D4

By MEGAN OGILVIE
The Canadian Press

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TORONTO - Judy Teper leans back in the dentist's chair, squinting against the bright light shining in her face. A nurse asks the 39-year-old to open her mouth. But Judy, whose fists are clenched in her lap, locks her jaw in a grimace.

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The Canadian Press

Dental clinic: Registered nurse Teresa Posedowski places patient Stanley Farber's glasses back on his head after he received a dental cleaning at the dental clinic at Toronto’s Mount Sinai Hospital.

"Now, Judy," says her father, Wilfred Teper, as he steps into the treatment room, "you are lying on a beach and that's the sun in your face and you are very relaxed."

"And here," he adds, as the nurse turns on the tooth polisher, "comes the tickling machine."

Judy giggles, and opens her mouth. Soon, her teeth are getting a good cleaning.

Like almost every other patient in this busy dental clinic at Toronto's Mount Sinai Hospital, Judy has a developmental delay. In her case, it is microcephalicy, a neurodevelopmental disorder in which the circumference of the head is smaller than normal because the brain has not developed properly. Other patients may have Down syndrome, autism spectrum disorder, cerebral palsy or an acquired brain injury.

All of them, no matter their condition, come to the first-floor clinic because dentists in their community cannot - or will not - take them as patients. A few, including the Tepers, take the subway to Mount Sinai. But the majority of patients come from all over the province, some travelling more than five hours for a 30-minute routine dental cleaning.

Many community dentists are reluctant to treat people with special needs because they are concerned they do not have the right equipment or skills, says Dr. Michael Sigal, who heads the Dental Program for Persons with Disabilities at Mount Sinai, the largest clinic of its kind in Canada and one of the top programs in North America.

"The first question I ask new patients is, 'Have you looked for a dentist in your community?' And they say, 'Yes, I've tried, but I can't find one,'" Sigal says. "There is a significant lack of access for these patients."

Yet, in almost all cases, dentists do not need special equipment or skills to treat persons with disabilities.

"It just takes more patience and a higher degree of, what I call, flexibility and lateral thinking," says Sigal, who is dentist-in-chief at Mount Sinai and head of pediatric dentistry at the University of Toronto. "You have to problem-solve on your feet."

"Some patients don't like shiny things, so we cover them up. Some patients may not like bright rooms, so we turn the lights out. They may not like white coats, so you take the coat off ... we try to accommodate patients, to learn what will work and what will not work."

Sigal says community dentists cite a combination of factors for their reluctance to treat patients with special needs.

First, he says, there may be physical barriers: an office may not be able to accommodate wheelchairs, for example. It also takes more time to treat a patient with special needs, which means dentists are less productive when they treat that population.

There is also a financial barrier: patients with special needs are often covered by the Ontario Disabilities Core Program, which only accounts for about 59 per cent of a dentist's regular fee as set out in its fee guide. As a pediatric dentist, Sigal can charge $65 to clean and scale a child's teeth. The provincial program pays dentists $45 for that same service, he says.

But perhaps the biggest reason community dentists refer patients to Mount Sinai is their fear of how a patient with special needs will behave during their appointment.

"These patients may hug, kiss, spit, bite, act out," Sigal says. "Most dentists' first reaction would be to pull away. They don't know how to react to that."

And, he adds, treating a potentially unco-operative patient may also disturb a waiting room of "normal" patients.

Some special-needs patients are non-verbal, he says, and express themselves using groans, shrieks and high-pitched squeals.

"With the financial, social and psychological factors, combined with the unknown, it's easier for dentists to tell patients to go see Dr. So-and-So at Mount Sinai," Sigal says. "We are the safety net."