Texas A&M New Program Educates Students In Special Needs Pediatric Dentistry

Through the lens of a 4-D ultrasound, new parents-to-be Anabel and Javier Mondragon excitedly waited to see their 25-week-old baby. Anabel grew anxious as she learned her Juliana would face the same challenges she had growing up: She would be born with a unilateral cleft lip and possible cleft palate.

Heartbroken knowing her daughter would likely experience the same cruelness because she looked different from other children, the young mother mentally prepared herself. “I would teach my daughter to have confidence and pride and remind her each day how beautiful she was.”

At 5 years old, the name-calling began. “Before I could ask my daughter if she was okay, she immediately said: ‘I look different because not all God’s masterpieces are the same. I’m beautiful, and there is no other Juliana like me!’”

What Anabel feared for her daughter is the same fear parents around the world experience for children born with special needs. And while bullying is enough to set any parent on edge, they also face a challenge that many don’t realize exists: finding quality dental care.

Patients Losing Patience
A pediatric dental residency at Howard University in Washington, D.C., opened Dr. Dan Burch’s eyes to “special care patients,” or those who encompass more than just special needs. The freshly coated dentist saw patients who were sick or had physical limitations and many others who could not maintain their own oral care for various reasons, and he suspected that this population’s dental needs were not being fulfilled.

Meeting a new patient in 2017, Burch—then clinical assistant professor at the School of Dentistry’s Department of Pediatric Dentistry—confirmed his suspicions.

“A patient had cerebral palsy and had to be treated in her wheelchair, but no private practices would do it,” he said. “Her mother was crying because she had been bouncing around dental offices for 10 years trying to find someone to clean her daughter’s teeth. I cleaned them and realized at that moment that it was our dental school’s responsibility to educate students on special care patients as a safety net for the Dallas-Fort Worth area.”

Burch was right. Research later proved that only five of Dallas’ 3,000 dentists serve this population, and the majority only accept private insurance. “There are about 300,000 people in this area with special needs, however, and less than 5% of them have private insurance,” Burch noted.

Armed with this knowledge, he got to work. “I presented my cause to my department in 2018 after the school underwent reaccreditation. The Commission on Dental Accreditation was working on a similar accreditation initiative knowing it would be a future concern.” The dean assembled a team and asked Burch to find a way to educate students on how to treat special care patients. With a grant from the federal Health Resources and Services Administration, a new special care dentistry fellowship pilot program was born in 2020.

Dan Burch, Lianna Pulliam
Dr. Dan Burch (left) is educating more students like Dr. Lianna Pulliam ’21 (right) on treating special-care dental patients through a new fellows training program in the School of Dentistry.
Photo: Scottish Rite for Children


Aggies Set the Standard
Today’s fellowship meets a growing need for children, 99% of whom are Medicaid patients. Burch, two fellows and a small group of full-time employees rotate to various children’s hospitals and clinics because they lack a dedicated patient space. Dr. Lianna Pulliam ’21, a fellow, spends 80-90% of her time with special care patients. “I’ve learned how to treat patients in the most accommodating workspaces and those that offer the bare minimum,” she shared.

To achieve maximum impact, this program needs a central clinic, more staff and a curriculum to educate all Texas A&M dental students, growing an awareness of the need and practitioners to fill it. The Crystal Charity Ball—a nonprofit established in 1952 to aid children’s charities in Dallas County—recently committed to working alongside the dental school to raise $1.6 million. A generous donation from the Hillcrest Foundation will join these funds to help the program in its goal to become self-sustaining in three years and exceed 6,000 annual patient visits—a 33% increase in oral health care for children who have special needs.

Burch now leads the new national postgraduate standard for accreditation in special care dentistry and sees the program’s growth and clinic’s establishment as opportunities for the School of Dentistry to distinguish itself from its peers. “I’d like us to be known not only as the program that set the national standard for special care dentistry, but also the premier training program in the country,” he said.

Pulliam, who works alongside Burch to treat around 100 special care patients like Juliana per week, is hopeful for the awareness this program will create once dental students are trained. She also works with Anabel, now a dental assistant who shares her personal journey to encourage other parents who have children with birth defects. “It’s humbling and rewarding to work with these patients,” Pulliam said with tears in her eyes. “Being more inclusive of this population needs to start somewhere. Why not here?”