Health & wellness

Dental care for the developmentally disabled

Since the 1970s, Tufts University School of Dental Medicine has partnered with the state to fill a gap in care

Dr. Joel Pearlman and dental assistant Susan Ford perform an exam on Robby McCall at the Tufts dental clinic in Wrentham.

Jessica Rinaldi/Globe Staff

Dr. Joel Pearlman and dental assistant Susan Ford perform an exam on Robby McCall at the Tufts dental clinic in Wrentham.

In a Wrentham dental office, Kayla Bessette leaned back in a patient chair as hygienist Patty Pezold leaned forward to scrape her teeth. Bessette’s body appeared relaxed, but there was tension in her face as she extended her hand and pulled back her lower lip for Pezold’s pick.

“Kayla has really strong lip muscles, so she likes to help me,” Pezold explained. “Sometimes when you’re nervous, it makes that muscle really tight.”

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Pezold spoke gently and encouragingly to Bessette as she completed the cleaning and applied a fluoride varnish; then hygienist and patient said goodbye, and Bessette returned to the waiting room to meet her mother.

Bessette, 29, is among hundreds of developmentally disabled adults who get their cleanings and fillings at this facility on the grounds of the Wrentham Development Center, one of seven Tufts dental facilities across Massachusetts run through a partnership with the state.

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Parents say the program changes lives for these patients who have cognitive and often physical disabilities that make brushing and flossing a challenge and can impair their ability to describe pain or discomfort.

“I’m very grateful that they exist,” said Sandra Silva, Bessette’s mother, who lives with her in Attleboro.

“She’s comfortable here, and that’s probably most important,” Silva, 56, said. “Nobody likes to go to the dentist — let’s be real — [but] she doesn’t resist coming. . . . She never asks to reschedule; she just goes with the flow.”

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The collaboration between the state and the Tufts University School of Dental Medicine grew out of a series of lawsuits filed by parents in the 1970s to demand better treatment and access to health care at the seven state schools for the developmentally disabled.

The parents alleged that the facilities were understaffed, overcrowded, and often unsanitary, violating residents’ right to minimally adequate care and treatment.

Globe reports from the early 1970s describe a system in which some young people who entered state schools with life skills such as being able to feed themselves or use the toilet unaided would regress, losing those abilities through neglect.

Among other deprivations, residents at state schools had little access to medical or dental care, and the treatment they did receive was often inadequate or inappropriate.

“The standard of care definitely was different. For individuals back in those days, it was not unusual to go, as a first option, to extracting teeth, and in some cases not replacing them with dentures,” said Gail Grossman, who has worked with people with disabilities since 1973.

“That has significantly changed, and I would say that the Tufts dental program and its reach and its ability to train dentists and have them move out into community settings has vastly expanded the quality of services and support that individuals receive in terms of dental care,” she continued.

Grossman has worked with the Tufts program for more than a decade as the assistant commissioner for quality management in the Department of Developmental Services, which provides assistance for about 34,000 developmentally disabled children and adults in the Commonwealth.

Three-quarters of the dental program’s funding comes from Medicaid reimbursements, with the rest — about $1.5 million — paid jointly by the Department of Developmental Services and the state Department of Public Health, Grossman said.

Originally built on the grounds of the state schools in Belchertown, Hathorne, Monson, Wrentham, Taunton, Templeton, and Waltham, several of the dental clinics have since moved into offices in those or neighboring communities as the state has gradually dismantled the old residential system for the developmentally disabled and replaced it with a network of group homes and home care providers.

Silva said her daughter Bessette has been coming to the Wrentham center for about a decade, the same period that Pezold has worked there.

“It’s just one less thing that you have to worry about, because continuity is very important to them, and routine,” said Silva.

Bessette said that when she brushes at home, it is hard for her to reach her bottom front teeth, and she has to pull her lip down as she did in the dental chair. She said she does what she can to look after her teeth. “When I go to restaurants, I order water instead of soda,” she said.

Pezold, 57, has been a hygienist for 32 years and worked for a long time in private practices, but she said treating the developmentally disabled has been particularly rewarding.

“I feel fortunate to work with them,” Pezold said. “I learn a lot from my patients. Our patients have a lot of struggles. . . . It reminds you to [feel] fortunate for what you have.”

The clinics are also sites for teaching the treatment of the developmentally disabled, with each Tufts dental school student required to spend at least one week working in a clinic. In recent years, they have also become sites for research on dental care for those with disabilities.

Dr. John Morgan, who was director of the program from 2000 to 2009 and has since shifted to a research role, said studies conducted at the clinics have shown that patients with developmental disabilities frequently develop cavities and periodontal disease even with access to quality dental care and that family caregivers have less training in assisting with oral health than professional aides.

He said further research could lead to important conclusions about how to improve the quality of care and to public policy changes.

“Maybe we need more support for the caregivers in some way, whether it’s financial support or other things that we could identify,” said Morgan, 63. “Certainly, looking at the home environment . . . and what kind of supports are there for oral health makes logical sense.”

Susan McCall has been bringing her 34-year-old son Robby McCall, who has autism, to the Wrentham clinic for six or seven years, she said. As a child, he was frightened to go to the dentist, she said, and he had difficulty sitting still. But as he has matured, he has become more relaxed.

She said it helps to remind him that he will get a reward for good behavior: a chocolate milkshake. She also praised the patience and kindness of Dr. Joel Pearlman, who worked at the old Fernald State School as a dental student in the 1970s and has been with the Tufts program since its inception in 1976.

“Robby needs someone who understands working with someone with a disability,” said McCall, 65, of Ashland. “Dr. Pearlman from the very beginning has been wonderful with him. It takes a certain personality to work with Robby, or . . . others who are developmentally disabled.”

Pearlman, 68, said he has always enjoyed working with developmentally disabled patients and their families and he is moved by the relationships he witnesses in his examining room.

“You put yourself in their place as a parent, and you can appreciate [their sacrifice],” he said. “We spend an hour of our time . . . but you have a parent who’s responsible 24/7. It humbles you to a certain extent. You have a lot of respect and regard for them not putting themselves first.”

Jeremy C. Fox can be reached at jeremy.fox@globe.com. Follow him on Twitter @jeremycfox.
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