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Dental School offers special care rotation (2-28-00)

The condition of patients treated at the San Antonio State Hospital ranges from profound mental retardation to paranoid schizophrenia, but they have a common need for dental care. Unfortunately, many lack access to it.

To answer this need, the staff at the State Hospitalís dental clinic, which is affiliated with The University of Texas Health Science Center at San Antonio, sees adults from the psychiatric units at the State Hospital, children from the San Antonio State School and tuberculosis patients from the Texas Center for Infectious Diseases. The Texas Department of Mental Health and Mental Retardation serves all these patients within the State Hospitalís grounds.

Each semester, senior students from the Dental School rotate through the clinic. One or two students work there throughout the summer. Dental Services Director Carol A. Willborn, D.D.S., said the rotation is a way for students to "nurture their compassionate spirit" while learning to meet the oral health care needs of these special patients. Student evaluations have been overwhelmingly positive. Most students said they had gained a new perspective on working with the mentally/physically challenged population and would be comfortable doing so in the future.

Not only do most of the patients have poor oral health, but many also suffer from a multitude of medical ailments. Students on rotation learn to take into account a personís medical needs as well as his or her dental requirements. Conditions such as diabetes affect the mouth. Certain medications can aggravate oral conditions. Many of the patients have complex medical histories that may alter their treatment plans.

"We want to give students the chance to evaluate a child or adult with special needs. So many practitioners feel they do not have the knowledge or experience to see a person with mental retardation," said Dr. Willborn. "This is an important area for education and training."

More than 80 percent of the patients who come to the clinic are indigent, Dr. Willborn said. The rate of tooth decay is high, gum disease is common and oral health knowledge is poor. Even though she has treated highly educated, affluent patients who have been admitted to the psychiatric units for evaluation, many of her patients have been living on the streets for years. "Weíre their last hope," Dr. Willborn said.

The students learn how to do tasks such as transferring wheelchair-bound patients, using specialized equipment for treating people with palsy or severe bite reflex, and communicating with someone who has low cognitive skills. Before any work can begin, all patients or their guardians must give the customary consent to treatment.

John Brown, B.D.Sc., Ph.D., chairman of the Department of Community Dentistry at the Health Science Center, says the discipline of special patient care requires a flexible approach. "It takes someone who is prepared to see it as a challenge and to learn the skills needed," he said. "We have a responsibility to all sectors of society. That is a dental educational challenge that Dr. Willborn, as an adjunct professor, helps us meet. We greatly value her expertise and contributions."

Dr. Willborn, who graduated from the Dental School in 1991, has been practicing at the State Hospital since 1993. Keithley Binz, D.D.S., a 1994 Dental School alumna, joined the staff in 1996.

Contact: Will Sansom or Jennifer Lorenzo