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Special Care with Compassion Evan Spivack, DDS

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Most patients who come to a dental office enter the operatory, and after exchanging pleasantries with the dentist or hygienist, sit back and open wide for treatment. That is most dental patients, but not those who come to the Special Care Treatment Center (SCTC) in Newark, New Jersey. A division of the Department of Pediatric Dentistry at the University of Medicine and Dentistry of New Jersey-New Jersey Dental School, the SCTC is the state’s largest provider of comprehensive dental care to people with a broad range of disabilities. Most patients have developmental disorders, such as Down syndrome, autism and cerebral palsy, however, those with complex medical and psychiatric conditions and nursing-home-based Alzheimer’s patients get treatment there, as well. It is the only facility of its kind in the region, so some patients travel as many as three hours for this highly specialized care.

The center found a home in the dental school when Drs. Justin Stone and Robert Kroll were preparing to dissolve their private practice. The two dentists had devoted their careers to caring for people with disabilities. They treated many with IV sedation in their office and at nearby local hospitals. By 1994, financial concerns made it extremely difficult to continue providing the services in a private-practice setting. The two were set to retire, until they were offered a second life in the state’s only dental school. From a small two-operatory space, the center has grown to seven operatories and a reception/consultation area. The waiting room and lab are shared spaces with the dental school clinics. There are 10,000 patients on the SCTC registry, and last year the center accommodated 3,500 patient visits.

According to the program’s director, Evan Spivack, DDS, FAGD, the true strength of the center is its dedicated staff. Two full-time and one part-time dentist are active in both patient care and educational programs. The dental hygienist, three dental assistants and three staff members are integral to the special care team approach. “The real secret to caring for people with special needs is to have patience, compassion and a willingness to extend yourself a bit further for your patients,” says Spivack. “Every person on our team really cares about making a difference and contributes to the quality of care we strive to consistently provide.”

The patients’ caregivers are all extremely grateful for the SCTC. Because there are so few providers, many of the patients have been bounced from dentist to dentist, sometimes going years without care. The parent of a 32-year-old Down syndrome patient explains that he was at a complete loss when his daughter’s longtime dentist gave up practicing. “We went to several other dentists, none of whom were comfortable treating special needs patients. They simply were not equipped to care for her,” he says. “The staff here is wonderful, and the care is excellent. I don’t know what would have happened if we hadn’t come here.” And, since the center is within a dental school, there is the added benefit of readily available comprehensive treatment by a team of general dentists and specialists.

Bill, a 30-year-old patient with mental retardation came to the SCTC with his parents, who were especially concerned about his extreme open bite and several loose anterior teeth. The parents were looking ahead to a time when Bill’s sister would be his caregiver, and they wanted to “normalize” his appearance as much as possible. Advanced periodontal disease, combined with a lifelong thumb-sucking habit, ruled out orthodontic intervention. Two anterior teeth and a troublesome third molar had to be extracted; however, periodontal therapy was successful in controlling inflammation and allowing for the maintenance of the remaining dentition. Root canal therapy and several restorations eliminated remaining dental pathology. The only problem still to be resolved was the open bite, maintained by pressure from Bill’s constant thumb sucking. Previous attempts to control his habit failed, until the dentist and Bill’s parents came up with a plan. All it took was a dollar a day and the thumb sucking stopped, almost immediately. This inexpensive orthodontic therapy was successful. The natural pressure from the lips quickly helped to minimize the open bite, and with a partial denture to replace the missing teeth, Bill and his parents were soon smiling. Close maintenance has kept those smiles going for several years.

Poor oral hygiene, often combined with other anatomic and developmental problems, leads to early and often dramatic tooth loss for many patients. A rigorous pharmacologic attack combined with close attention from dental hygienist, Sheryll Victoria, helps to meet this challenge.

Victoria points to David with pride, one of the center’s most dramatic success stories. Initially presenting with poor oral hygiene and wrap-around cervical caries on nearly every tooth, the 33- year-old patient appeared to be heading rapidly toward a future in complete dentures. Although mildly autistic, David made a connection with the animated and bubbly hygienist, and soon the results of improved home care became evident. To help slow demineralization and protect from recurring decay, nearly all the teeth were restored with glass ionomer materials. Several teeth required root canal therapy, but only two teeth, a lower second molar and an upper lateral incisor, needed to be extracted.

Seeing the progress David was making, his mother became active in reinforcing the home care efforts, and religiously brought David to his appointments. Soon, the oral hygiene and periodontal condition had reached the point where several of the anterior restorations could be replaced with porcelain-fused metal crowns, and a three-unit fixed bridge replaced the missing incisor. Although David now spends part of the year living with his father in Florida, he is still seen at the center for at least two re-care visits each year, always looking forward to seeing his friend, Sheryll.

Many of the patients have behavioral or medical conditions that preclude administering dental care in an outpatient setting. They might have severe, chronic aspiration issues, uncontrolled seizure activity, advanced dementia or profound mental retardation. In many cases, their oral health is poor and requires significant restorative and surgical intervention. Comprehensive treatment in the operating room under general anesthesia is the only and ideal way to deliver care. Currently, the center provides such services to more than 300 patients annually.

Over time, the complexity of the special needs population has increased. Mark Robinson, DMD, FAGD, has been providing full-time treatment to this population for more than 10 years. “Our patients are much more medically complex now than they were even a few years ago,” he points out. “People are living longer, often with chronic illnesses, and taking more medications than ever. On the other end of the spectrum, premature babies are now surviving into childhood and beyond, many of whom would not have been viable just a few years ago. Many have severely debilitating conditions, and many have significant oral and dental issues.” Maintaining good oral health is critical to avoiding or minimizing systemic infections. “Dental care for this population is more than a quality-of-life issue; it’s sometimes life and death,” he adds.

As part of an academic institution, Drs. Spivack and Robinson strongly believe in the importance of educating the next generation of dentists in the value of providing care for this large and often vulnerable population. They are active both in lecturing to dental students and postdoctoral residents, and have initiated a trimester-long elective program in special care dentistry for interested students. The program, which enrolls nearly one-third of the fourth-year class, includes lectures from dental, medical and legal professionals, as well as clinical experiences at the center. Another important academic initiative is the two-year general practice residency position in special care dentistry. Accepting one resident per year, the fourth resident is now enrolled in the CODA-accredited program. The resident receives intensive experience in caring for special needs patients in the OR and in the clinic.

At times, the dentists and staff are involved in more than caring for patients’ teeth. As Dr. Spivack points out, “sometimes you need to look outside the mouth.” He recalls one patient, a 44- year-old woman with mental retardation and several medical diagnoses, who came for treatment accompanied by her elderly mother. It soon became apparent that the mother – the sole caretaker – was too frail and overwhelmed to follow through on her disabled daughter’s many dental and medical needs. She, herself, had many unmet needs and did not know where to turn for help. Taking care of the patient’s teeth became secondary to arranging for social services to help both the mother and daughter. It took less than a half hour to have a social worker, experienced in working with persons with special needs, get in touch with the mother and begin to line up services and support. “It cost me nothing more than a few minutes of my time, and we really were able to make a difference,” Dr. Spivack says. “The hug I got from mom, after she found out she would be getting help, made it even more worthwhile.”
More About Dr. Evan Spivack
Evan Spivack, DDS, is director of the Special Care Treatment Center (SCTC) at UMDNJ-New Jersey Dental School. Part of the Department of Pediatric Dentistry, the SCTC is the only tertiary care special needs center in the state.

A graduate of the University of Maryland Dental School, Dr. Spivack completed a residency program at St. Barnabas Hospital in Bronx, New York, and a one-year fellowship in special care dentistry at Helen Hayes Hospital in West Haverstraw, New York. He served on the faculty of New York University’s College of Dentistry, has been on the staffs of several hospitals and nursing facilities and had a private practice. Prior to coming to NJDS, Dr. Spivack was director of Special Dental Services at St. Joseph’s Regional Medical Center in Paterson, New Jersey.

Dr. Spivack lectures across the country on special care dentistry to medical, dental, allied health professionals and to lay groups. He is a fellow of the Academy of General Dentistry and serves as editor and vice president of that organization’s New Jersey chapter.

Dr. Spivack cares for outpatients and treats more complex patients, who need multiple procedures under general anesthesia in The University Hospital’s operating rooms. He teaches pre-doctoral and postdoctoral dental students, and he is involved in teaching dental assistant and dental hygiene students, from UMDNJ-School of Health Related Professions, who rotate through the SCTC. Dr. Spivack developed the first CODA-accredited Special Care Dental Residency program in the United States.
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September 2025
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