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How Interdisciplinary Care Brought Terrance Back to Life

As a young man with autism, Terrance struggled to get the oral health care he needed. A visit to the Lee Specialty Clinic in Kentucky changed that — and inspired his family.

In 2015, Terrance Davis was 18 years old and hadn’t been to the dentist in more than two years. His autism made it challenging for his mom, Tina, to find a provider who was prepared to deliver the care he needed. They had tried — and failed — several times.

Then, one day, a brochure showed up in the mail. It was about a clinic, Lee Specialty Clinic, that offered a broad range of health care services for patients with intellectual and developmental disabilities. Suddenly, Terrance and Tina had a glimmer of hope.

“The biggest thing that I was fascinated with was the dental department,” Tina said. “They hadn’t even opened the doors yet and I was ready to run right over.”

When the doors opened, the experience exceeded Tina’s expectations. Benefitting from the integrated care model — a team-based approach that combines and coordinates services to better meet the needs of patients — Terrance emerged with a new outlook.

“When we first came to this clinic, my son was not of this world,” Tina said. “But they tapped into something none of us could tap into and his whole demeanor changed.”

Tina’s experience trying to find a place to get appropriate dental care for her son is all too common among families and patients with intellectual and developmental disabilities. In fact, a study by the Journal of American Academy of Pediatrics found that dental care is the most unmet health need for children with special health care needs. Poorer and uninsured children with disabilities were also more likely to have unmet dental needs.

“This is a group of people who through no fault of their own find themselves needing some help and guidance,” said Matthew Holder, co-founder and CEO of Lee Specialty Clinic. “Discrimination, stigma, medical providers and dentists not being prepared to deliver care to them... The entire system is not designed to provide care for these folks.”

It’s a system that provider organizations — like Lee Specialty Clinic — and benefits companies — like DentaQuest — are trying to change.

The True Value of Integrated Care

Terrance received care for the first time at Lee Specialty while his mom waited anxiously in the lobby.

“I went to get his mom so she could see how great he was doing,” said Dr. Kristen Compton, the developmental dentistry director at the clinic. “And when I opened the door, she was leaning against it. She almost fell through the door and we started laughing together!”

Tina’s anxiety quickly turned to relief and wonder.

“This was the first time that he was ever able to experience dental care in a positive light and the first time he was able to receive dental care without being sedated,” Compton said. “He was very stiff for his first appointment, so we let him keep playing his game on his phone and made sure he was comfortable. And he did great.”

From there, Terrance was connected to other services at the clinic. He accessed physical therapy and went to the swimming pool, where his inner athlete and personality came out.

“The magic of this is that we were able to provide this level of interdisciplinary care, where you have the dentist talking to the physician, who’s talking to the psychiatrist,” Holder said. “We didn’t fully appreciate at first just what that was going to do for the quality of care we would be able to offer.”

It’s a tangible illustration of why oral health leaders, now five years later, are continuing to drive the industry toward a system that takes a more holistic, personalized approach to care.

“I think it’s most important to consider it from the patient’s perspective,” said Dr. Myechia Minter-Jordan, president and CEO of the DentaQuest Partnership for Oral Health Advancement and Catalyst Institute, Inc. “Integrated care is what’s best for all patients.”

A recent DentaQuest Partnership white paper highlights integrated care as a core component to transforming the oral health system. It outlines how personalized care plans can effectively decrease emergency department visits and reduce health care expenditures. In addition, medical-dental integration can produce significant cost savings to the overall health system by addressing undiagnosed systemic disease and helping to manage chronic illness.

“One of the most important aspects of medical-dental integration is that it holds the patient at the center,” Minter-Jordan said. “And it allows the providers to come up with a comprehensive care plan that is inclusive of the whole patient.”

Traditionally, oral health has been secluded from the rest of the health care system and from conversations about overall health, even though studies show more than 90% of all systemic diseases have oral manifestations. For example, according to research from the DentaQuest Partnership:

  • Putting off dental care during early adulthood is linked to an increased risk of having high blood pressure.
  • Tooth decay and other oral infections in children can contribute directly to atherosclerosis in adulthood — a disease in which the inner wall of the arteries become clogged with plaque.
  • The odds of having a first heart attack were 28% higher for people with gum disease than for those without.

“When you think about cardiovascular disease, obesity, mental health, pre-term labor,” said Minter-Jordan, “there’s always a connection back to oral health that is closely linked to these chronic diseases.”

For people with disabilities, who often have a higher risk of these comorbidities, the difference that access to oral care can make is especially significant.

According to the Special Olympics, about half of the athletes who received oral examinations through its Special Smiles program were unaware that they had underlining oral health issues. The data showed that almost 50% of the athletes had signs of gingivitis, 25% had untreated tooth decay, 9% received an urgent dental referral and 12% experienced mouth pain.

A New Future for the Davis Family

Five years later, Terrance continues to visit Lee Specialty.

“It’s a very different experience with him now and a lot of that has to do with how we’re treating him,” Compton said. “We’re not just treating his teeth; we’re treating Terrance holistically and that has allowed Terrance to become more of himself.”

The impact of the positive experience has extended to his Terrance’s brother, Alex, too. In fact, it has launched his career. Impressed by the compassion and care Alex displayed with his brother and other patients and families, the Lee Specialty dental team offered Alex a job.

“I went to school for business, so this was not something I was prepared for or expecting,” Alex said. “My brother inspired me.”

Alex says that the clinic is often a last stop for a lot of people who have nowhere else to turn. They often see patients come in who have behavioral problems, he says, who haven’t seen a dentist in years. But as their oral health needs are addressed and they receive ongoing care and support, there is a drastic change in their behavior.

“Before working here, I had no idea about what dentistry can do for people. Seeing how much of an impact it has on this population has changed how I view what dental is,” he said. “I realize now that when it comes to dental care, it's more than just cleaning or pulling teeth. We’re actually making a real difference in people’s lives.”

And every day, he sees that difference in his brother’s life. He sees it when Terrance competes as an athlete in the Special Olympics. He sees it when Terrance brushes his teeth and starts learning about the importance of preventive care. And he sees it when Terrance smiles.

Their mom sees it, too.

“Now,” says Tina, “this child’s smile is like a million bucks.”

Editor's Note: For more, watch a video of Terrance's story.