Those With Special Needs Now Have a Dentist Devoted to Their Care

Touro College of Dental Medicine Fellow Promotes Equitable Dental Care for People with Intellectual and Developmental Disabilities

March 12, 2024
Dr. Marie Robles
Dr. Marie Robles

For the patient sitting in Dr. Marie Robles’ dental chair for the first time, visits to previous dentists had been nothing short of challenging. Diagnosed with an intellectual disability, he relied on his mother to routinely travel hours in search of a practitioner trained to provide dental care for individuals with IDD. Once she found a practitioner, her son was so terrified of the procedures, that he required sedation along with protective stabilization. With Dr. Robles, his experience was markedly different.

“We began with desensitization,” explained Dr. Robles, a 2022 alumna of Touro College of Dental Medicine (TCDM) who is a fellow at TCDM as part of New York State Academic Dental Centers (NYSADC) Fellowship to Address Oral Health Disparities. “We showed him different dental chairs to help familiarize him with his surroundings and allow him to feel more comfortable. Fortunately, at TCDM, we have TVs by our dental chairs, so we were able to put on Disney Plus, and he loved watching cartoons. It took a while but once he relaxed, then he let me do a cleaning.”

Eventually, the patient allowed Dr. Robles to fill cavities and even do extractions. “It’s all about developing trust,” said Dr. Robles who managed to assuage her patient’s fears by singing with him and talking about Christmas presents. To explain how the numbing agent worked, she told him that the tooth was “going to sleep.”

Patients with IDD and their families often face an arduous task seeking and receiving dental care. The reasons for these difficulties are two-fold: varied levels of practitioner training and experience in managing patients’ needs and limited practitioners providing Medicaid, on which many people with IDD rely for dental coverage. “One group home travelled three hours to get to the Westchester clinic simply to get basic dental care,” said Dr. Robles, who as a fellow, treats patients with IDD at the Westchester Institute for Human Development and in the Touro Dental Health clinic.

Dr. Robles’ passion for helping individuals with IDD runs deep. Growing up with a sister diagnosed with epilepsy and mild intellectual disability, she recalled hours spent in hospital waiting rooms and the challenges of finding comprehensive dental care for her sister. After graduating from UC Davis with a degree in biology, Dr. Robles spent a year as a dental assistant. “I worked in a practice where we had many patients with special needs,” she explained. “I saw the need for dentists who were willing to be trained and treat this population.” In one case, a family hadn’t been able to get their son dental care in over a decade.

During her second year at Touro College of Dental Medicine, Dr. Robles, together with TCDM faculty members Drs. Raquel Rozdolski and Susan DiSenso and her fellow students, helped develop a program known as Smiles United. The program consisted of developing oral home care instructional videos focused on training direct support professionals in group homes across New York State who care for people with IDD. Videos consisted of basic dental hygiene instruction paired with dental products and advice on proper dental care. They were then provided to group homes throughout NYS.

“For example, if an individual had difficulty holding a toothbrush, we demonstrated how to attach a tennis ball to the end of the toothbrush to make it easier for them to hold and brush their teeth,” said Dr. Robles. “We also included videos of behavioral guidance techniques like positive reinforcement, as well as how to prevent cavities.”

In her fourth year, Dr. Robles was awarded the New York State Academic Dental Centers (NYSADC) Scholarship to Address Oral Health Disparities.

During her general practice residency (GPR) at St. Barnabas, Dr. Robles gained more experience treating patients with IDD, including providing treatment in an operating room (OR) for patients who needed dental care under general anesthesia. “It was eye-opening,” said Dr. Robles. “I saw the need for dentists who can work in the OR when they have a patient that can’t be treated in the dental chair.” During her GPR, she applied to Touro College of Dental Medicine’s New York State Academic Dental Centers (NYSADC) Fellowship to Address Oral Health Disparities.

“I was very excited to come back. I knew I would love to see all the familiar faces and the faculty that helped train me,” said Dr. Robles.

As part of her fellowship, she also works with TCDM students, educating and assisting them treat patients with IDD. “There should be more exposure to treating individuals with IDD in all dental schools. This would increase the number of dentists who are comfortable treating patients with special needs.”

As part of the New York State scholarship she received as a student, Dr. Robles is required to spend another year in New York State treating individuals with special needs after her fellowship is completed. “It’s not really a big commitment,” reflected Robles. “Since I love it and want to do it for the rest of my life.”