At the heart of the matter

Dr Mark Gryst is one of the few registered and specifically qualified Special Needs dentists in the country.
Dr Mark Gryst is one of the few registered and specifically qualified Special Needs dentists in the country.

With our ageing population, Dr Mark Gryst explains why the demands for Special Needs dentistry are about to expand in a whole range of ways. John Burfitt reports

There was a time, years ago in Adelaide, when Dr Mark Gryst was working in a public health clinic. Whenever the receptionist saw a person in a wheelchair approaching the front doors, she would immediately call Dr Gryst and announce his next patient was on their way.

“Whether that person was a patient or not, there was just an assumption if they were in a wheelchair, I would be the one treating them,” Dr Gryst tells. “Whenever someone had a patient who had some kind of disability, their dentist would often palm them over to me. I got a reputation for that.”

Considering he has devoted his 34-year career to Special Needs dentistry, such an assumption is certainly understandable. It is even more so when Australian Dental Association (ADA) figures reveal Dr Gryst is one of the few registered and specifically qualified Special Needs dentists in the country. As of December 2014, there are 17 in Australia.

By definition, Special Needs dentistry covers patients with intellectual disabilities, physical, medical or psychiatric issues, behavioural problems and the frail and elderly. “Many dentists just didn’t know how to cope with people with disabilities and how to treat them as patients,” Dr Gryst explains.

“Even to this day, I get patients referred to me all the time. Some of the dentists are passing the buck, but others I assume just do not know what to do. Then there are others who simply do not want to spend the time learning new skills.”

At a time when the future health needs of Australia’s ageing population is under focus by the government, a significant proportion of the ADA’s
2015-16 Federal Pre-Budget submission was devoted to the dental needs of people over the age of 65.

The submission highlighted such issues as over 50 per cent of Australians over the age of 65 have gum disease or periodontitis, over 20 per cent have complete tooth loss and those who have retained their teeth often have complex restorations which need maintenance. It also highlighted the fact that residents in aged care facilities are particularly at risk of poor oral health.

“Dentistry remains one of the poor cousins when it comes to the health of people with special needs and there is this perception that it is harder to get a patient to a dentist,” Dr Gryst says.

“Often, there is unintentional neglect. If there is something going on with their skin or eyes, then that can easily be spotted. But unless you are looking in someone’s mouth, you have no idea what the state of their oral health is.”

“Many dentists just didn’t know how to cope with people with disabilities and how to treat them as patients.” Dr Mark Gryst, Special Needs dentist

Dr Gryst, 61, currently divides his time between his private practice in the Colgate Australian Clinical Dental Research Centre and the public sector
at the Special Needs Unit at the Adelaide Dental Hospital.

He has been dealing with Special Needs since graduating from the University of Adelaide in 1981, and full-time since 1985. He completed his RACDS secondary exams in Special Needs in 2002, achieving his specialty registration in 2005.

One of his first jobs out of university was working in a residential facility for 700 people with intellectual disabilities.

“I was interested in the area, I enjoyed it and I found I had skills in those areas. I found I was good at it,” Dr Gryst says.

“I have always tended to be more compassionate in that way. I quickly realised that if I could offer a service to regular patients, then I thought why was I not offering it for an individual with Special Needs? In this area—Special Needs—it tends to break down into those who enjoy working with the medically compromised and those who enjoy working with people with disabilities, the frail and the elderly. I am in the latter category.

“It might be very routine dentistry, but it might be on a patient who doesn’t want to be there, who is not compliant and who has a range of serious medical issues. That is what I find so fascinating and it is that variability that makes it so interesting.

Dr Gryst then adds, “You see things in Special Needs that you will never see anywhere else in dentistry.”

The most important lesson about treating patients with Special Needs he learned from early on, Dr Gryst recalls, is one style of service does not fit all.

“You have to treat each person specifically for their condition, so a Down syndrome person is treated differently to a cerebral palsy person and differently again to someone who has had a stroke or has dementia,” he says. “I still get patients I am not sure how to treat, but you just get in and do your best.”

By adopting such an approach from early in his career, a reputation for being the dentist who could treat patients deemed ‘difficult cases’ quickly grew. To this day, he still often receives patients other dentists deem too hard to handle.

“A little empathy goes a long way,” says the Adelaide-based dentist, Dr Mark Gryst.
“A little empathy goes a long way,” says the Adelaide-based dentist, Dr Mark Gryst.

“I frequently get referred patients from other dentists who claim they were not able to treat this person who will need a general anaesthetic to treat,” he says. “When they come in, we are often able to treat the patient in the chair, without general anaesthetic and without issues. And that is not about being arrogant; it is just that we have different skills.

“I occasionally have to quell that notion these patients are dangerous. A little empathy goes a long way towards understanding that, and in treating them successfully.”

While Dr Gryst has worked extensively in the care of people with Special Needs, it is the area of aged care that is of particular concern.

He fears the industry has not been set up well enough to cater to the growing demands of this sector into the future. “There are many dentists doing good work in nursing homes, but the problem is there is not enough of them,” Dr Gryst says. “The dental industry has not taken up the role of taking care of them in a better way, and it’s getting all a bit too late.

As for recent reports of an oversupply of dentists in Australia, Dr Gryst responds, “I don’t think we have an oversupply in the Special Needs area. One of the things about Special Needs is this is not an area you can ask people to do. It is something people want to be doing and feel committed to.”

Among the range of oral health issues presented in the elderly, it is the rapid decay and deterioration of teeth that is of most concern, resulting from dry mouth or too often from a high sugar intake from sucking on sweets or drinking cordial every day.

“One of the biggest things these patients endure is boredom, and every time they put sugar into their mouth, they are just adding to the decay,” he explains. “Then there are other patients who are losing their memory and forget to brush their teeth. As a result, their mouths tend to break down quickly.”

What Dr Gryst advocates for the future of aged dental care is better access to dental treatments in nursing homes through not only a committed team of dentists but also better trained general medical staff.

“Every nursing home should have a dental team attached to it, otherwise people are going to suffer,” he says. “I also think training the staff to better monitor what is being consumed to stop the deterioration of teeth that we are currently seeing is crucial.”

The other area of reform Dr Gryst would like to see is for health funds to support preventive care as much as restorative care. “There is just going to have to be funding for preventive care in nursing homes into the future,” he states.

The best hope for good change lies with the training of the new generation of dentists coming through the ranks at our universities. Dr Gryst, who works with final-year students at the University of Adelaide, believes on the job experience is the best way to recruit new professionals into the field.

As he has now entered his sixties, Dr Gryst says he feels he has commenced, “the final chapter” of his own career. Creating a legacy of a dental profession well equipped to deal with people of Special Needs has now become one of his top priorities.

“The advice I give is for graduates to get a few years of general experience, then they are equipped to deal with Special Needs after that.” Dr Mark Gryst, Special Needs dentist

“We are a lot better now in how we handle Special Needs, but we still have a great deal of work to do, and I just don’t know if there is adequate exposure of people with disabilities to undergraduates,” he says.

“We used to run an all-day course at the end of fourth year and afterwards there were always students keen to consider that area. But if they are not exposed to it, they don’t know about it. They need to see it and experience it to understand it. We have in the past also had electives when students spent time with dentists working in Special Needs.

“This is not a sexy area of dentistry and it is not always fun. The advice I give is for graduates to get a few years of general experience, then they are equipped to deal with Special Needs after that.”

It is not only the landscape of treatment that is changing, but the attitude towards it as well.

“Until recently, the majority of work was done in the government area,” explains Dr Gryst. “Now it’s in private as well. This is such a big area for all of us to take care of.

“I recently had a phone call from a colleague who said he had a group of Down syndrome lads coming in. I responded to him: ‘I suppose you want me to take them.’ Instead, he said, ‘No, actually I want to know how to do it better than I am.’

“Hearing that kind of approach to Special Needs made me very happy.”

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