By Marin Wolf
The first time Ella Jacobs met Dr. Dan Burch, she was on the verge of tears.
Jacobs was afraid Burch, a clinical assistant professor at Texas A&M College of Dentistry, would tell her the same thing as every dentist before him: that he couldn’t treat her youngest daughter, Jaramella Allen. And she was angry that her daughter might have to keep living in constant pain from untreated dental problems.
Allen, 33, was born with microcephaly, or an unexpectedly small head, and a host of other medical problems. She regularly has seizures, can’t speak and relies on her mother and sister for round-the-clock care.
She’s also the size of a child, leaving her in a dental limbo. Pediatric dentists say Allen’s too old to be their patient, while adult dentists say they’re not qualified to treat her. In the eight years since she moved to Wichita Falls, Ella has called dozens of dentists and oral surgeons in North Texas trying to find someone, anyone, who would see her daughter.
Allen lost 17 teeth during that time.
Few dentists are trained in treating adults with intellectual and developmental disabilities, especially when those disabilities require a patient to be sedated for dental exams and cleanings. There are only five dental offices in North Texas that work with this population.
It’s a reality that inspired Burch to start the Compromised Care and Hospital Dentistry Fellowship at Texas A&M College of Dentistry, one of the first fellowship programs in the state designed to serve special-needs patients across their lifetimes.
When Jacobs, Allen and Ella’s other daughter París Ward made the two-hour trip from their homes in Wichita Falls to Dallas to see Burch in August, they were too emotionally and physically exhausted to feel any hope. That changed when Burch said not only could he take Allen as a patient, but she could get the care she needed that same day.
“We were getting so desperate. We were willing to drive 10 hours if we had to just to find someone to relieve the pain,” Jacobs said. “Finally, after eight years, we felt this relief. It was almost overwhelming.”
From military to dental mentor
As a child in a military household, Burch, 38, grew up wanting to be an aerospace engineer. Then, one Saturday morning at his home in Tennessee, a family friend mentioned that, even when the economy is bad and other businesses are failing, people still have to go to the dentist.
“That sparked the idea in my mind. I didn’t ever want to be laid off. Maybe I could do dentistry,” Burch said.
Dentistry seemed like a good compromise — Burch could still work with his hands like an engineer, and he’d help people every day.
Burch followed in his parents’ footsteps by joining the Army, where he worked as a dental assistant before graduating at the top of his class in a dental hygiene program. He left the Army with the goal of going to dental school, eventually enrolling at the University of Tennessee Health Science Center.
He started to work with adults with special medical needs once he got to his residency in pediatric dentistry at Howard University.
“I was seeing people across their lifespan, from a 67-year-old to a 40-year-old and that would be in between two kids, one 4 and another that’s 11 months old,” Burch said. “In my mind, I thought it would be something that’s temporary.”
After finishing his residency, Burch was offered a position in the department of pediatric dentistry at Texas A&M’s dental school. He saw patients at a number of clinics, including at Children’s Medical Center in Dallas and the orthopedic hospital Texas Scottish Rite for Children.
“It felt like one of the biggest successes of my life. I’d worked hard in residency and I’m at one of the best programs in America,” Burch said. “Life couldn’t get any better than that.”
Burch was practicing like a more traditional pediatric dentist, seeing only children and adolescents, until he met a mother and her 28-year-old daughter at a Fort Worth clinic.
The mother cried at the clinic’s front desk. No pediatric dentists trained to treat patients with special medical needs would see her daughter, who had cerebral palsy and uses a wheelchair, because she was an adult. She’d been bounced from dentist to dentist for a decade with no help.
Because of his unique residency training at Howard, Burch agreed to see the patient, who needed a dental cleaning and X-rays.
“I was just heartbroken that it took 10 years for her just to get X-rays and a cleaning,” Burch said. “We are the premier training institution for dentistry in this region, and we had a patient that fell through the cracks.”
“I knew there had to be something more I could do,” he said.
Jumping into action
Burch rallied different departments across the Texas A&M College of Dentistry and applied for grant funding in 2020. He secured a five-year, $3.3 million grant from the U.S. Health Resources and Services Administration to start a fellowship program to train dentists to care for patients with intellectual and developmental issues, regardless of age.
The fellowship, now in its second year, is still small, with only two fellows per year. Still, in the first year-and-a-half of the program, Burch has helped to increase care for more than 15,000 patients.
The fellows rotate through Children’s Medical Center, Scottish Rite, HHM Health and North Dallas Shared Ministries, learning to treat patients with a range of needs.
Like Burch, Dr. Lianna Pulliam didn’t know that specializing in the treatment of special-needs people was an option. The Compromised Care fellowship opened her eyes to how little has been done for this patient group.
“Working with this population, you see how sick their mouths can get when parents can’t really brush their teeth and they can’t brush their own teeth. And COVID-19 has been so hard and has delayed everything for them,” Pulliam said.
It came as no surprise to her that Burch received the Health Equity Hero Award from DentaQuest, one of the largest providers of Medicaid dental benefits, for his efforts to teach the next generation of dentists who care for people with intellectual and developmental disabilities. As part of the award, Burch joins a cohort of 12 dentists and public health experts from across the country who are working to increase health care access for underserved groups.
“There is a very serious lack of dentists and dental professionals across the country who have the expertise to work with this very particular population,” said Gonzalo Perez, manager of case management at DentaQuest. “Dr. Burch’s fellowship not only works to increase access to care for these individuals, but it also provides necessary training for dentists who can then go out into the community with this experience.”
Burch has no plans to slow down. He wants to expand the program to four fellows and add rotation sites, both at hospitals and private practice clinics.
He’s working with A&M’s College of Dentistry to create a space devoted to people with special needs. The campus clinic will include specialty chairs, including one for obese patients and one with a wheelchair ramp.
In the long term, Burch hopes other dental schools will follow suit in creating special-needs-specific training programs that serve children and adults. Maybe patients like Allen won’t have to suffer from preventable pain.
“That drive home from Dr. Burch’s office was one of the best drives we’ve ever had,” Allen’s older sister París Ward said. “They weren’t afraid and they didn’t treat her any differently than anyone else. They just did what needed to be done.”
