Dental Neglect

[Concerned Citizen]

I have a concern that a disabled adult may be suffering dental neglect. The situation is as follows:

On January 22, of the previous year, the dental treatment notes indicate that the disabled adult was “under treatment [to] determine if full-mouth extraction needed, or restore w/ RCT, SSC and partials as needed”.

The disabled adult had 13 teeth extracted between March and October of the previous year.

On January 10, the disabled adult had a dental appointment, but it was just a cleaning. His dental records indicates: “informed caretaker that patient needs tx in or ASAP to prevent further deterioration of dentition.” Dentition is the arrangement of natural or artificial teeth in the mouth. The notes also indicate “Schedule OR tx. Call Mother to discuss”.

On October 6, the disabled adult went to the dental clinic for the last time. He had a routine cleaning, after having 13 teeth extracted during 4 previous appointments. His dental notes indicate that he still had 15 teeth. The dental notes also indicate “caries [tooth decay] present on almost every tooth”. The very last entry in the dental notes indicate: “NV: OR tx” - meaning “Next visit: operating room treatment”. But it appears that he's never seen the operating room at the dental clinic.

Under Florida Statutes § 825.102, (3)(a) “Neglect of an elderly person or disabled adult” means:

1. 
   
   
   • “A caregiver’s failure or omission to provide an elderly person or disabled adult with the care, supervision, and services necessary to maintain the elderly person’s or disabled adult’s physical and mental health, including, but not limited to, food, nutrition, clothing, shelter, supervision, medicine, and medical services that a prudent person would consider essential for the well-being of the elderly person or disabled adult”; or
   • “A caregiver’s failure to make a reasonable effort to protect an elderly person or disabled adult from abuse, neglect, or exploitation by another person”.

So my question is, does it appear that this disabled adult is suffering dental neglect?

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[Concerned Citizen]

Dental neglect is a very serious subject and worthy of debate, especially in a forum setting. Its a topic that is thoroughly discussed in dental school, because you'll need to be aware of it when treating patients. As a dentist, you'll be a mandatory report of abuse and neglect.

 

[drtoothyman]

not sure what you are suggesting. having all the teeth extracted and having dentures is not uncommon and unfortunately is more common in adults with disabilities. If you are asking if the teeth were neglected...the answer is absolutely. If you are asking if this would legally be deemed neglect or abuse on the part of the caretaker or parents the answer is unclear. you could make the case that the treatment has been delayed for too long...or are you mad at the dentist for some reason? I'm confused...sounds like they just need to schedule for sedation and full mouth extraction and then find someone good to make dentures. It's usually best if you work with the guardian so the patient can get treatment...if you start pointing fingers and blaming people they may be less likely to get treatment for the patient if they are afraid they will be judged...just my thoughts

 

[Concerned Citizen]

not sure what you are suggesting. having all the teeth extracted and having dentures is not uncommon and unfortunately is more common in adults with disabilities. If you are asking if the teeth were neglected...the answer is absolutely. If you are asking if this would legally be deemed neglect or abuse on the part of the caretaker or parents the answer is unclear. you could make the case that the treatment has been delayed for too long...or are you mad at the dentist for some reason? I'm confused...sounds like they just need to schedule for sedation and full mouth extraction and then find someone good to make dentures. It's usually best if you work with the guardian so the patient can get treatment...if you start pointing fingers and blaming people they may be less likely to get treatment for the patient if they are afraid they will be judged...just my thoughts

My concern is with the caregiver, who is an agency serving the developmentally disabled. They had 13 teeth extractions, but no restorations done for more than a year. There are caries on almost every tooth.

 

[Concerned Citizen]

My concern is with the caregiver, an agency serving the developmentally disabled. They had 13 teeth extracted, but never followed up with any restorations done. Its been more than a year and now there's caries present on almost every tooth remaining.

 

[drtoothyman]

have you talked with the caregiver about your concerns? If not - I would start there and encourage them to go to an oral surgeon and have the remaining teeth extracted. Usually first appointment is consultation and next appointment is sedation and extractions. Again hard to say if it warrants neglect...again the disabled person may be seeing other doctors for treatment for other issues and maybe the teeth kind of got put on the backburner...it is possible to have decay everywhere but not necessarily have pain. Especially in rural areas people might not place a huge importance on dental care so maybe the caregiver doesn't understand the importance of the situation.
Again communication with the caregiver is key...if you start pointing the finger people tend to get defensive - if you try and work with them it may be better for the pt - and that's what matters.

 

[drtoothyman]

of course if they understand the need for dental work and for some reason are purposefully withholding treatment or being lazy then there is no excuse for that!

 

[charlestweed]

As Drtoothyman pointed out earlier, it's not uncommon to extract several teeth on mentally and physically disabled patients. Many of these patients cannot brush/floss their own teeth or take a bath by themselves. Since they can't brush and floss daily, they will eventually lose all their teeth even if they see their dentists every year. Even a kid with a normal IQ can get new cavity within 6 months, if he or she continues to neglect his/her teeth by consuming food with high sugar content and not brushing/flossing daily. As an orthodontist, who treats mostly kids, I've seen kids with loving caring parents have to have several teeth extracted due to cavities.

During my GPR residency, my co-residents and I treated mentally and physically disabled patients (autism, cerebral palsy, Huntington's disease, MS etc) in the OR under general anesthesia every week. While the patient was asleep, we brought in a portable xray machine to take FMX, we did full mouth exam. We then peformed scaling and root planning, Ag fillings on teeth that are restorable, and extracted hopeless teeth to get the patient out of pain. Since the state medicaid only paid for the OR procedure once a year, we had to do everything in one session. Many of these patients return a year later with new carious lesions and more teeth that need extractions.

 

[Saddleshoes]

Let me guess...
1. This disabled adult is a relative of yours.
2. This disabled adult is dependent upon the State of Florida to pay the bills.
3. The State of Florida must approve of said treatment in advance because it involves treatment in an OR setting.

I'm guessing the whole problem would go away if a "Concerned Citizen" would step forward to make sure the bill for this unfortunate disabled adult is covered.

 

[Concerned Citizen]

Let me guess...
1. This disabled adult is a relative of yours.
2. This disabled adult is dependent upon the State of Florida to pay the bills.
3. The State of Florida must approve of said treatment in advance because it involves treatment in an OR setting.

I'm guessing the whole problem would go away if a "Concerned Citizen" would step forward to make sure the bill for this unfortunate disabled adult is covered.

No. The disabled adult is not a relative of mine. My son was employed by the agency and suffered a traumatic brain injury when the resident struck him in the forehead at a dental appointment. I happened to look at the dental records after they were subpoenaed. The disabled adult had 13 teeth extracted over 3 different appointments and never received any general anesthesia. He was obviously traumatized, but I also believe he suffered neglect.

But for anyone to try and blame a parent or legal guardian for a caregiver's neglect is offensive. The dental records indicate that "patient needs OR tx ASAP to prevent further deterioration of the dentition." Waiting more than a year to provide prescribed restorations is obviously dental neglect.

 

[drtoothyman]

Oh....when you said "caregiver" are you refering to the dentist or a nursing home type situation. I assumed you were talking about the latter....if by caregiver yout mean the dentist who volunteered his or her time (I say volunteered because there is no money to be made in treating disabled folk...I know because I do it at my pracTice as goodwill) then get off this forum...any dentist who is caring to treat a disabled person is doing so because they are trying to be a good person. Most dentists will refuse to treat handicapped folk unfortunately. No clue what you mean when you say they received a traumatic brain injury at the dentist...if you truly believe this you are brain is damaged as well.

 

[Concerned Citizen]

Oh....when you said "caregiver" are you refering to the dentist or a nursing home type situation. I assumed you were talking about the latter....if by caregiver yout mean the dentist who volunteered his or her time (I say volunteered because there is no money to be made in treating disabled folk...I know because I do it at my pracTice as goodwill) then get off this forum...any dentist who is caring to treat a disabled person is doing so because they are trying to be a good person. Most dentists will refuse to treat handicapped folk unfortunately. No clue what you mean when you say they received a traumatic brain injury at the dentist...if you truly believe this you are brain is damaged as well.

My son was punched in the head by the disabled adult, who is a very large and powerful man. Your assumption that a disabled adult can't be a good athlete or powerful man shows that you may be prejudiced. After being punched in the head, he was later diagnosed with a brain fistula, and the medical records are clear and unambiguous that it was caused by the punch. The caregiver was the ARC of a particular county in Florida. And please don't think that I am trying to blame the dental clinic or staff in any way. The young disabled man suffered trauma because the caregiver and legal guardian would not consent to "tx in OR" which I believe is general anesthesia or sedation. And to my knowledge the dental clinic did not volunteer, but their hands were tied because consent was never given to treat in the operating room, as prescribed. But unrelated to appointment where my son was punched in the head, is the fact that the ARC is guilty of dental neglect because on January 22, of the previous year, the dental treatment notes indicate that the disabled adult was “under treatment [to] determine if full-mouth extraction needed, or restore w/ RCT, SSC and partials as needed”. The disabled adult had 13 teeth extracted between March and October of the previous year. On January 10, the disabled adult had a dental appointment, but it was just a cleaning. His dental records indicates: “informed caretaker that patient needs tx in or ASAP to prevent further deterioration of dentition.” Dentition is the arrangement of natural or artificial teeth in the mouth. The notes also indicate “Schedule OR tx. Call Mother to discuss”. On October 6, the disabled adult went to the dental clinic for the last time. He had a routine cleaning, after having 13 teeth extracted during 4 previous appointments. His dental notes indicate that he still had 15 teeth. The dental notes also indicate “caries [tooth decay] present on almost every tooth”. The very last entry in the dental notes indicate: “NV: OR tx” - meaning “Next visit: operating room treatment”. But because the young man never had the prescribed dental treatment, the ARC [his caregiver] committed dental neglect of a disabled adult. And anyone who doesn't think that our developmentally disabled population should have the same access to quality and proper dental care as the rest of society - is just a dull-minded twit.

 

[drtoothyman]

Sorry. That makes more sense. You should have just started your post with that paragraph....it was really unclear before who the caregiver was, the dental clinic, who the ARC was and how all this fit into the picture. And yes disabled people can be very physically in shape. I thought you were saying that pulling 13 teeth gave the pt brain damage and you were looking to sue the dentist...This is just a bad situation all the way around... sorry to hear...and yes they absolutely should have the same access to care - it's a shame that this is not always the case. Seems like someone should have followed up with dental treatment sooner and if the pt was combative this should have definitely been taken care of at a hospital with GA. I'm sure a lawyer could make a case either way. Again your above posts made no sense to me - sorry again.

 

[Concerned Citizen]

Sorry. That makes more sense. You should have just started your post with that paragraph....it was really unclear before who the caregiver was, the dental clinic, who the ARC was and how all this fit into the picture. And yes disabled people can be very physically in shape. I thought you were saying that pulling 13 teeth gave the pt brain damage and you were looking to sue the dentist...This is just a bad situation all the way around... sorry to hear...and yes they absolutely should have the same access to care - it's a shame that this is not always the case. Seems like someone should have followed up with dental treatment sooner and if the pt was combative this should have definitely been taken care of at a hospital with GA. I'm sure a lawyer could make a case either way. Again your above posts made no sense to me - sorry again.

I apologize if I seemed terse. This whole situation has caused me considerable stress. And I want to thank you for your candidness. I know its just hard to believe that an agency could allow the dental neglect of one of their residents. But I guess an agency is only as good as the people it hires.

 

[tinman831]

SDN is not the place for soliciting medical advice. Closing thread.