This past winter, Andrea Pugh noticed her sister Patty was losing weight, quickly and without explanation. Living with Down Syndrome and unable to speak, Patty, 53, continued to shed pounds as her family tried to find an explanation.

Doctors tested her for a variety of illnesses but couldn't find an answer. Finally, a family physician suggested that simple tooth pain might be the reason for her not eating.

Andrea began searching for a dentist who would treat her sister. Years earlier, a local dentist had dismissed Patty as a patient, saying he could no longer help her.

Now it seemed nobody else could either -- at least nobody within a few hours of Franklin County, which is roughly three hours from Pittsburgh. After more than 40 calls and no luck, Andrea heard about special needs patients being treated at the University of Pittsburgh.

In March, Patty had her first appointment at the Center for Patients With Special Needs at the University of Pittsburgh School of Dental Medicine. After being sedated for a routine exam, she received a dire diagnosis -- all of her teeth were loose and needed to be removed.

"Some of the teeth had developed bad abscesses, which had to be painful and poisonous to her system," Andrea says. "Patty must have put up with a lot of pain that she wasn't able to communicate to us."

Andrea thought this must be the worst case the team of student doctors had ever seen. But it wasn't. In fact, it is a surprisingly common outcome for special needs patients of Patty's age. As they grow older, it is a struggle to convince them to brush their teeth twice a day.

As the Pugh family learned, finding a dentist willing and able to treat special needs patients is also a challenge. A typical office visit often isn’t as simple as showing up. The process could require sedative drugs, coaxing from a doctor or nurse, physical restraint or even complete anesthesia.

"A dentist’s staff may not have the requisite training, or there may be even behavioral issues that are loud and disruptive in the waiting room,” says Dr. Erik Scheifele, director of Pitt’s special needs dental center. “Just getting them into the office might be difficult. Insurance is another hurdle. Not every dentist will accept the medical assistance insurance used by many disabled people."

The handful of practices and clinics that do see special needs patients becomes a godsend to parents and caregivers desperate to find treatment for their loved ones. In addition to Pitt's clinic, Accessible Dental Services runs special needs clinics in Murrysville, Green Tree and Rochester.

“We’ve only been open to the general public since November, and we’ve already received an overwhelming response,” says Pat DiMico, chief operating officer of ADS. “It can be difficult finding a dentist who not only takes the insurance but has the time, skills, training and equipment.”

Janet Britt of Westmoreland County knows this firsthand. Her daughter Michele, 35, is autistic and blind, and has a congenital leg disorder that requires braces. But at the dentist’s office, she becomes “like a sumo wrestler,” her mom says.

A typical oral exam begins with physical restraint, and more advanced procedures require full sedation. Michele went to the dentist at Children’s Hospital until she was 21. Since then, she’s been getting bi-annual checkups at Pitt.

“I can't say enough about the people there,” Janet says. “I have never had a bad episode. They're trained; they know what to expect even before she gets there; and they have incredible patience.”

The American Dental Association has called for dental schools to recognize the access problems facing special needs patients. In that respect, Pitt is a trailblazer. Its special needs center has been operating since the 1970s, and all dental students rotate through the clinic, as do dental assistant students.

“What you need as a dentist is patience, TLC, and a willingness to get to know the patient,” says Scheifele.

That patience and understanding have helped Patty Pugh recover quickly from her tooth extractions. At an August follow-up visit, the dentist gave her a glowing report. She’s eating again, learning to chew with her gums and has already put on 20 pounds to get back to a healthy 125.

“She’s also smiling a lot more,” Andrea says. “She’s pain-free and happy.”

For more information about Pitt's special needs dental clinic call 412-648-8616 or visit www.dental.pitt.edu/patients.

For more information about Accessible Dental Services, call 412-820-1010 or visit www.accessibledental.org.