At the Marshfield Clinic in Chippewa Falls, Wis., hygienist Karen Eslinger is getting her room ready. It's all quite routine 鈥� covering the chair's headrest with plastic, opening instruments, wiping down trays.
But then she starts getting creative.
"My next patient is pretty tiny and frail, so I like to go to oral surgery and get a heated blanket. I wrap her up, and I think it soothes her," Eslinger says.
The patient is 16-year-old Kathy Falk. She has , which is a genetic disorder with a constellation of symptoms that look like cerebral palsy, Parkinson's, anxiety and autism all wrapped up together. She uses a wheelchair, can't speak and would find it difficult holding her mouth open for long stretches.
Kathy's parents lift her from her wheelchair into the dental chair. Eslinger swaddles her in the warmed blanket and fits her with tiger-striped sunglasses to block the glaring light. She narrates the entire cleaning, telling Kathy everything she's about to do, interspersed with words of encouragement.
"She's challenging to get the toothbrush in here and we can only ask so much, you know; whatever she tolerates," Eslinger says as she's bent over Kathy with an electric toothbrush. "You're doing the best you can."
For someone with severe disabilities like Kathy, Eslinger and this clinic are quite a find. They welcome patients with all kinds of physical and behavioral disabilities.
People with disabilities are often insured through Medicaid, the federal health care program for the poor and disabled. The program doesn't always pay for dental care, and when it does, those payments of the costs.
That means it can be hard to find a dentist willing and able to do the work.
Dentists and hygienists at the Marshfield Clinic take people with Medicaid and people without any insurance. They specialize in caring for people with disabilities who need extra help to get through a checkup and cleaning. Some patients with autism may be afraid of lights, sounds or touch. Some with physical disabilities may be unable to hold their head in place.
"I have a patient who comes in, and before she gets in the chair we read some books, and then she gets a little calmer and stops crying and we can do a little more of the cleaning," Eslinger says. The patient is in her 30s.
A patient with Down syndrome was so frightened that Eslinger started off cleaning his teeth in the lobby. Each appointment moved closer to the treatment room, until finally she persuaded him to get into the chair.
The work is also quite physical, says Beth Rowan, another hygienist at the clinic who cares for special needs patients.
She's down the hall from Eslinger, cleaning the teeth of Lindsay Klecker, a 31-year-old woman with cerebral palsy and a seizure disorder. Lindsay is blind and uses a wheelchair. Her mother says she functions at the level of a toddler.
Rowan leans over Lindsay, working to floss her teeth while her mother stands at her head, singing to her throughout the cleaning.
"It's hard on your body; they're strong," Rowan says. "They're pulling and tugging, their head is strong, their lips are strong, their tongue is strong."
For invasive procedures like fillings or root canals, the dentists at the Marshfield Clinic go across the street to St. Joseph's Hospital, where patients can be treated in an operating room under full anesthesia.
"There's a certain percentage of the population that absolutely requires having anesthesia for their dental care to be safe," says John Morgan, a professor in the division of special care at Tufts University School of Dental Medicine. Tufts runs a that cares for people with disabilities.
Morgan is lead author of a published in the Journal of the American Dental Association that shows that people with disabilities have worse oral health than the general population.
"Access to dental care is one part of the issue, but there's also the issue of what happens at home; what can be done to help im