Dr Tony Eldridge realised many special-needs patients were being shunted into the hospital system unnecessarily. As a result, he’s established a unique conscious sedation clinic within the public system geared to those patients, writes Sharon Aris
The Hobart Orofacial Pain and Special Needs Clinic is unique. Here, Dr Tony Eldridge treats not only complex dental and medical conditions, including chronic orofacial pain and sleep disorders, but also complex patients. This includes those with extensive medical histories, social impairment, seniors, residents in aged care facilities, people with high levels of anxiety and dental phobias, and those with physical, mental and intellectual disabilities.
Dr Eldridge’s professional journey here was prompted by personal experience seeking treatment for his own headache and neck pain—‘A doctor will truly understand his patients only after he has become one himself’, he quotes prominently on his website—moving away from general dentistry into temporomandibular joint disorders and establishing a referral-based practice in 2004. He now offers patients specialised treatment for chronic orofacial pain disorders, headaches, oral medicine, oral surgery and sleep disorders in both adults and children.
However, it was while consulting for Oral Health Services Tasmania (OHST) on pain management and oral surgery, Dr Eldridge realised patients were often referred to the public general anaesthetic (GA) waiting list for treatment who otherwise could be treated in the chair under conscious sedation. This included patients with complex medical histories, those with intellectual and physical disabilities, a history of stroke, Parkinson’s and Huntington’s diseases, or those with dental fears and phobias or an inability to tolerate routine dental treatment. With few options available other than GA, Dr Eldridge and OHST discussed the possibility of establishing a conscious sedation clinic in the public system. Already familiar with complex pharmacology, Dr Eldridge undertook his third post-graduate degree, the Graduate Diploma in Clinical Dentistry
(Conscious Sedation and Pain Control), at the University of Sydney in 2012.
On completion Dr Eldridge expanded his clinic to incorporate special-needs patients and the clinic is now the only practice of its kind in Tasmania, providing various combinations of oral, inhalational, intramuscular and intravenous sedation in a fully endorsed environment as per the strict standards set by the Australian and New Zealand College of Anaesthetists for conscious sedation.
“Patients with dental fears and phobias present significant challenges to the dental profession,” he says. Historically, many have undergone upper and lower dental clearances as they often feel this is their only treatment option.
“These people have been referred to us, and following comprehensive discussions regarding their specific backgrounds, phobias and social issues and their emotional, psychological and dental needs, most—if not all—don’t actually want to have full clearances. They just want to be able to smile again without embarrassment. We’re extremely proud to have assisted many of our patients through some brilliant, life-changing successes.
“Many people with histories of physical abuse, sexual abuse, childhood abuse, drug abuse and domestic violence often suffer from significant dental fears and phobias. This is often overlooked when providing dental treatment and it can impact significantly on the successful outcomes and long-term management. I’ve done work with people who can’t tolerate anything in their mouth, or people coming up from behind them. These patients, in particular, require very high levels of specialised care and regularly need multidisciplinary approaches,” continues Dr Eldridge.
“We saw a 25-year-old young woman who suffered significant dental phobia as a direct result of a long history of child abuse. She was referred to us for a full upper and lower clearance. Due to her dental deterioration from the phobia, she had developed agoraphobia, extreme embarrassment, and significant depression. This had led to a cycle of marijuana abuse. She couldn’t leave the house because she was ashamed of her appearance, so she couldn’t get a job and had no money.
“Because of the complexity of her case, I sought assistance from OHST, the Hobart Day Surgery, and a private anaesthetist. Working as a team, we were able to provide her with all facets of care and support. She is now doing incredibly well. When you have an opportunity to change lives like that, the professional reward is amazing.”
Taken for grants
Australian Dental Association Foundation (ADAF) and Wrigley Company Foundation Community Service Grant Initiatives provide funding to dentists, dentistry students and teams of dental professionals to help improve the oral health of some of Australia’s most disadvantaged communities.
The grants provide funding to cover the purchase of supplies and other expenses to either develop or expand existing community service programs. In 2013 a total of $82,000 was awarded to 13 programs across Australia. Dr Eldridge received a $US6000 grant.