UF College of Dentistry, or UFCD, trains dentists to care for patients with intellectual or developmental disabilities; a vulnerable population 14 of 15 Florida dentists feel unprepared to treat.
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For years, a mother drove five hours and paid nearly $4,000 per visit so her son with intellectual and developmental disabilities, or IDDs, could receive routine dental cleanings under IV sedation.
She arrived to see Dr. Bryan Smallwood at the Marion County Department of Health expecting another operating room waitlist; past providers insisted that sedation was the only safe option.
Smallwood, D.M.D., M.P.H., C.P.H., a 2022 UF College of Dentistry graduate who focuses on treating patients with IDDs, asked to first evaluate her son.
“She cautioned me that he would need sedation and that he had never tolerated dental work without it,” Smallwood said.
But “never tolerated” meant no one had ever tried.
“I talked to the patient, explained each step and worked slowly” Smallwood said.
He completed a comprehensive exam, full radiographs and cleaning — no sedation. The visit cost less than $100 out-of-pocket.
For a mother accustomed to 10-hour round trips and thousands in expenses, it proved the barrier wasn’t her son. It was a system that never gave him a chance.
This is a familiar narrative. Families are often told loved ones with IDDs are “too difficult” to treat, funneling them to operating rooms, not because they need it, but because most dentists were never taught an alternative.
The Real Crisis: Everyone Tells Them Wrong
“Most new patients who come to my office have been told they need an OR dentist,” Smallwood said. “Everyone tells them this is the only way to treat patients with IDDs. Nothing could be further from the truth.”
In Florida, an estimated 470,000 residents have IDDs, according to the Florida Developmental Disabilities Council. Most will struggle to find a dentist trained to treat them.
Nationally, only 56 percent of adults with disabilities visited a dentist in the past year, compared to 70 percent of adults without disabilities, according to a 2024 State of Oral Health Equity in America (SOHEA) survey.
First-year UF dental student Lauren Mai wanted to know why.
Mai began researching barriers to care for patients with IDDs alongside faculty mentor Astha Singhal, B.D.S., M.P.H., Ph.D., as part of the 2025 cohort for the UFCD’s Summer Research Program.
She interviewed 15 general dentists across Florida and found 14 of them felt underprepared by their dental school training to independently treat patients with IDDs. She also found fear. Dentists worry about inadvertent harm to patients or staff, which reinforces their reluctance even when training opportunities exist.
“Most dentists reported minimal or no formal training on treating patients with IDDs in dental school,” her results reported. “This research identifies several opportunities within dental education and beyond to better prepare general dentists to provide care for this underserved population.”
Mai identified four strategies to address the crisis: targeted continuing education, early exposure in dental school, mentorship opportunities and systemic support. UFCD’s training and care model incorporates all four approaches; strategies Mai herself is now experiencing as a DMD student.
The Clinical Skill Is Adaptation
Of the 300 patients with IDDs Smallwood has treated in the past two years, only 17 required operating room care. That means 94 percent received routine treatment in a standard clinical setting because the provider knew how to adapt.
“The part that requires training is actively analyzing the most effective type of communication,” Smallwood said. “Some [patients] do better with pictures, others with numbers and some need to be shown everything step by step.”
It’s the same clinical reasoning dentists use to adapt to different clinical situations, for example when a patient has neck pain: adjust the chair angle and be careful with head positioning. Dental care for patients with IDDs just requires more adaptations, documented systematically, Smallwood said.
He logs those adaptations meticulously in his clinical notes.
“This becomes my recipe for success every time they come back,” Smallwood said. “I know what works and what has failed just by reading through my adaptations section.”
That said, he understands that sedation is sometimes necessary. Some patients with IDDs have medical or behavioral or other complexities that require it. But for Smallwood, those 17 cases, out of 300, prove sedation should be the exception, not the reflex.
He even bought specialized equipment when he first started treating patients with IDDs, assuming he’d need it.
“I’ve only used it a couple of times,” Smallwood said. “Most of my patients require nothing beyond what a normal clinical setting provides.”
The Care Desert Starts at 18
The problem for most patients with IDDs intensifies when they age out of pediatric care. Most pediatric dentists receive some training during residency to treat children with disabilities, but most adult dentists don’t receive the equivalent training, a recent CareQuest Institute for Oral Health article explained.
These patients lose access to equipped providers precisely when their oral health needs grow more complex.
At 21, Medicaid dental benefits in Florida expand for individuals with IDDs to cover crowns, root canals and extra cleanings. Yet many dentists don’t accept Medicaid, meaning coverage doesn’t guarantee access. At the same time, while Florida Medicaid covers medically necessary sedation, the co-pays and deductibles attached to facility fees, anesthesia and pre-op consultations are where families can get trapped.
These reimbursement gaps and limited provider networks mean families can still face out-of-pocket costs exceeding $4,000 per visit, as Smallwood’s recent patient anecdote proves.
UFCD providers like Smallwood underscore the population of 41 percent of adults with disabilities who don’t require any major accommodation, according to the SOHEA survey. They simply need a provider willing and prepared to treat them.
Smallwood credits his adaptation and communication-centric approach to Timothy Garvey, D.M.D., a clinical assistant professor of pediatric dentistry who has treated patients with IDDs through UFCD for 35 years.
He said Garvey is fond of saying, “Anyone can do my job; all they have to do is try.”
Recounting the mentorship he received while earning his D.M.D. at UF, Smallwood said Garvey follows that claim with examples of patients who were easy to treat but had long struggled to find care. Garvey he asks his students and residents intentional questions, trying to understand who they are and what motivates them as future dentists and specialists.
“The lesson [Garvey] doesn’t realize he’s teaching is that listening can be our most valuable method of understanding,” Smallwood said. “Combine that with tailored patient questions and you have a recipe for success.”
Smallwood and Garvey believe most dentists already have the foundational skills necessary to offer compassionate care for patients with IDDs; they just don’t realize it.
“The beautiful thing about caring for patients, IDDs or not, is that we have all been preparing for this moment our entire lives,” Smallwood said. “The hours we spent on the playground connecting with our friends, the time we spend communicating with those around us; all of that has given us the ability to pick up on all sorts of communication.”
A Strong Foundation of Statewide Impact
For nearly 40 years, UFCD faculty clinicians like Garvey have treated patients with IDDs in college-owned dental centers and affiliated clinics across Florida, training residents to do the same.
Advanced Education in General Dentistry residents train to serve this population at the college’s Hialeah and St. Petersburg dental centers.
St. Petersburg set out to treat 40 patients with IDDs annually when its Special Day Foundation partnership launched in 2010; now it averages over 100 enrollments each year. Meanwhile, in FY 24-25 alone, Hialeah residents treated 100 patients with IDDs.
UFCD’s NCF Pediatric Dental Center, launched in 2008 through a partnership with Naples Children Foundation, now serves as the training ground for residents who specialize in treating children with IDDs. Naples’ residents served 335 children with IDDs in FY 24-25, up from 294 the previous year.
Partnerships with the Special Day Foundation, CareQuest Institute for Oral Health and the Golisano Foundation have expanded reach and resources across all three sites.
Whitney Haley, a dental hygienist who received a University of Florida Gold Superior Accomplishment Award in 2025, organizes home-based care for patients with IDDs across UFCD’s Hialeah, Naples and St. Petersburg dental centers.
“Whether it is a lack of provider education, lack of financial support or lack of compassion… there is lack [among this patient population,]” Haley said.
One of the largest areas of “lack” Haley has observed among patients with IDDs is transportation access. Sixty-two percent of adults with disabilities cite this “lack” as an obstacle to obtaining health care, according to the SOHEA survey.
UFCD’s response to this barrier is bringing care directly to patients.
Haley’s home-based care coordination across Hialeah, Naples and St. Petersburg is one model. Another is UFCD’s work with the mobile clinic at The Arc of Alachua County, which delivers screenings and preventive care to adults with disabilities in North Central Florida.
“By combining offsite dental hygiene visits with caretaker education and doctor exposure, both for the doctor and the patient, we are decreasing ‘the lack’ and increasing access,” Haley said.
These models do more than solve a logistical problem. They challenge the assumption that dental care must happen in a dental office, just as Smallwood challenged the assumption that patients with IDDs necessitate sedation.
“I’ve seen patients who once needed sedation for routine care no longer need it,” Haley said. “And I’ve seen newly licensed doctors go the extra mile to provide complete, compassionate care.”
Scaling Care Capacity for Patients with IDDs
Since January 2024, UFCD has expanded hands-on training for patients with IDDs to predoctoral students. Ninety-two DMD students have rotated through Marion County’s clinic under Smallwood’s mentorship, with 10 more training at The Arc of Alachua County via UFCD’s mobile dental unit.
These numbers reflect an unmet need that UFCD has been able to satisfy. In 2023, before Smallwood and rotating students arrived, Marion County’s clinic treated 4 patients with IDDs. In 2024, that jumped to 74 patients. By October 2025, the clinic had already served 226 patients with IDDs, a more than 5,000 percent increase in just two years.
The demand was always there. The trained providers weren’t. UFCD’s newly announced multi-phase Dental Science Building renovation and addition project is the infrastructure that will support the college in continuing to meet that demand.
The 100,000‑square‑foot addition begins construction in August 2026, with occupancy expected in August 2028; renovation of the existing 11‑story dental tower is slated for completion in 2030. This historic work is backed by the largest investment the State of Florida has made in a medical science building at any state university.
“Our Personalized Care Clinic will be designed to deliver expanded, individual care for patients with intellectual and developmental disabilities including sensory adapted rooms that provide them a safe, welcoming environment that will be more comfortable and less frightening,” Dean Isabel Garcia said at the December 2025 groundbreaking event for the building project.
The building addition will also establish the Center for Integrative Oral and Dental Medicine where dentists, physicians and other health professionals can more effectively collaborate on complex patient cases.
“Those new spaces will enable us to do more for patients whose complex treatment is just not accommodated in their home communities,” Dean Garcia said.
Now and into this transformed era of Gator Dentistry, each DMD graduate and trained resident from UFCD becomes a provider prepared to serve these patients who other practices may turn away.
“We are already seeing this bear fruit as several dentists from last year’s graduating class are working in public health and treating adults with IDD daily,” Smallwood said.
Families are told sedation is the standard. Dentists assume they’re unequipped. But the barrier isn’t the patient; it’s a system that never taught them otherwise. UFCD is redefining it — one dentist, one student and one patient at a time.