Read about the program’s approach based on interdisciplinary collaboration among pediatric dentistry, pediatric medicine, and behavioral psychology practitioners in the latest issue of “CATALYST.”
Photo: UMSOD’s Erica Caffrey (center) performs a dental exam on a patient at Kennedy Krieger.
The University of Maryland School of Dentistry (UMSOD) has partnered with the Kennedy Krieger Institute to provide dental care for children and adolescents with neurodevelopmental disabilities, the first such program at Kennedy Krieger in over 20 years.
Since September, Erica Caffrey, DDS, clinical assistant professor of pediatric dentistry, has traveled to Kennedy Krieger accompanied by a UMSOD pediatric dental resident to conduct monthly oral health exams for children in the Baltimore-based institute’s Neurobehavioral Unit. According to Caffrey, the visits address a persistent gap in dental care for children with neurodevelopmental disabilities.
For children with severe autism, intellectual developmental disabilities, and complex genetic syndromes, a trip to the dentist can be an ordeal that most dental offices are not equipped to handle. Sensory sensitivities mean that everything from the overhead light to the taste of a latex glove to the color of a lead apron can trigger distress. Some patients exhibit combative or self-injuring behaviors and wear helmets or protective clothing. Many can’t communicate verbally.
Often, the solution is to refer the child for dental work under general anesthesia. That means added medical risk and a waitlist that can stretch for months.
“Often, when these kids can’t get dental exams, they get referred immediately for dental exams under sedation or general anesthesia, which increases health care burden, cost of care, and medical risks,” Caffrey said. “If an exam can be accomplished without that, then we may avoid those increased burdens and risks.”
Impactful Results
The program’s approach is based on interdisciplinary collaboration among pediatric dentistry, pediatric medicine, and behavioral psychology. Before each dental visit, a Kennedy Krieger behavioral psychologist works with the child over several sessions to desensitize them to the exam environment. Patients practice sitting in the chair and are slowly introduced to dental instruments, the feel of gloved hands near their face, and opening their mouth long enough for an exam. They can be seen in a hospital bed or in a more traditional dental setting depending on the needs of the child.
Caffrey said the results have been striking.
“I’m seeing really remarkable outcomes where a patient who previously couldn’t sit down in a chair comes in and is willing to allow a dental exam, have fluoride varnish applied, and, in some cases, even put on a nasal mask to breathe some laughing gas,” she said. “That requires a lot of work on the part of the behavioral team. But it shows that there is hope and promise for these kids, and that patience and practice can really help.”
In the roughly 20 exams conducted since September, only one of the patients has required follow-up treatment for decay, Caffrey said. That patient was able to be seen for an additional visit in the same clinic for caries management. Many have tolerated X-rays, an outcome Caffrey said was remarkable given the severity of their behavioral challenges. According to Kennedy Krieger staff, several parents have cried happy tears upon learning their child was finally going to receive a dental exam.
Read more about the School of Dentistry partnership with the Kennedy Krieger Institute in the spring issue of CATALYST.
The latest issue of "CATALYST" magazine celebrates the students and alumni who represent the future of Maryland’s health, law, and social work professions. Read about a School of Nursing alumna who turned her 2023 Grid Pitch idea into Ryan’s Place, a health care center in Gaithersburg, Md.; how Maryland Carey Law’s Law and Health Care Program prepares students to serve; a School of Dentistry graduate who studies gene therapies to prevent and treat cleft lip; a School of Social Work graduate who has been appointed to Maryland’s Commission on LGBTQIA+ Affairs; the School of Pharmacy’s newly launched, one-of-a-kind MS in Artificial Intelligence for Drug Development program; and what’s on the desk of Courtney Jones Carney, assistant vice president of student success, leadership, and engagement.