The Blende Dental Group (BDG), a small practice based in the Laurel Heights neighborhood, has provided dental services to patients with disabilities, complex medical conditions, or severe phobias for more than 20 years. "About two and a half years ago, we started to notice an increase in dementia stories, and it hit me personally," said Practice Manager Amanda White, RN, BSN, who has also worked as a nurse and a caregiver in an assisted-living community within a dementia unit. She related that a number of recent dementia cases involved patients who had stopped going to their dentists for treatment because those practices did not offer sleep or sedation dentistry and patients with dementia or agoraphobia were prevented from traveling to the office. While this was not as much an issue with BDG, which specializes in sleep and sedation dentistry, the need was identified because the home-bound patients were suffering in pain.
The decision was made to take the care to the patients, much in the way Dr. David Blende's father did a generation before as a rural physician who provided medical house calls. "Let's contact care facilities with dementia units and say we'll come to you and do dental screenings," said White. "We would get the occasional calls to see just one person. The increase in the number of requests for visits, along with the increase in the number of communities we are now working with, led us to create the separate division, Bay Area House Call Dentists (BAHCD). Now, we do about three house calls a week, and it's increasing. I would expect in the next six months to a year that we'll be doing it on a daily basis."
Mobile logistics
"There's a lot of infrastructure to run a dental practice like this," said White who manages both the office-based BDG and off-site BAHCD practices. However, she has three GPs at BDG to utilize to provide mobile services. Dr. Cheryl Elacio is dedicated primarily to doing house calls, but if necessary, White said she also schedules Dr. Blende and Dr. Samer Itani for visits. In addition, there are five assistants who travel to care sites. "We always take a dentist and an assistant, so our staff feel safe," she said, adding that the patients typically have a personal caregiver present to also make the patient more at ease. "There's a minimum of two people there, so everyone feels comfortable," said White.
Much as with a standard initial visit at the dental office, the first off-site visit with a patient begins with a full diagnostic exam, including a full set of x-rays. "Everything is pretty much the same, but mobile," said White referring to the equipment used for site visits. The BAHCD team uses Aribex's hand-held Nomad intraoral x-ray system coupled with a Dexis digital sensor and a laptop computer.
In addition to the BDG staff, White said that she utilizes the services of a Registered Dental Hygienist in Alternative Practice (RDHAP), a licensed specialist who is able to provide basic hygiene treatment to patients outside of a traditional dental practice and without the direct supervision of a dentist. "Whatever the hygiene needs are determined to be during the initial visit, we can send the RDHAP to do all of the hygiene maintenance and hygiene care," said White.
Because many of the patients have not received even hygiene care for an extended time, many need additional treatment beyond basic hygiene care. "Typically, that's going to be extractions, abscesses, dentures, some really basic fillings, and sealants," said White. "When someone needs fairly extensive dentistry, then we schedule them at their local hospital for same-day surgery," which would be any procedures that would involve anesthesia to minimize anxiety by the patient. She added that the practice dentists and referring specialists have privileges at local hospitals throughout the San Francisco area. "Then all the follow-ups can be done back at their house. We can have them come out once, get all their treatment done, and even maintain them at home for years after that without having to come out for any other additional dental treatment."
Not for everyone
White is clear that the BAHCD is not meant to be a convenience for patients who simply do not want to come to the office for treatment, but for those who have long-term physical, mental, or emotional conditions and are unable to leave their homes. She said there was one patient who had suffered a back injury and needed home care, but he is now able to come in for regular dental care.
"There are the people who can't come in," she said. "There's already such a great need there. That's where we want to focus."
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