HJBR Nov/Dec 2022

HEALTHCARE JOURNAL OF BATON ROUGE I  NOV / DEC 2022 43 of doctors would be able to as well, if they were trained and provided the appropriate techniques and skill sets needed to be suc- cessful. And, if using general anesthesia can be avoided, it will be safer for the patient and less expensive. Plus, if they’re success- ful with our loved ones, our whole family is going to want to come to their practice. This is the story of our lives, and a lot of people with I/DD: basic exams and medical proce- dures are just not as easy as you’d think.” This partnership with advocates, legis- lators, and the Governor’s office to expand access and improve dental services for Louisiana’s vulnerable residents is emblem- atic of our work to improve the health and quality of life of all Louisianans. It also ex- emplifies why we titled the fiscal year 2022 business plan “Together” — we are able to achieve more meaningful progress and im- provements in healthcare when we listen to our communities and engage with diverse stakeholders to make Louisiana to be a stronger, healthier place. n a thorough examand clean- ing, and there were very few dentists who would see her. Additionally, the wait for a dental exam with anesthe- sia was over five years. And because of other medical complications and risks in- volved with such practice, Jenny having to go under general anesthesia was problematic.” That all changed when Dwyer found a dentist who had training and experience treating patients with I/DD using a method called “pos- itive behavior intervention.” For the first time ever, the dentist was able to convince Jenny to cooperate for an exam through a series of techniques that made the exam seem fun to Jenny. Developing those skills and working with patients like Jenny takes time, so Medicaid worked with advocates to allow providers to charge Medicaid an enhancedMedicaid rate for each examand see patients with I/DD up to four visits per year. Our hope is that the additional fee will help encourage more dentists to accept pa- tients like Tommy and Jenny with I/DD, but additional training is needed to increase the number of providers. In next year’s busi- ness plan, LDH will implement a strategy to increase the number of dentists that can treat patients with I/DD, including training seminars in coordination with the Louisiana Dental Association. “A lot of dentists aren’t comfortable because they aren’t trained to work with patients with I/DD and they don’t know what to expect,” Dwyer said. “But our den- tist connected with Jenny, and I think a lot Courtney N. Phillips, PhD Secretary Louisiana Department of Health then that doctors discovered a tooth that required a root canal was causing the infec- tion. In the end, Tommy required nine teeth extractions — two front lower teeth, three wisdom teeth, and three impacted molars in addition to the tooth needing the root canal. Reflecting on her brother’s inability to communicate with his caregivers the loca- tion and origin of his tooth pain, Cowen said she is still troubled by the thought that her brother was likely suffering in silence for months. “Tommy, I guess, just lived with the pain because, well, that’s all there was to do,” Cowen said. “When all the teeth were pulled, the infection cleared up.” Before the comprehensive Medicaid den- tal plan was in place, Medicaid only covered dentures, and managed care organizations covered some services with limitations. Un- fortunately for patients like Tommy, simply pulling teeth to prevent infections is not the optimal solution, particularly for those who have always enjoyed eating good food. “What if you can’t handle dentures?” Cowen said. “Do you want to live like that?” We are pleased that adults with I/DD now have access to a plan that provides for com- prehensive services. But we recognize the fight is not over for families like Cowen and her fellow advocate, Kathy Dwyer. Dwyer, chairwoman of the Louisiana Dental Task Force, is now setting her sights on expand- ing the number of dentists trained to treat patients with I/DD. For years, dental exams were a dreaded ordeal for Dwyer and her daughter Jenny, who has multiple disabilities. “She has serious aversion to doctors probing in her mouth. She can’t tolerate dental exams,” Dwyer said. “So, whenever we had gone to a dentist, there was always some sort of restraint involved. Jenny didn’t like that, at all. It was very upsetting for her. Without general anesthesia they couldn’t do Jacob Dent, DDS, poses after a successful exam with Jenny Dwyer.