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Dr. Elizabeth Benz is the director of the Samuels Sinclair Dental Center at Rhode Island Hospital in Providence, one of the only programs in the country that provides dental care within a hospital setting. The center opened in 1931 with the mission to ensure children could receive dental care regardless of whether their families could pay. It has since grown to specialize in delivering dental services to intellectually and developmentally disabled patients of all ages.
Q. Can you give me a brief history of the Samuels Sinclair Dental Center at Rhode Island Hospital?
A. The Sinclair Dental Center was created through a $300,000 endowment from Colonel Joseph Samuels to build a space just so children could access dental care regardless of their ability to pay. At the time, the center had a social worker in-house who would check a patient’s eligibility and income, and you could pay 25 cents for your initial exam and then 5 cents a visit after that. If you could not afford that, you were given free care. We’ve had generations of patients come through here.
Then there was a big push nationwide to deinstitutionalize the intellectually disabled population in the 1970s and 1980s. Locally, the Ladd School in Rhode Island closed, which was an institutional facility for special needs patients. Previously, they had received all of their treatment directly at those facilities — from haircuts to dental and medical appointments. When those patients were pushed into group home settings within the community, they needed places to go. We took them in, and that’s been our secondary mission here at the dental center. We probably treat approximately 90 to 95 percent of the intellectually disabled patients that are in group homes in the state.
Q. How much do patients pay to receive care at the center now?
A. The majority of our patients do not pay out of pocket, and it’s mostly because most of these patients are on state aid and they have limited places to go. Adults special needs patients are pretty much only seen here.
Q. Are there dental centers like this one everywhere?
A. The closest facility to ours is Tufts’ specialty care clinic, which has offices across the state of Massachusetts. But I still have patients that come here from group homes that are north of Boston, and a lot from Connecticut. It’s because what we do is not taught in dental schools or from textbooks.
Q. What do you mean?
A. This is physical work. We do some medical stabilization for some patients. Our autism spectrum disorder patients tend to like the stabilization because they are the ones who usually like weighted blankets, and other tools like that. Patients with Down syndrome, on the other hand, tend to hate it. They don’t like when their personal space is being invaded. There are times where they are rocking and rolling in their chair, and you have to just move with them to get what you need to get done in their mouths — and do it really quickly.
Because of this, patients with special needs tend to need breaks during appointments, which makes these appointments five times longer than they would with a neurotypical patient. You have to have a whole different set of skills in order to have this job, not just go to dentistry school and call it a day.
Q. This center and Delta Dental of Rhode Island are launching a residency program, too.
A. We’ve had our general dentistry residency since about 2015. Historically we’ve taken two residents per year, and now we’ve started taking three. We’re only one of three special care dentistry sites in New England.
Delta Dental is helping us fund the launch of the state’s first oral surgery residency program, which will help us address the demand at both the local and national level. It’ll be a four-year oral and maxillofacial surgery program that accepts two residents per year, and supports newly related clinical [and other] positions at Rhode Island Hospital. We hope to get this up and running in the next two to three years.
Q. Why is this new oral surgery residency so important?
A. In Rhode Island, we only have about 22 oral surgeons in the entire state. None of them take Medicaid.
Q. The number of people who are on public insurance in Rhode Island is staggering. What is your caseload like?
A. We’ve seen increases in our visit volume every year by about 500 to 1,000 visits. And we’re handling that with the same amount of staff, but just working double and triple time to accommodate everyone. It’s really an access to care issue. If you have Medicaid as a child, you have a couple of other options in Rhode Island for places to go for dental care. As an adult, there’s hardly anywhere other than here [outside of some community health centers].
Q. What is your end goal for this residency program?
A. My goal with our residency program is to educate a new dentist coming out of dental school, give them the skills they need, and then have them take some of these patients to their private practice, wherever they practice. I don’t expect them to take the toughest patients, but going through a residency program here shows them that everyone can have dental care, it’s just a matter of how it’s performed, and what kinds of behavior modifications, time, and compassion you’re going to have to think about.
Q. Why is it that so many private practice dentists do not take Medicaid?
A. Our Medicaid rates in Rhode Island increased slightly in July. Before that, our rates hadn’t been raised since 1991. There is no longer an overabundance of dentists in the state either, so it’s not like everyone can take a few Medicaid patients to do their little part. A whole generation of dentists have retired, and taking in Medicaid patients isn’t keeping the lights on or allowing you to pay your staff by any means. It’s a money-losing endeavor.