SOD grant to help remove dental barriers to life-saving care

Published on Monday, June 8, 2020

By: Kate Royals

What if a cavity was the only thing standing between you and life-saving chemotherapy treatment?

Or an abscessed tooth was the single barrier to getting on the kidney transplant list?

Enter Dr. Mark Livingston, chair of the Department of Advanced General Dentistry at the University of Mississippi Medical Center, and the general dentists who work with him.

Livingston and his colleagues are called on to provide dental treatment to severely ill patients from across the Medical Center, including those receiving cardiovascular surgery, organ transplants, cancer treatment and adults who are developmentally delayed.

While cavities, abscessed teeth, decay, and periodontal and gum disease don’t pose an immediate threat to most people’s life, they can have a major negative impact on a medically compromised person and his ability to be treated.

“Something as simple as a toothache can play an impact on life-giving care,” said Livingston, one of five providers in the department who cares for these patients.

Currently Livingston and his four colleagues oversee 11 residents and two clinics. They are stretched thin with their patient loads and have no one to coordinate patient care and scheduling, an important and monumental job that requires a range of medical knowledge.

But thanks to a $2.25 million, five-year Health Resources and Services Administration grant, Livingston will soon be hiring two additional faculty members and providers, in addition to a registered nurse, to care for more patients and to make the care more efficient and timely.

“There are many patients who come to UMMC for life-saving treatments but who cannot proceed with those treatments until their oral diseases are under control,” said Dr. Jason Griggs, associate dean of research for the School of Dentistry and chair of the Department of Biomedical Materials Science. “This project will not only help patients, but will also increase revenue both for the hospital and for the dental school.”

The news was welcome to Karan and Eric Clark of Oxford. Their 26-year-old daughter Catherine has Down Syndrome and struggles with depression and anxiety. Like many developmentally delayed adults, Catherine requires sedation before undergoing any dental procedures.

Catherine is terrified of the dentist, and even a simple blood draw requires the strength of three to four people to hold her down on the table, said Karan.

So last year, when she stopped eating and lost 25 pounds over the course of three to four months, Karan, a registered nurse, and Eric were doing everything they could to figure out what was wrong. They took her to Livingston, her dentist, but because of the backlog of patients and the small number of faculty in the department who handle such cases, the next available time in the operating room at the Medical Center was nearly a year out.

The delay led to a terrible domino effect. Catherine’s parents took her to several doctors trying to figure out what was causing her not to eat.

“We almost lost her,” said Eric. “For six months, nobody could tell us why she was resisting eating.”

After a diagnosis of strep throat, Catharine was given a course of antibiotics that triggered C. difficile infection, and landed her in the hospital for five days. 

After being discharged from the hospital and recovering from the infection, she was prescribed increased antidepressants. She finally told her mother a tooth in the back of her mouth was bothering her – something Livingston would have seen if he’d been able to examine her when her parents first brought her six months earlier.

“It turned out she had a bad infection,” said Karan. “So, all this time, there was something wrong with her tooth, and the pain was interfering with her eating and drinking.”

A local dentist was able to sedate Catherine and extract the tooth, but because many dentists do not have training in caring for special needs patients, Karan and Eric said the extraction experience was “traumatic,” and by then Catherine had suffered unnecessarily for months.

After having the tooth extracted, Catherine began eating normally and gaining weight.

The Clarks’ story illustrates why the grant is so needed.

“By having more faculty, we will have a better staffing pattern to allow us to go to the operating room more often, so the backlog should decrease,” said Livingston.

In addition, it will expand the services faculty can provide, said Dr. David Felton, dean of the School of Dentistry.

“The HRSA grant will enable the School of Dentistry to treat the huge backlog of patients in need of pre-surgical clearance. In the past, due to lack of available faculty, we’ve been forced to provide primarily tooth extractions to provide this clearance,” said Felton. “Now, we can provide additional dental services and help patients keep their teeth longer. This is a very important grant for the School of Dentistry in our ever-expanding role within the Medical Center.”

The grant will make more opportunities possible for patients who cannot afford dental care, which is often not covered by Medicaid, Medicare or private insurance.

“This will be a safety net for patients,” said Livingston, adding that it also gives them some room to help those who can’t afford even basic care. “If they can’t afford the care they need, they will at least get a minimal level of care where they don’t have to worry about reimbursing the University.”

The grant will also enable the training and education of more residents with patients who many local dentists across Mississippi may not feel comfortable treating.

“It’s going to be even more intensive training for our residents in treating medically compromised patients,” said Livingston. “We’ll be graduating residents who are feeling much more confident about treating patients who have certain underlying diseases.”

The hope is some of these residents will remain in Mississippi and provide much-needed, local care to patients in other areas of the state – without the patients having to travel to Jackson.