for children with special health care needs. Its goal is to help determine the need for a regional training center that could provide guidelines and resources for access and coordination of sedated oral health treatment in hospital or day surgery centers.

Mohammed Azhar
Reward for good behavior: Mohammed Azhar comforts his son Yehya, 6, as he chooses a toy for being good during his Ready, Set, Smile exam.

“Treating a patient like Yehya is a unique experience and one of the more difficult situations our student participants will be faced with,” said Dr. Robert Rada, the primary educator for Ready, Set, Smile. “Most patients with special needs can be treated with minimal challenges.”

Dr. Rada’s LaGrange, Illinois, practice addresses the oral health of special needs patients and he works with Dr. Lance Lambert, a pediatric dentist in Glen Ellyn, Illinois, in Ready, Set, Smile. Both are part-time faculty members at the University of Illinois-Chicago College of Dentistry.

Ready, Set, Smile is funded through a three-year grant from the Illinois Children’s Healthcare Foundation with assistance from Delta Dental of Illinois and includes an ongoing educational program through the DuPage County Health Department. Students and dentists attend a series of lectures and clinical hands-on sessions on how to treat special needs patients in the office as well as in a hospital operating room under general anesthesia.

On Oct. 29, eight dental students from Midwestern and the University of Illinois-Chicago College of Dentistry treated 22 special needs children under the supervision of Dr. Rada and other dentists at the DuPage County Health Department. Dr. Rada and his team recruited patients who did not have a dental home or who needed a checkup, primarily children with autism, cerebral palsy, genetic syndromes or Down syndrome.

“They have special health care issues. Many of them are taking multiple medications. Oftentimes these patients exhibit behavioral challenges because of their physical and/or intellectual disabilities. Sometimes people come with breathing tubes or have seizure disorders or have various cardiac problems,” Dr. Rada said. “General dentists often find these patients unfamiliar and difficult to treat. That’s a big problem in this country. There are really only a small number of dentists willing and able to take on these special needs patients, so they must go to hospital dental clinics and wait months to years to be treated.”

This year, 64 children received 156 dental procedures at five clinical training sessions that 70 dental health professionals — including dentists, hygienists, assistants and students — attended. Four educational seminars were also held this year, with 225 attendees.

Dr. Rada has been in practice since 1987, and around two-thirds of his patients have special needs. He’s known in the Chicago suburbs as “the” dentist to visit if a loved one has disabilities and many people travel long distances to see him.

Many of his patients have significant oral health issues, such as advanced periodontal disease or caries, and are taking medications that cause dry mouth, Dr. Rada said. Some have malocclusions that are often associated with their developmental disabilities. For many, their oral health has had to take a back seat to their other medical health care needs, he said.

Dr. Rada said his ultimate goal through Ready, Set, Smile is to develop a referral network in the region for oral health care access for children and adults with special needs. He figures by providing dental students with the necessary education and training, participation in this program is a great start for building a base of practitioners who can handle the influx of special needs patients in the area.

Elijah Tschetter
Just sit back and relax: Elijah Tschetter, 5, smiles before he’s examined at the Ready, Set, Smile clinic
Oct. 29.

Cindy Tschetter is the mother of three of those patients. Her son Josh, 9, is autistic and her twin boys Elijah and Isaiah, 5, were born with cleft palates and have some sensory disabilities.

Midwestern students Ryan Kuebler and Jacob Sonn, under the supervision of Dr. Sal Storniolo, dentist at the DuPage County Health Department and adjunct faculty member at Midwestern University, transformed Josh’s visit into a Star Wars experience by giving him a curing light to hold as his lightsaber while they checked his teeth. They also had everybody in the room say “ahhhh” to incite Josh to open his mouth.

Ms. Tschetter said she was pleased with the care provided to her boys and would bring them back to this clinic, given how well they did and that the quality care was provided free of charge. Mr. Azhar was also planning to bring Yehya back to a future clinic so he could have another cavity filled.

Yehya had one cavity treated at a clinic Oct. 22, another on Oct. 29 and still had one more. But he was so frightened and out of sorts that the dental students gave Mr. Azhar the choice of whether he wanted them to continue or if he wanted to postpone the last treatment. Mr. Azhar agreed and picked Yehya up and hugged him, wiping the tears from his eyes.

The students seemed overwhelmed after treating Yehya, saying he was the most difficult patient they had ever seen.

“For these students, it’s tough because they’ve only had minimal experience even treating pediatric patients who don’t have any special needs,” Dr. Rada said.

They admitted it was a tough day but said Ready, Set, Smile has prepared them for these types of days.

“Initially you think, ‘I can’t handle it,’” said Mr. Cribbs. “But with the training we’ve had, it makes you more confident.”

Dentists, dental team members or students who are interested in participating in the program may email Dr. Rada at bobr759@sbcglobal.net.