Gentle dental:
Weiner winner treats children with special needs
Children's Hospital Boston's Department of Dentistry sees roughly 8,000 patients annually—about 60 percent of whom have special needs, and require extra care, time and attention. That's where this year's Weiner Award winner, Linda Nelson, DMD, MScD, comes in.
With over 25 years of experience treating children with special needs—15 of them at Children's—Nelson has developed a unique insight into this patient population and their overall health. "The term 'special needs' encompasses kids with many different conditions—from the whole spectrum of autistic disorders, to bipolar disorder, to cerebral palsy and more," says Nelson. "My interest in this particular group evolved over time. And it's been truly gratifying."
So what makes going to the dentist different for a child with special needs? Picture your typical visit to the dentist: you're asked to sit in a chair, nearly flat on your back, with your mouth open for an extended period of time, while a team of masked dentists, hygienists and dental assistants looms over you. Now try to imagine it from the perspective of a child with autism, who has an oral sensitivity. He's in an unfamiliar setting, with unfamiliar people who want to look in his mouth. There's nothing more difficult for him, so he may refuse to let go of his mother, hide his face or lash out aggressively when approached by the dentist.
"You have to spend a lot of extra time earning their trust and making sure they're aware of everything that's going on," Nelson says. "We encourage children with special needs to bring their own toothbrush and toothpaste. And when they arrive, we show them how the dental chair works and let them know how many steps will be involved in their visit’Äîgetting into the chair, opening their mouth, etc. They are rewarded after each step they complete, and we all applaud their good work."
Nelson's initial interest in treating children with special needs began during her residency at Boston University Medical Center, during which she spent much of her time at the Eunice Kennedy Shriver Center in Waltham, Mass., working with adults and adolescents with global developmental delay. In fact, part of the compensation for her residency came from a Massachusetts Developmental Disabilities Council (MDDC) grant. She also explored why dentists in Massachusetts weren't treating developmentally disabled children for her pediatric dentistry master's thesis at Boston University.
"I found out there were several reasons dentists weren't seeing these children," says Nelson. "They weren't comfortable due to their lack of exposure to them; their offices weren't handicapped accessible; they didn't have the time needed to treat them; or they weren't being adequately reimbursed for their time."
Nelson's thesis yielded the first-ever listing of Massachusetts dentists who treat children with special needs. The list is maintained by the MDDC, and dentists who reapply to the Board of Registration in Dentistry for licensure in Massachusetts still fill out Nelson's survey today.
But for Nelson, the listing wasn't enough. Two major questions remained: What are the oral health care needs of children with special needs and are they being met? But she was unable to tap the resources needed to find the answers.
Enter the Weiner Award. Established in 1997 to acknowledge former president and CEO David S. Weiner's 30 years of service to Children's, the award recognizes outstanding individuals who demonstrate commitment, leadership and potential for success in helping improve the health of children.
"I have the highest regard for Dr. Nelson, both professionally and personally," says Paula Wool, administrator of the Department of Dentistry. "Her dedication and commitment to working with special needs patients and their families in order to improve and maintain their oral health is unparalleled."
The $20,000 allotted to Nelson for winning the Weiner Award will help fund a dental needs assessment of pre-school children with special needs and their families. Historically, by the time Nelson sees these children they have dental disease requiring multi-hour treatment, which can only be performed under general anesthesia in the operating room. She hopes the assessment will help determine if children with special needs have more tooth decay, and if so, how it can be prevented. "There is an eight-month waiting list to go to the operating room for dental work right now," says Nelson. "If this project keeps one kid out of the OR, then we've met our goal."
"I cannot even begin to tell you how excited I am about this award," she adds. "I'm extremely honored."
