University Times

“I’m a dreamer,” Erik Scheifele says with a smile as he scans the empty room that soon will welcome the dental school’s special-needs patients.

Scheifele is the new director of the Pitt dental school’s Clinic for Patients With Special Needs, which is expanding into a larger space in Salk Hall. He envisions a waiting room designed not only to accommodate patients in wheelchairs, but one designed to minimize stress and sensory overload for patients with autism. And that’s just the start. Throughout the suite that most recently housed the school’s dental implant clinic, Scheifele sees walls and doors that need removing, empty spaces that will become conference rooms and offices, new equipment waiting to be set in place and more needing to be ordered.

The clinic will include a screening room, three dental chairs for patients who require no sedation or IV sedation, two chairs for those who need general anesthesia, a recovery area, plus a conference room, storage, staff and office areas.

Within a matter of months, the physical work will be done, if all goes as planned to meet a hoped-for opening in late spring. But Scheifele’s dreams go far beyond the clinic’s physical setting.

Citing his two goals as director of the special-needs clinic — to provide care for patients and to train more clinicians to treat them — he launches into an enthusiastic list of possibilities for the clinic’s long-term future.

Scheifele says Pitt already is head-and-shoulders above many other dental schools because its dental students all rotate through the special-needs clinic, while students in many dental programs have limited exposure to patients with special needs. In addition, at Pitt, students with a particular interest in special-needs patients can choose to take what the dental school calls a “selective” for additional training.

But Scheifele sees the potential to increase a wide range of health care professionals’ exposure to special-needs patients in the clinic — not just dental students, hygienists, anesthesiologists and nurse-anesthetists, but also potentially recovery room nurses and even social workers. He imagines coordinating with other physicians who could perform eye or ear exams for patients while they are under anesthesia to receive dental care.

Scheifele hopes someday to start a fellowship program that would provide an additional year of training for a dentist who is interested in treatment of patients with special needs. His dreamer’s eye already has landed on a vacant office space. He also believes foundation and individual donors would step forward to support the program.

In addition, he envisions offering continuing education for dentists already practicing in the community, to help them become more comfortable and willing to treat special-needs patients.

While Scheifele is a dreamer, he also is a realist. First things must come first, and that will start when the clinic’s existing patients begin to receive their care in the new center.

Scheifele’s own interest in special-needs patients sprang from his pediatrics training. “It comes with pediatric dentistry,” he said, noting that the management of some adults with special needs is similar to pediatric dentistry.

Before returning to Pitt Dec. 1 to assume his dual position as head of the dental school’s graduate residency program in pediatric dentistry and director of the special-needs clinic, Scheifele directed Temple University’s pediatric dental programs. He had been a faculty member in the Pitt dental school from 2000 to 2002.

Since his return, Scheifele’s biggest challenge has been managing his time, he says. Although the pediatric residency program is running well, he needs to get his own systems established there, while at the same time developing a curriculum and preparing to open the expanded special-needs clinic.

“It’s a big task,” he says, adding that he’s received universal offers of support. “I’m already looking forward to getting up and running.”

The clinic’s current pool of about 600 special-needs patients is seen in a smaller space, also in Salk Hall. The clinic, open on Tuesday afternoons and Wednesdays, schedules 10-12 patients on a typical day. When the expanded clinic opens, it will have sufficient space and equipment to accommodate six or seven patients at a time, although the number of patients that can be treated will depend on staffing, which has yet to be determined, Scheifele says. “There’s definitely going to be an increase in the number of patients we see,” he says.

Scheifele says the expansion will allow the clinic’s students and faculty supervisors to serve a wider range of special-needs clients. The plan is to serve patients of all intellectual and cognitive levels — from those who just need a little TLC and extra time to those who require sedation or general anesthesia in order to be treated. “The clinic’s going to be a lot more broad-based,” he says, noting that it now typically serves only those with profound special needs.

He envisions the ability to treat more patients who don’t need general anesthesia in the clinic, which will be helpful in giving students experience in interacting with special-needs patients. He also sees the potential for “mainstreaming” more patients by performing more complicated treatments for patients who then could get their routine care out in the community.

Scheifele sees the opportunity for students under his supervision to educate caregivers in better oral hygiene practices. “There’s no point in bringing a patient to us every six months and finding new cavities and conditions. A lot is preventable,” he says, noting that both children and adults who are in institutional settings often lack proper oral hygiene either because their caregivers aren’t knowledgeable or there aren’t enough of them.

The dental school’s goal is not only to help students gain competency in assessing special-needs patients, but to increase the numbers of dentists in the community who are prepared to care for these patients. “There definitely is a need for it,” Scheifele said. Special-needs patients often face many barriers to treatment. Many special-needs patients receive medical assistance, which some dentists don’t accept. Other offices may not be equipped to accommodate a wheelchair or to have space for a caregiver who accompanies a patient.

Sometimes behavior issues make certain patients a disruption in the waiting room. Other times, it may be a patient’s complex medical condition that dissuades a dentist.

While many dentists do treat special-needs patients, some lack confidence in how to approach such patients. “Some clinicians are not comfortable doing that,” he says.

Scheifele is confident there is a large unmet need in the tri-state area for the clinic’s services. “The minute we open our doors full time, we’re going to have a great patient population,” he says.

“It’s great that we can offer this service, but we’re only one little clinic,” Schiefele adds, noting he is aiming for the larger goal of spreading the responsibility to care for special-needs patients among more dentists, in part by graduating those with experience.

“The more people we make comfortable and educated, the more people who are going to be willing to treat these patients,” he says.

—Kimberly K. Barlow