There have been many achievements in raising awareness for neurological, behavioral and anatomical conditions over the last century. Some conditions are well known and broadly supported.
Autism Spectrum Disorder is one of these.
Some are often overlooked, such as Oppositional Defiant Disorder. Specifically, there is little literature detailing the challenges patients face when accessing oral care.
It’s imperative to highlight the challenges patients encounter in the realm of dental treatment, and spotlight local practices near Oglethorpe County that provide care for this patient population.
Awareness months
September: Oppositional Defiant Disorder (ODD)
October: Attention Deficit Disorder/Attention Deficit Hyperactive Disorder (ADD/ADHD)
November: Epilepsy
December: Tongue Tie (problems breastfeeding and/or speech pathology)
Awareness in the community
It’s common in the community and within the medical community for people to have little to no experience or exposure engaging with people who have oppositional defiant disorder.
It’s a neurological condition characterized by a persistent pattern of defiant, disobedient and hostile behavior toward authority figures.
“I think one of the greatest challenges for families dealing with ODD is people doubting its validity,” said Dr. Jessica Armstrong of Tebo Dental, which has several locations in Georgia. “I used to be one of those people that thought it was just permissive parenting or lack of discipline. I think this opinion is very common. Most don't understand the neurodiversity of ODD and the physiology of it. Particularly as it usually occurs in conjunction with other neurodiversities such as ADHD or ASD.”
Patient outbursts and refusals are often misunderstood, leading to frustration for both the patient and the doctor. More awareness, patience and preparation will help everyone involved.
“Creating a comfortable and accommodating environment is crucial for patients regardless of neurological status: phobic, young, epileptic, autistic and/or ADD/ADHD patients all deserve and require compassion and patience when seeking dental treatment,” said endodontist Dr. Marcus Johnson of City Endodontics, which is based in New York City. “A desensitization visit to your office, a pre-operative phone consultation and behavioral modification techniques help build trust and develop a relationship between the doctor, staff, patient and family.”
Access to care
These practical strategies allow the patient to feel a sense of control in their care. Patients also have the benefit of pharmacological aid.
“As a dentist working in a school based clinic, I routinely encounter patients with epilepsy, ODD, ADD, ADHD, ASD, phobia and severe early childhood caries,” said Dr. Merissa Nelms of Hilsman Health Center in Athens. “Studies show patients with these conditions have more severe dental needs, and my experience is the same. A holistic, multi-practitioner approach is the best way to treat these patients while avoiding the creation or escalation of dental phobia. I require patients to have a primary care provider and access to mental health resources before beginning any dental treatment. In my practice, I offer mild sedation via nitrous oxide, but most patients require general anesthesia to safely complete dental procedures. These levels of sedation require special training, equipment, staff and monitoring, especially with children. In these instances, I'm grateful to have specialists in pediatrics and dental anesthesia who I can refer to.”
Several physician and dental specialists provide access to patients needing tongue tie and frenum surgeries.
“I have done frenulum release (a simple snip) surgery for 35 years. Never with anesthesia (for infants) and never with a significant whimper,” said Dr. Rob Pitts of Oglethorpe Ear, Nose & Throat in Lexington. “The babies are allowed to nurse immediately. The indication in a newborn is simply limited tongue range of motion in a child that is having difficulty latching. In an older, post-lingual child with speech difficulty a multidisciplinary approach with a speech therapist is necessary. Those children would likely need sedation. In these older children there is rarely a benefit if they can protrude their tongue tip past the lower incisors preoperatively.”
For older patients seeking frenum surgery with sedation, Dr. Stan Satterfield, Dr. Jayni Bradley with Athens Area Pediatric Dentistry and myself at Greenpoint Pediatric Dentistry provide these services.
Raising awareness for conditions that pose challenges to care and providing resources for treatment is a benefit to our community.
Here are practices and practitioners who can help:
- Greenpoint Pediatric Dentistry
- Athens Dental Implant Center
- Athens Area Pediatric Dentistry
- Oglethorpe Ear, Nose & Throat
- Hilsman Health Center
- City Endodontics
- Tebo Dental
Dr. John T. Hansford Jr., the son of Tim and Ann Hansford of Stephens, is a double board certified pediatric dentist and dental anesthesiologist. He graduated from the Medical College of Georgia in 2010. He practices in Athens and Watkinsville.