This story is part of a series on the challenges and solutions related to oral health in Michigan, Indiana, and Ohio. It is made possible with funding support from the Delta Dental Foundation.
At Ohio State University’s
Nisonger Center, some patients with disabilities travel hundreds of miles to the Columbus campus for dental care. Dr. Stephen Beetstra, the center’s dental program director, says this speaks volumes about the scarcity of accessible dental services.
“Our patients come from all over, some as far away as Arkansas,” says Beetstra. “We get referrals from every county in Ohio and neighboring states like Kentucky and West Virginia. For many, we’re the only option because the training and equipment required to treat this population aren’t available elsewhere.”
Inclusive dentistry is transforming access to care for individuals with disabilities, dental anxiety, and other special needs. The
Delta Dental Foundation in Okemos, Michigan, supports these programs by underwriting training, sensory-friendly tools, and other resources to help clinics across the Midwest establish Centers for Dental Inclusivity.
The Nisonger Center at Ohio State,
Neighborhood Health in Fort Wayne, Indiana, and the
Center for Family Health in Jackson, Michigan, are pioneers in inclusive dentistry. They create welcoming environments and provide tailored care that addresses barriers to dental treatment.
Part of overall health care
The Nisonger Center, established in 1971, specializes in providing dental care for individuals with intellectual and developmental disabilities. Operating as part of the university’s medical school rather than its dental school, the clinic uses an interdisciplinary model to deliver comprehensive care. Beetstra’s team includes physicians, psychologists, occupational therapists and physical therapists.
“Our collaborative approach ensures we’re not only addressing dental issues but also considering the patient’s overall health and comfort,” Beetstra says.
Beetstra says many of the clinic’s patients are referred for sedation because of their past experiences or medical complexities. However, through training and innovative tools, the clinic can avoid sedation for 85% of these patients.
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Ohio State UniversityDr. Stephen Beetstra's team at Ohio State University’s Nisonger Center collaborates with a patient with disabilities.
“Sedating patients carries risks, particularly because many of them are on psychiatric medications that can interact with anesthesia,” says Beetstra. “By avoiding sedation whenever possible, we protect our patients’ health and reduce costs. Taking a patient to the operating room can cost $12,000 to $15,000, while we can provide safe, cost-effective care in the clinic.”
One tool the clinic uses is a vacuum backpack, which creates a body mold to stabilize and comfort patients during procedures, particularly those with conditions like cerebral palsy. Innovations like this, combined with a commitment to training the next generation of dentists, are helping to close the gap in care for adults with disabilities.
That gap is huge. Because of challenges such as lack of transportation, complex medical conditions, medications that can exacerbate oral health issues, lack of fine motor control, extreme anxiety, and an inability to open one's mouth, people with disabilities experience much higher rates of dental disease than the general population. A survey from the
Indiana University Center for Health Equity found that half of respondents with disabilities reported active dental issues such as pain or bleeding gums, and two-thirds had lost teeth due to untreated dental issues.
“Oral health is critical for people with disabilities,” says Beetstra. “One of the leading causes of death in this population is aspiration pneumonia, which can be triggered by bacteria in the mouth. Cleaning their teeth isn’t just about oral health, it’s about preventing serious, potentially fatal infections.”
‘Transformative’ effort
The scarcity of accessible dental care is also felt in Fort Wayne, where Neighborhood Health has become a lifeline for patients with special needs and dental anxiety. Dr. Tyler Kimmel, chief dental officer, says the Delta Dental Foundation has been instrumental in helping the clinic implement inclusive practices.
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Dr. Tyler Kimmel
“The Delta Dental Foundation’s support has been transformative,” says Kimmel. “They’ve partnered with us through their Centers for Inclusive Dentistry program, providing training and consulting for the past two years.”
Simple yet impactful changes, such as dimmable LED lighting, weighted blankets, and sensory tools, have made a significant difference for patients, Kimmel says. Staff training at the New York University (NYU) Center for Persons with Disabilities has also helped the clinic adopt practical approaches to serving patients with special needs.
“Our inclusive approach benefits more than just people with disabilities,” Kimmel adds. “Tools like weighted blankets or sensory-friendly environments also help patients with anxiety, trauma histories, or even just children nervous about dental visits. It’s about delivering trauma-informed care for all.”
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Neighborhood HealthNeighborhood Health has introduced sensory-friendly exam rooms featuring specialized lighting to create a calming environment for patients.
Neighborhood Health serves 20,000 patients annually, offering medical, dental, and behavioral health services. The clinic also integrates dental care into medical visits, embedding hygienists into primary care teams.
“Dentistry has been siloed from overall health care for too long, but that’s changing,” says Kimmel. “Oral health directly impacts conditions like diabetes and heart disease. By embedding hygienists into medical teams, we make it easier for patients to access dental care.”
The clinic’s new facility, set to open next summer, will include features specifically designed for patients with disabilities, such as frosted sliding glass doors to create customizable environments and portable dental equipment for use during medical visits.
“Delta Dental’s funding allowed us to expand these accommodations from one room to all 15 of our exam rooms,” says Kimmel. “This has not only benefited patients but also created a calming work environment for our staff. It’s a win for everyone.”
Outsized impact
In Jackson, the Center for Family Health is also leading the charge in sensory-friendly dentistry. Dr. Kathryn Thornton, who oversees the dental clinic, says the Delta Dental Foundation’s support has been critical to their success.
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Center for Family HealthDr. Kathryn Thornton
“We sent a few teams of dentists, hygienists, and assistants to do the training at both the University of Pennsylvania and NYU,” says Thornton. “When the foundation offered to bring in a group to make a sensory room and modify our operatories, we jumped on the opportunity.”
The sensory room includes customizable lighting, sound-dampening features, and a daybed, providing an alternative waiting area or decompression space. There’s also LED lighting that patients can adjust, along with calming star projections.
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Center for Family HealthThe Center for Family Health's sensory room features adjustable lighting, sound-dampening, and a daybed, providing a calming decompression space.
“These small changes have had a big impact on both our patients and staff,” Thornton says. “We recently treated a teenager who previously required general anesthesia for dental care. With our sensory-friendly spaces and nitrous oxide, she was able to receive treatment here without sedation.”
The Delta Dental Foundation has prioritized these initiatives, providing funding, training, and awareness. But there are systemic challenges. For example, desensitization visits happen when a procedure is performed and, as a result, are not typically covered by insurance. That can place a financial burden on clinics.
According to the Centers for Disease Control and Prevention, 8.2% of Michigan residents with disabilities experience difficulty with independent living, and 4.7% report challenges with self-care, including brushing their teeth. These challenges contribute to higher rates of tooth decay and oral health disparities.
“Small wins might feel minor, but they’re significant for the person you’re helping,” Thornton says. “Building on those wins is key.”