This Townie pioneered special-needs and sedation dentistry programs in Arizona before moving into private practice
Dentists spend most of their working hours in their practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Dentaltown’s recurring Office Visit feature offers a chance for Townies to meet their peers and hear their stories.
This issue’s dentist, Dr. Bruce Spigner, has been my dentist since I moved to central Phoenix in the early 2000s. (A few years ago, when I mentioned that I’d just started a new job at a company that produced a magazine called Dentaltown, he excused himself for a moment and walked back into the room holding the latest issue.)
Some of the information in this profile I already knew, like how he worked on special-needs patients in a particular operatory, usually early in the morning. But I’d never realized the length and breadth of Spigner’s history in that field—or considered things like the tax and toil of standing in a hospital operating room for 12 hours, trying to finish as much dental work as possible on an anesthetized patient in one session.
Also, his building may or may not be haunted, depending on whom you ask. It’s just one more part of his story that I hope you find as interesting as I did.
How did you decide to get into dentistry?
In high school, biology and chemistry fascinated me, and I also loved mechanical drawing and design. When I was a junior, I chipped a front tooth during a trip to New York City and my uncle, who had a rather exclusive dental practice in Harlem, not only restored my tooth but also shared his love for dentistry and showed me some of the restorative results he’d achieved with his clientele. The science of dentistry and the attention to “mechanical detail” led to my decision to pursue a career in dentistry.
After high school, I spent one year as an exchange student in La Paz, Bolivia, then returned to the United States to complete my predental curriculum at Northern Arizona University in Flagstaff. I graduated with a degree in zoology and minors in chemistry and sociology, then began my dental education at the University of Southern California.
During my junior year at USC, I became part of a mobile clinic team that would go on weekends and breaks to provide free dental care to underserved populations. That’s where my interest in special-care dentistry began.
That was then reinforced during an externship, as well?
I completed my requirements early as a senior, which gave me the opportunity to work in the oral surgery area of the USC mobile clinic and to do an externship at Rancho Los Amigos Rehabilitation Hospital in Long Beach. The dental clinic there specialized in providing care for individuals suffering from stroke, spinal cord injury, head injury and complex disabilities. As you might imagine, these patients presented with complex behavior and physical challenges, which required a unique set of skills for us to diagnose and treat each patient safely and effectively.
After I finished the externship and my work with the oral surgery area of the mobile clinic, I decided to complete a residency in hospital dentistry at UCLA.
I chose UCLA’s residency because of its focus on special needs and hospital dentistry, because I intended to take my expertise back to Arizona, where this population was underserved. (Back then, the state had no dental schools.)
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2. Midwest Dental burs for high-and low-speed handpieces.
3. Schick intraoral camera and digital X-ray sensors, which are great tools for patient education. We’re able to view the images full-screen and show the patient (and insurance companies) findings that aren’t visible on X-rays. It’s also a great tool for oral hygiene instructions.
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Your first job out of school was a big one!
It was! I was hired as the dental director of the Arizona Department of Developmental Disabilities training center in Coolidge, a farming town 60 miles southwest of Phoenix. This facility had a large number of buildings that housed people with special needs, from high-functioning developmentally disabled adults to the severely disabled. The center had an infirmary with a physician, nursing staff, caseworkers and caretakers, and a dental office staffed by me, a dental hygienist and a dental assistant/front office person.
My responsibility was to develop and administer a dental care program for the facility, and also to provide dental care for the 500-plus residents: oral hygiene instruction, dental prophies, endo, surgical and all levels of restorative care. If patients were too uncooperative to be treated under normal circumstances, the infirmary physician, who had anesthesia training, would put them to sleep and we’d do all the restorative, periodontal and preventive care under general anesthesia. We also developed educational in-services with caretakers, to facilitate a higher level of dental awareness and to improve the oral health of each resident.
How did you end up moving to Phoenix?
At the end of two years at the training program in Coolidge, I was ready to move on. I’d done all I could to improve the lives of the clients, and working with this population of patients full time is extremely hard work. I’d always dreamed of establishing a hospital-based practice, similar to the one I’d worked in at UCLA and Rancho Los Amigos but also providing care for the medical staff, nurses and employees as well.
The opportunity presented itself when Good Samaritan Medical Center in Phoenix, the largest medical center in the state, began looking to provide dental care for its rehab population of patients, and hoped to model its program on Rancho Los Amigos’, which of course I had firsthand knowledge about. In August 1984, I was hired as director of dental service at Good Sam, which was the first medical center in Arizona to open up a dental facility of this kind.
What was it like to set up this program?
A local hygienist, Cindy Kleiman, helped pave the way. Cindy already had been working with spinal cord and stroke patients, making adaptive mouth wands to enable them to use their mouths instead of hands as tools, and fabricating adaptive tools to enable anyone with hand or arm weakness to hold and manipulate a toothbrush, thus helping to establish the need for dental care in a hospital setting.
In early 1985, we opened the Center for Dental Health at Good Samaritan Medical Center. We had a five-operatory clinic with a specialized piece of equipment called a wheelchair lift, which would let us treat patients in their own wheelchairs instead of having to transfer them to a dental chair. Initially, we treated patients undergoing rehabilitation therapy for stroke, spinal cord injury and head injury, but we soon expanded service to all areas of the medical center, including ER, cardiology, oncology, transplant, endocrinology, orthopedics and critical care. Patient types included cancer patients undergoing radiation and chemotherapy, patients with poorly controlled diabetes or with cardiac valve defects, patients preparing to undergo organ transplants or joint replacements, patients with fever of unknown origin, and dental trauma patients who presented in the emergency room. We recognized the critical role that oral health plays in overall systemic health, especially when managing patients who have compromised immune systems.
We also began seeing outpatients with special needs, using the OR to provide comprehensive care under general anesthesia for patients who were uncooperative to dental care under normal circumstances.
As a part of the medical center overall role in medical education, I would present in-services to the medical residents, nursing staff and employees about dental disease and methods of treatment and prevention. Eventually, we began seeing the medical staff, nurses and employees of the medical center, and expanded our care to individuals in the community as well.
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• iBond Etch Gel (Kulzer)
• Prime and Bond (Dentsply Sirona)
• RelyX Unicem light-cure cement and RelyX luting cement (3M)
• Integrity Temporary Crown & Bridge Material (Dentsply Sirona)
• Impregum (3M)
• Examix (GC America)
• Open Dental
• Schick intraoral sensors (Patterson)
When, why and how did you move into private practice?
In 1990, hospitals began initiating cost-containment measures, which provided the opportunity for me to assume ownership and transition our dental office from a corporate one to a private practice. We continued to utilize our clinic on the Good Samaritan campus and provide services for the hospital on a contractual basis. In 1993 the medical center began renovating the building my office was in, so I decided to move across the street into the historic Grunow Medical Building.
The Grunow building was close to the medical center, had easy parking for patients with mobility challenges, and plenty of historic ambience: It had been built as a medical clinic back in 1931 in honor of Lois Grunow, a 7-year-old girl who’d died in Chicago after a possible misdiagnosis. Her father, William Grunow, a wealthy businessman from the Midwest, endowed $1 million to create the clinic—one of the first in the state, with 13 specialists, a laboratory, a research center, a radiology department and a medical library. (A painting of Lois hangs in the building’s main lobby, seen here.)
The building was renovated in the 1990s, but was still nearly empty, which let me design the practice for quiet, comfort and efficiency. Our office has five treatment rooms—two dedicated to hygiene and three to restorative care—that have windows that look out into a Spanish courtyard, and curved walls and soffits to break up the space and dampen sound travel. Two treatment rooms have glass doors we can close if necessary while we’re caring for more vocal special-needs patients.
Our sedation/surgical suite is designed for seclusion, comfort and function. Patients who require sedation are treated either in this suite or, if need requires, in the hospital operating room across the street. (Good Sam’s new name is Banner University Medical Center Phoenix.) All IV and general anesthesia sedation is performed by a board-certified M.D. anesthesiologist.
Your hygienist, Tina, swears the Grunow building is haunted.
Winnie Ruth Judd, the “Phoenix Trunk Murderess,” was a secretary in one of the clinic’s offices in the 1930s, which is when she killed two women, dismembered them, stuffed the bodies in steamer trunks and boarded a train to California, where a baggage agent made a gruesome discovery the next day because the trunks were leaking. There’s also a rumor that as part of the clinic’s medical research, the building had a morgue in the basement where autopsies were performed—and the basement happens to be where we store our rarely used items and old files. Obviously, it’s all speculation and hearsay, but it adds to the charm and mystique of this building. I don’t believe it is haunted, although I’ve had staff who swear they’ve experienced weird occurrences here.
Although you’ve scaled back on hospital dentistry, you still have patients who come in for sedation. Who’s a typical patient who requires sedation dentistry, and how do you schedule them?
There’s no “typical” because there’s such a wide range. Some patients are afraid of needles, or dentistry in general. Others have severe gag reflexes. Some have an intolerance or allergy to local anesthestics, limiting their ability to numb adequately for dental procedures. Patients who have moderate, severe or profound mental retardation, or some forms of autism, dementia or Alzheimer’s disease, are unable to cooperate with dental treatment. And patients with neurological disorders such as cerebral palsy and Parkinson’s disease aren’t able to sit still during dental treatment. We determine the level of sedation based on each person’s dental history, past and current medical history, and current level of cooperation and dental health. If we can perform treatment simply by listening to the patient and giving TLC, we won’t need sedation. If that’s ineffective, we’ll recommend the lightest level of sedation necessary to accomplish our dental objective. Options include nitrous oxide, oral sedation, IV sedation administered by an M.D. anesthesiologist, and general anesthesia in a hospital setting.
Our cases can go for as short as an hour or as long as 12 hours in the OR, depending on the health of the patient and required dental needs.
The patient population we treat with sedation are predominantly teenage and adult. Most pediatric dentists are trained to treat the pediatric population, but as these individuals transition into adulthood, their dental needs can dramatically change. Procedures performed include endodontics, perio therapy, operative, restorative care, removable and fixed prosthodontics, implant restorations, minor oral surgery (including extractions, bone grafts and minor soft-tissue biopsies) and all forms of aesthetic dentistry.
Pretreatment and follow-up care include oral hygiene education and recall maintenance, and our goal is to provide recall and follow care without sedation whenever possible.
For a while, you were on the Arizona state dental board. How did that come about, and what were those duties like?
I served as a governor-appointed member to the Arizona Board of Dental Examiners for a term of four years, from January 2006 to December 2010. My role was to protect the public by ensuring that any individual who practiced dentistry in the state of Arizona did so within the standard of care and safely. As part of the board’s duties, we’d review statutes, hear complaints brought before the board and rule on action, whether disciplinary or otherwise, to ensure the safety of all individuals receiving dental care.
I was first approached about taking a board position by a colleague who was familiar with the responsibilities and thought I’d make a good board member. Having never considered board membership, I sought to learn more about the duties involved and after some coaxing, decided to accept this rare opportunity and honor.
As a part of our duties, we were trained as dental examiners on the Western Regional Examiner Board. Passing this or a similar exam is required to receive a license to practice dentistry in the U.S., so as examiners, we evaluated the candidate treatment of various dental procedures.
What do you like best about being a dentist?
1. Patient relationships—our patients become like family.
2. The joy I share with my awesome team.
3. The satisfaction of a happy, healthy, beautiful smile.
4. Transitioning a fearful patient into a happy and fear-free patient.
5. The artistry of restorative and aesthetic dentistry.
What have been the hardest challenges of being a dentist?
I’ve been blessed throughout my dental career to have opportunities most haven’t, and I’ve worked with team members second to none. However, I’d say the hardest challenge is leading a team where each and every individual has the same ownership and work ethic, and everyone is able to work together as a team with minimal direction.
Where do you see yourself in ... five years? A decade from now?
I’m still excited about coming to work every day and so, Lord willing, I’d like to work for the next five years preparing my practice to transition from full time to part time and share my unique knowledge in special-care dentistry with students at a local dental school. In a decade, I’d like to retire from private practice and spend time with my family, traveling, teaching and perhaps doing foreign missionary dentistry.
In that time, where do you see the future of dentistry going?
As in medicine, dentistry is headed away from the private practice model into large groups and corporate dentistry. A select group of dentists will practice as sole or private practitioners, but as that generation retires, those practices will in many cases be purchased by corporate entities focused on productivity, efficiency and cost containment.
What’s life like outside of the office?
I like to spend time with my family, take road trips, hike, listen to music and study the Bible.
If you ever did run into a ghost hanging around your office, what would your reaction be?
"If there’s something strange in your neighborhood, who you gonna call? Ghostbusters! I ain’t afraid of no ghosts."