By Vanessa Salvia
Every once in a while Dr. Gregory Williams at Tigard Family Dentistry in Tigard, Oregon gets asked by his colleagues to talk about how he has been successful with his Oregon Mobile Dentistry practice. When those conversations come up, he tells them the truth—it’s hard work, and it’s not for everyone.
“I know more dentists who have tried to do it and failed than who have successfully continued with a mobile practice,” says Williams.
Williams was approached by a dental society in 1999 to provide dental care to nursing home residents in the area of his practice. A local facility had a dental suite in it, and the dental director who had been providing care there was transi-tioning out of the practice. “I looked at it and had an interest in it,” says Williams. “My dental practice is situated in an area where there are a lot of retirees, so I’m very comfortable working with the retirement population.”
It also didn’t hurt that in 1999 Williams was just a year out of Oregon Health and Science University, and was eager to create a successful practice as well as make a difference in the world. “I genuinely wanted to help people when I started my practice,” he says. “I still do.”
In 2007, Williams and another dentist, Dr. Scott R. Dyer, created an organization called Wide Open Humanitarian, Inc. to perform charitable dentistry around the world. In 2011, the pair started another dental clinic to improve the dental care of patients on the Oregon Health Plan, which covers a lot of low-income residents.
Through the efforts of Wide Open Humanitarian, Williams had accumulated some mobile dental equipment that sat unused for much of the time. He put together his mobile equipment and his experience working with the nursing home population and created a mobile dentistry unit. “We had the equipment and we had experience doing it,” re-calls Williams. “I think it was around 2011 that we decided to reach out to the community of nursing homes in the area and see if there was interest in having a dentist on site.”
He found mixed interest. While all nursing homes are required to provide some level of dental care, not all are open to the idea of partnering with a dentist in this way. Oregon state law requires that all residents of a nursing care facility have to have a staff dentist or a dental director. How the facilities meet compliance, or whether they meet compliance at all, does vary.
“Nursing home residents should have a dental exam at last annually, and that doesn’t always happen,” says Williams. Reasons for this lack of care can be complicated. It may take a significant amount of time to move from diagnosis to treatment with this population because the patient may have a representative with health care power of attorney or financial power of attorney who may not authorize the treatment or payment for some reason. Whatever the cause, it’s clear that the lack of dental care does impact patient health.
Caring for this population is difficult. “It’s hard, physically demanding work that is almost never ergonomic,” he ex-plains. “If you work half a day doing mobile dentistry your body feels it. You’re working on patients who have physical and mental disabilities. Much of the time you’re not dealing with patients who can make their own decisions. And even if they are able to make their own decisions they often have power of attorney.”
The mobile dentist must bring to the site everything they need. The equipment must be reliable or else they must have backup equipment, or be able to fix things or work without them on the fly. “You may be in the middle of a pro-cedure and then not have the right instrument, so you have to be very flexible and accommodating to make it work,” Williams says.
Standards of care may be lower than what the dentist is used to. For instance, a patient may have a denture that has been left in their mouth far too long without being cleaned. To get patients from a nursing home into a mobile dental unit is challenging, because many of the patients aren’t very mobile. By the time the patient’s helper—perhaps their child, who may be in their 50s or 60s themselves—gets the patient into the dentist chair, the patient, the child and the dentist are worn out. You may be all set up to provide fantastic care for patients who don’t want to sit in a dentist chair, or don’t understand what the dentist is trying to do.
Everything about it is hard, but due to the dedication and care of Williams and his staff, they have successfully been able to partner with two dozen nursing facilities in the Portland metropolitan area.
“The team comes back from a day out in the mobile unit and says it’s hard,” Williams reports. “It takes a special kind of person who can handle the physical rigors of it as well as the emotional challenges of it. Not every dentist is capable of the demands of that kind of work—physical, mental, emotional, all of it. We’re a traditional dental practice just like any other, but more than anything our goal is to try to help these people out.”