Dentistry “On The Go”

By Claudia Buck
The Sacramento Bee.

Prefer to see your dentist from the comfort of your La-Z-Boy? It can be done.

A growing number of dental professionals will come to you if you can’t make it to their offices. They show up for appointments at patients’ homes or residential care facilities, packing lightweight X-ray equipment, portable drills and battery-powered examining tools that let them gently handle on-the-go cleaning and treating of teeth.

Some see patients with physical or mental disabilities, including agoraphobia and autism. But they primarily treat independent seniors living in residential care facilities who just find it easier to have their dental care delivered to their door.

On a recent morning at Mistywood, a senior living complex in Roseville, Dr. Dave Kanas was seeing his first patient of the day, a man who’d been bothered by a loose tooth and a partial denture that needed adjusting. Kanas and his patient, Harry “Buzz” Harrison, joked and bantered like old friends.

Kanas, who retired from regular dentistry seven years ago, snapped on blue dental gloves and a mask, opened his portable dental kit — improvised from a fishing tackle box — and got to work. He did a thorough exam of Harrison’s mouth, using a fiber-optic light with a disposable mirror. Picking up a portable X-ray machine, he shot and developed a black-and-white image of Buzz’s loose tooth — in 50 seconds. Finally, he adjusted Harrison’s partial denture, made of a new flexible plastic, to make it more comfortable.

Harrison, wearing blue jeans and a California football jersey, never had to leave his green recliner.

“I’d be lost without him,” said Harrison, a lively octogenarian who’s lived four years in his studio apartment. Without a mobile dentist, “I’d have to drive to an appointment, and you don’t want me driving,” chuckled the 81-year-old retired high school teacher.

“If (patients) can go to their dentists, I encourage that,” said Kanas, an Auburn resident who bought a Prius last year because he averages 400 miles a week driving to see patients from Sacramento to Grass Valley. “Mobile dentistry takes over when they can’t go anymore,” primarily for medical or age-related reasons.

Like replacing a missing tooth, mobile dentistry fills a niche.

“Research shows about 30 percent of the population experiences barriers to (dental) care, which include transportation, geography, education, language and economics,” said Alicia Malaby, spokeswoman for the Sacramento-based California Dental Association, in an email. “Mobile dental visits eliminate a barrier, allowing patients to obtain care and helping them maintain good oral health.”

The CDA doesn’t track how many of its licensed dentists are mobile practitioners. But the California Dental Hygienists’ Association oversees a licensed class of hygienists who are allowed to work independently of dentists and do mobile teeth cleaning. That category of hygienists has nearly quintupled in the last decade, from 112 licenses in 2005 to 540 this year.

Especially for older patients, there’s a real need to bring dentistry to their bedside. “In some cases, we are the only dental entity patients see,” said CDHA president Karine Strickland, who has a mobile hygienist practice based in Santa Cruz.

One of California’s pioneers for mobile hygienists is Sacramentan Judy Boothby, who was instrumental in getting state legislation passed in 1998, creating a new license for a Registered Dental Hygienist in Alternative Practice, known as RDHAPs. She holds the state’s license No. 1.

Boothby, who visits 50 to 70 patients a week from Yuba City to Jackson, sees an endless variety of cases. She’s treated patients in their 20s with multiple sclerosis and young children with autism. She’s had patients with dementia, Alzheimer’s and Lou Gehrig’s disease. She’s had women in their 80s who want their teeth whitened for a grandchild’s wedding. And in three cases this year, Boothby said, she found evidence of oral cancers, which were referred to a dentist for treatment.

“The worst thing to see is an elderly person with $5,000 worth of crowns and bridges, but their gums are bleeding and infected. They end up losing all that expensive dental work because nobody is brushing or flossing their teeth,” said Boothby.

Recently, an assisted living facility called about a new resident who wasn’t eating, she said. An exam revealed part of his denture had broken off and was imbedded in the roof of his mouth. In such cases, where care goes beyond routine oral hygeine, RDHAPs like Boothby refer to traveling dentists like Kanas for further treatment.

Kanas, now semi-retired and without the overhead and staffing of a conventional office, said he enjoys his mobile practice primarily because of the patient camaraderie and flexible scheduling.

“I don’t make as much as I did, but the happiness factor is what I’m interested in. I’m much more relaxed than I was with a full practice and the pressure of trying to keep up the patient volume,” he said.

Technology has made mobile equipment lighter and quieter, helping the profession’s growth and acceptance.

“It’s definitely enabled by technology. Mobile dentistry just wouldn’t be possible without the technology we have today,” said Dr. Masood Cajee, owner of SmilesAhead Dental Care, based in Manteca. “We can take X-rays with a handheld X-ray gun that didn’t exist 20 years ago.”

Cajee, whose mobile visits represent about 5 to 10 percent of his overall practice, said, “It takes dentistry beyond the four walls of the practice and serves populations that were really difficult to serve before.”

Boothby keeps a rolling cart filled with sterilized packets, ultrasonic cleaner and a suction vacuum for cleanings. Kanas found his 15-pound X-ray machine in Washington state, part of surplus military equipment used by dentists who parachuted into remote areas to treat soldiers. His equipment is battery-powered, so he’s never hunting for cords or plugs.
Despite technical improvements, mobile dentistry clearly isn’t for everyone.

“In a nursing home environment, it’s very difficult. You don’t know if they’re available or agreeable to be seen because their day-to-day health or mental status may change daily,” said Cajee, who worked several years for a dental practice that provided care to Sacramento skilled nursing facilities.

Other issues are the ergonomics of leaning over bedridden patients and those in wheelchairs. Incontinence, aggressive Alzheimer’s patients and other issues that residents struggle with on a daily basis also can be off-putting.

In some cases, after an initial visit to assess a patient’s needs and mental state, Kanas will prescribe a Valium to relax a patient before an upcoming visit.

Despite these challenges, Kanas said he often walks out from appointments “with a smile on my face,” buoyed by the personalities and stories from his clients. Boothby recalls a husband who hired her for several years to regularly clean the teeth of his invalid, homebound wife. In thanking Boothby, she said he told her: “I always know when you’ve been there. She always has her lipstick on, her breath smells better …
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and I can kiss her.”

It’s a bit of giving back. “We’ve all had parents, grandparents or even young people who are unable to help themselves,” said Cajee. “Sometimes it’s the small things you’re doing that can provide some comfort. It fulfills the best of this calling we call dentistry.”

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