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Navigating Complex Dental Care for Special Needs and Elderly Patients
22 Plays6 days ago
About the Hosts:
Dr. Savanah Craig and Dr. Ronnetta Sartor are both emerging professionals in the field of dentistry, navigating the complexities of early careers in dental practice. Dr. Craig is known for her work in both South Carolina and Ohio, specifically working with special needs patients and providing IV sedation procedures. Dr. Sartor, based in South Carolina, has a wealth of experience in handling older populations with complex medical histories and special needs patients. Both have been trained extensively in residencies focusing on diverse dental care needs.
Episode Summary:
In this engaging episode of "Beyond Graduation," Dr. Savanah Craig and Dr. Ronnetta Sartor delve into the intricate challenges faced by dental practitioners who work with complex patient cases. The episode explores the ethical considerations and logistical dilemmas arising when treating elderly, special needs, or medically compromised patients. Both hosts share their personal experiences and discuss their approaches to decision-making, emphasizing the importance of collaboration with medical professionals and ethical boundaries in patient care.
This episode explores the sensitive and nuanced dynamics of dental practice, especially for those just starting in the field. Dr. Craig and Dr. Sartor illustrate the emotional and professional challenges faced while balancing patient needs and operating within limitations, such as OR availability and insurance complications. With themes of compassion, professional integrity, and the importance of continuous learning, the episode not only informs but also inspires practitioners at different stages of their careers.
Key Takeaways:
- Dentists often face ethical dilemmas when treating patients with complex medical or special needs.
- Collaboration with medical professionals is crucial in providing safe and effective care.
- Patient safety should always be prioritized, even at the risk of turning away business or referring to specialists.
- Real-world practice involves acknowledging and working within certain limitations, such as insurance issues and OR availability.
- Continuous learning and setting realistic expectations are key components for managing diverse patient needs.
Connect with Us:
- Savanah Craig, DDS: @savanahcraigdds
- Ronnetta Sartor, DMD: @dr_sartor
- FutureDentists Beyond Graduation: @futuredentistsbeyondgraduation
- FutureDentists: @futuredentists
- IgniteDDS: @ignitedds and @ignitedds_coaching
- A-dec: @adecdental and https://www.a-dec.com/find-a-dealer
We invite you to listen to the full episode to dive deeper into the nuanced conversations around special needs dentistry and the ethical decision-making process for early-career dental professionals. Stay tuned for more enlightening content on "Beyond Graduation."
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Transcript
Introduction to ADEC's Smart Start Program
00:00:00
Speaker
ADEC's Smart Start program offers first-time practice owners their deepest discounts on equipment and furniture for two years, plus other savings and complimentary services. Ask your ADEC rep for details and start smart with ADEC.
Podcast Introduction by Drs. Craig and Sartor
00:00:13
Speaker
Join Drs. Savannah Craig and Renetta Sartor as we navigate life beyond graduation. Real conversations about forging our own paths in our early years and our careers.
Welcoming Listeners to 'Beyond Graduation'
00:00:24
Speaker
There's a reason it's called practicing dentistry. Right. Welcome back to another episode of Beyond Graduation. i am Savannah Craig with me as always. I am Renetta Sartor.
00:00:34
Speaker
All right, Renetta. so this has been on my mind and I'm secretly hoping you'll have all the answers to this.
Challenges in Dental Practice and Patient Limitations
00:00:41
Speaker
When i wanted to go into dentistry and like part of the reason I did ah residency is because I really wanted and I know that you were felt similar like to treat a wide range of patients with varying complexity and just like you know, be everything for everyone.
00:01:02
Speaker
And then you realize that you have limitations in a variety of ways, ah variety of reasons to not be able to be everything to everyone.
00:01:16
Speaker
But recently I have had a lot of very complex patients come to my practice, either patients with developmental and...
00:01:27
Speaker
disabilities or very, very sick in other ways, nonverbal, really, really elderly and really, really sick patients, cancer patients.
Ethical Dilemmas with Complex Patients
00:01:40
Speaker
Just it's been this microcosm recently in my practice, and am trying to navigate the ethics of who to treat, when to treat,
00:01:51
Speaker
Where to refer? is some care better than no care? How do you, especially with like special needs and elderly populations, like the wait time for specialists or operating rooms is a lot. The fees and insurance. And this is a whole other thing of like being in network. A lot of people need that financial assistance. And so they end up in my chair and Just navigating like when to do it, when not to do it, when to refer, where to refer. Yeah.
00:02:23
Speaker
These are all great points. Yeah. They're great points. And, you know, it's something that comes up very frequently too. What I have tried to do is if someone is this a special needs patient in whatever realm, whether they just need a little extra TLC, I try to get all of the information that I can from a medical perspective to see If it's something that I'm comfortable doing in in my office.
00:02:52
Speaker
Yeah. And if I'm if you'm not, then I just try to inform them of all the reasons why I'm not comfortable. Totally. But also not leave them hanging, but give them some resources to other places that may be able to help.
00:03:09
Speaker
I think where it gets really tricky, and you know this because, I mean, you've been in South Carolina to see, and now you're in Ohio and you, you know, at the college help out with special needs patients in the or But where it gets tricky is finding a place that can see these patients in a timely manner. Because I know i know here in South Carolina, if someone with special needs needs to go to the OR, you Sometimes there's a wait list of a year plus for that. So it's like you want to provide our heart goes out a whole bunch because we we want to provide the care that we need, but in a safe manner.
00:03:53
Speaker
Yep. So I don't know that I have the answer either, but I can say that I completely understand. And it's something you've been to my office before in the town that I live in. We see a lot of the older population.
00:04:09
Speaker
So lots of medications, lots of health issues and that sort of thing. So as much as I can do in my office, I will do. But it's a lot of collaborating in consultations with their medical providers so that on both ends, you know, I'm expressing to them the things I'm concerned about and they're expressing to me what they are concerned about to be able to do the best thing we can for the patient.
00:04:37
Speaker
Yeah.
Risks and Limitations of In-office Sedation
00:04:38
Speaker
And that's all you can do, but it's still it's still so hard. So yeah, so like you were alluding to, i do some OR dentistry at the University of Cincinnati. And- and We take special needs patients to the operating room. But and I'm sure you kind of run into this, too, with the only places to refer tend to be like these big academic institutions.
00:05:05
Speaker
And we did a ton of this in residency. But there's a lot of red tape as a provider. and then you feel so bad, at least I do, of like, I will try.
00:05:19
Speaker
I will try to treat patients in the office if I feel like it is safe enough to try. but I tell the parents, I reserve the right to terminate this appointment at any point where I feel it's unsafe. I have sharp needles. I have drills.
00:05:36
Speaker
i And I don't want to be the one that like traumatizes this patient or harms their loved one. like Teeth are so important. Obviously, that's what I do every day, but it is not worth risking your life over.
00:05:48
Speaker
but then When those patients can't tolerate the ah the office, because I think a misconception is levels of sedation and how that impacts our complex medical patients. Tell me more about what you mean by that.
00:06:05
Speaker
Yeah. So family members who are looking for anyone to care for their loved one, Google, right? And they find that I am an IV sedation provider in network with their insurance and they think they've struck gold.
00:06:20
Speaker
And then you do enough Googling and you find that I have insurance. a background with these things, right? And so they come in and they're like, well, so-and-so has been treated under sedation before, like you can do it. And and you find out with a conversation that it is OR dentistry that they've had.
00:06:38
Speaker
And here's the difference, right? Sedation in my office, number one, it is me. i am all you have. If something goes wrong, There's no code team. there's There's no backup.
00:06:53
Speaker
It is me. And so I've taken some IV sedation courses where they talk about you are the pilot who flies in clear blue skies.
00:07:04
Speaker
You do have a crash cor car, so to speak. Yes. With medications and AED and that sort of thing. So yes, you've got your team as support, but you are correct.
00:07:14
Speaker
Yeah, you you're you're the pilot. And so there's that piece of it. The other piece of it is in-office sedation is a moderate conscious sedation, which is like blab blah, blah, blah, blah. But you still are there with me. Like the the way that this type of sedation works mostly is amnesia.
00:07:34
Speaker
Right. And so you, if... If you are someone who just needs brought down a level, in-office sedation will work for you. But if you need, due to a variety of things, if you need to be 100% unconscious, and especially our special needs patients who can have some tremors or uncontrolled muscle movements that are not their fault, my sedation is not deep enough to prevent those things.
00:08:04
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The other thing we find out is Some of our most special patients have what we call a paradoxical effect to IV sedation, which is where instead of my Versed making you nice and sleepy, it makes you super excited to be here. or my favorite in a lot of females, not my favorite, but very weepy, even though they're not in pain or anything like that.
00:08:28
Speaker
They'll be crying and smiling at the same time and saying, you're not doing anything to hurt me. just can't stop crying. And so if you are someone whose brain works a little bit differently where I can't reason you through, you're fine. Everything's fine. We're good. We're going. You're numb.
00:08:48
Speaker
Or you have these uncontrolled, to no fault of your own, IV sedation isn't
Comparing OR and In-office Sedation
00:08:56
Speaker
safer. The other thing with IV sedation is we have an open airway.
00:09:01
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In the hospital, you are intubated. The anesthesiologist is protecting your airway and keeping you safe. And I just do my dentistry and you are unaware of any of it.
00:09:11
Speaker
Until you wake up. Until you wake up. And it is super, super safe because... You're just not really there for it. So we don't have to worry about you moving unexpectedly or anything like that.
00:09:24
Speaker
One of the things I wanted to add to that too, Savannah, is that in an OR setting, there's an anesthesiologist or a nurse anesthetist. There's so many people. Right. And those are the people that are making sure that patient's okay from a breathing and pain perspective. In OR setting, doctor has an even a more extensive team. And you're not, you know, the only pilot in the cockpit pretty much. Correct.
00:09:54
Speaker
You focus on a dentistry and the dentistry alone, and you have support to help you focus on everything else for the patient. Yep.
00:10:05
Speaker
And yeah, and so there are people who just need to be treated in an OR setting for their safety as well as my safety, right? But it's not easy to get an OR slot.
00:10:17
Speaker
This is so true. Like I have a patient right now. So in my office, it's different. So, you know, we both were trained to do like IV moderate sedation. I still hold my permits and everything for that.
00:10:29
Speaker
But in my office, because I'm the only doctor from a capacity standpoint, Yep. I just don't have the capacity to still do IV sedation at this time. So what I do is conscious sedation with oral sedation, which is like a volume or halcyon plus nitrous oxide.
00:10:51
Speaker
Yep. Or in other words, laughing gas. Yep. And so in my office, if patients can't have a procedure done with that level of sedation, then for me, it's a referral.
00:11:03
Speaker
But there are some patients, for example, I have a patient has had a traumatic brain injury. and some of that sedation needs to be monitored.
00:11:14
Speaker
You know, like if she were to need any extensive dental work, you know, She may be a case that needs to go to the OR setting to make sure.
00:11:25
Speaker
but she has ah husband who is amazing. and he brings her in like every three months for us to clean her teeth. Yeah. Some days she have good days.
00:11:36
Speaker
Some days she don't. And we just learn to work around it. That's the other piece of this. Yeah.
Customizing Dental Care to Patient Needs
00:11:42
Speaker
And, you know, her husband is very patient and he's grateful that we're patient with her too. And we're not going to ever push anything.
00:11:49
Speaker
To kind of put her in a bad headspace or anything like that. Yeah. The other. yeah and And that's that's the thing. you just do the best you can.
00:12:00
Speaker
but I think everything is about setting expectations, but which I think comes with learning that you can't be everything to everyone is just being like, I'm willing to give this a try.
00:12:12
Speaker
if it doesn't work out, you might have to go somewhere else or. I have a lot of elderly patients that teeth just run their course sometimes and just telling them like, hey, we can do X, Y, Z to buy us time.
00:12:31
Speaker
And sometimes that's a hard conversation of like, how much time are we trying to buy? you know, like let's i like that sounds terrible, but like Or I had a couple of patients with cancer who don't have like emergent dental needs and the needed consultations to go on some bisphosphonate medications to stop like cancer metastasis and being like,
00:12:57
Speaker
do you want to come in and treat these couple of cavities? Do you want to not spend time at the dental office? Like, I don't i don't know what's a priority to you. Or, you know, would you do you just just want your loved one to have their teeth cleaned and they don't really want these class 5 lesions taken care of? Or, like, i' I've just ordered some SDF and knowing that, like, we'll at least arrest some things. They're probably still going to catch some plaque or, like, we'll put some GI over it. But...
00:13:27
Speaker
It's not a perfect solution. but sometimes doing something is better than doing nothing. in Trying to know what that balance is. Right. But I think part of it is collaborating, right? Like you, I kind of talked about it earlier, like collaborating with their other doctors, if you can, then collaborating with a patient and their family member, because it's no one size fits all. It's just figuring out what's best for them at this particular time it may change but it may say for right now let's just try to do what we can it's the least amount of invasive because you know there are some patients that their doctor will tell you hey they can't have any dental work done right now yeah so then you mainly just move to things that are palliative and like preventive type type measures to try to you know In your words, buy them some time, you know?
00:14:26
Speaker
No, I think that's a good point of like at this time because I think as dentists we're trained to think 700 steps ahead of like, okay, we do this and then when this fails, we'll do this and then when this fails, we'll do this and then I need you to know all of the pros and cons and risks and benefits of every single thing but sometimes you're like, let's kick this can a little bit and see how we do and and put a filling on this front tooth to to make
Special Needs Training in Residency
00:14:54
Speaker
it work. Yeah.
00:14:55
Speaker
did did So I know when I went to dental school, we had like a special needs clinic at our school where we would help see special needs patients.
00:15:08
Speaker
And so that got rid of a lot of the nerves surrounding that for me. So when it came time for residency, I feel like I was a little bit more confident in it.
00:15:21
Speaker
While you were in dental school, did you have any type of training with special needs patients or anything like that? We had very limited because they the clinic was like switching directors and also it was COVID time. So things were very weird with that.
00:15:38
Speaker
So we didn't have a ton of experience until residency. And I think we did a really good job in residency of like trying when we could. And then i think we just had... and like Our attendings, I think, had a really special place in their heart for those types of patients and would pull strings to get OR slots when they could with some like emergent things.
00:16:00
Speaker
But then you find out like in the real world world, your hands can be kind of tied. And I think that's the problem I have is like – Going down to Cincinnati once a month is great and I'm doing something, but I always feel like I could be doing more even though I can't. I don't have the time or capacity or hospital privileges to do more. And that i mean that could be a full-time job. You could go to the OR every day.
00:16:31
Speaker
I don't go to the OR, but a few times a year, maybe quarterly, I'll go to the free... yeah Children's Clinic, and that's not specifically for like special needs patients, but it's just for children who is in the middle place where they don't qualify for Medicaid, but can't. They need help.
00:16:52
Speaker
Right. They need help. can't you know They're kind of in between of qualifying for different type of insurances. And you you'd be surprised the number of patients that are in that category too Yeah, it's hard. But i I think like you said, you just navigate it the best you can and do the best you can with with the situation you're in and being honest about what you're what you can and can't do for people.
Encouragement for Diverse Residencies
00:17:22
Speaker
Friends, let us know how you how you navigate these challenges. If you know of any resources for patients who need a little bit more care, if you're interested in this type of thing, we would definitely encourage you to do a residency and try to get more comfortable thinking outside of the box a little bit.
00:17:40
Speaker
Any final thoughts, Renetta? I think you summed up really well. I think also like if you're interested in this type of dentistry and you're still in still in school, But you're looking at residencies, maybe look at residencies that are devoted specifically to that that type of care.
00:17:59
Speaker
Or it could be in our case, you know, residencies as dedicated to seeing all different types of patient populations, but especially patients with complex medical histories.
00:18:11
Speaker
All right, we'll catch you back next time. you for joining us for this episode of Beyond Graduation. If you enjoyed this week's episode, be sure to share it with a friend. Connect with us on social media at Savannah Craig DBS and at Dr. Sartor.
00:18:28
Speaker
And remember, you are not alone on this journey. ADEC certified pre-owned equipment is a sustainable, affordable choice that makes genuine ADEC equipment available to every doctor. Each package is sold on a first-come, first-served basis. So if you see one you like, contact your dealer. For more information, go to www.adec.com backslash findadealer. Thank you for listening to Beyond Graduation brought to you by Ignite DDS and Future Dentists. This episode was sponsored by Ignite DDS Coaching. We build self-determined futures. For more information, please reach out to the Ignite DDS team.