“A mother from a Florida city about two hours away called me because her adult son with profound intellectual disabilities was waking up at night screaming in pain,” says Dr. Timothy Garvey, D.M.D, who lives and works in Gainesville. “She had taken him to the emergency room a few times, but they all do the same thing: they give an antibiotic, assuming it’s an infection, and tell them to go find a dentist. They do not treat the root cause of non-traumatic dental pain in emergency rooms.”
Dr. Garvey is one of few dentists in Florida who dedicates a majority of their practice to patients with intellectual and developmental disabilities (IDD). Many of the patients treated over his 45-year career cannot talk or express their pain in words. Several have never had dental care at all, largely due to extreme lack of Florida dentists who will treat them.
“After taking a set of x-rays, I extracted all 32 teeth from the patient. They were as bad as you can imagine in your worst nightmares.”
“I followed up a few weeks later. The reaction from his mother was not what I expected—she was so happy that he was finally out of pain. He’ll never have teeth again until the day he dies, but the pain is gone. He’s finally started eating again and putting weight on.”
How Bad is Dental Care for the IDD Community in Florida?
Dr Garvey estimates there are a handful of dentists statewide who prioritize the treatment of the IDD community. Although he is based in Gainesville, his patients are brought to him by desperate relatives, sometimes as far away as Miami.
This severe lack of dental access has devastating consequences. For too many Floridians with intellectual and developmental disabilities, every tooth is pulled not because it’s the best dental option—but because it’s the only one left. That may relieve the pain. But it also removes something more permanent – dignity.
Many patients in the IDD community rely on Medicaid for insurance coverage, which further hampers access to dental care. Few Florida dentists accept Medicaid (under 18%), and even fewer will treat patients they deem ‘non-compliant.’
“Most dentists won’t treat patients with profound disabilities,” Dr. Garvey explains. “Due to their inability to describe their pain, some patients lash out—hitting their heads against walls, biting their fists. There’s virtually nowhere else for them to go.”
The Need for a Dental Home
Currently, Dr. Garvey has a waiting list of 3 to 4 years. The caregiver of a patient recently told Dr. Garvey that 50 other dental offices had refused them.
‘“That’s not the largest number I’ve heard,” he adds.
Interconnected Solutions are Needed
Dr. Frank Catalanotto, president of Floridians for Dental Access, believes dental therapy is a key part of the solution to Florida’s oral health crisis. Currently, nearly 6 million Floridians live in Dental Health Professional Shortage Areas.
Dr. Garvey agrees that it could be one of the many interconnected solutions
needed. Dental therapists in Minnesota are trained to provide care for some patients with intellectual disabilities.
However, there exists no one ‘silver bullet’ solution,” both dentists agree.
Roy Miller, president of American Children’s Campaign looks to the roles the legislature and executive branch agencies should play. “We always want to see a comprehensive plan in place to pinpoint the scope of the problem and a plan to address it. In the case of IDD, some broad goals exist but nothing we would call ready for action.”
Medicaid has been in the news lately with many fearing the federal changes. As it stands today, according to Dr. Garvey, Medicaid only reimburses just $27 for removing a tooth, while the going rate for private insurance is about $300.
“Pulling teeth is an absolute last resort. I want to save teeth whenever possible. Many of my patients can’t handle implants or dentures. But getting patients out of pain is my number one priority,” says Dr. Garvey. “I wish I didn’t have to resort so often to what should be the worst-case scenario.”
Florida must do better to protect the ability to smile for its most vulnerable residents.
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About Dr. Garvey
Timothy Garvey, D.M.D., has been practicing dentistry for 45 years and focused on patients in the IDD community for the last 36 years. He is a clinical assistant professor in the University of Florida Department of Pediatric Dentistry. Opinions expressed in this article are his own and not representative of UF, the UF College of Dentistry or any organizations with which he is affiliated.