When Dr. Mary-Ellen Cascone describes her work at Sinai Health, her enthusiasm is palpable. As head of the Special Needs Dentistry program, Dr. Cascone is renowned for her remarkable dedication and compassion in her care for patients.

The Special Needs program is an integral element of Sinai's Department of Dentistry, which has stood for the past 50 years as the only centre of its kind in Ontario. Adult patients with complex and high-risk medical conditions, disabilities, trauma, rare or difficult-to-diagnose conditions, severe oral disease and chronic orofacial pain are referred from across the province for our unparalleled expertise in oral and maxillofacial surgery, emergency dentistry, oral pathology and more. In total, we treat nearly 20,000 patients annually - one of the highest volumes in Canada.

Among those patients is Novelette, aged 38, who battles the challenges of Epidermolysis Bullosa, an extremely rare and complex medical condition that causes the skin to be fragile and to blister easily. Tears, sores, and blisters occur when something rubs or bumps the skin — including inside the mouth. "It's like my body doesn't produce enough of the glue that holds skin together," explains Novelette. She is grateful for the dental care she has received at Sinai since she turned 18. Dr. Cascone's thoughtful approach, from applying Vaseline on instruments to innovative positioning, ensures her comfort during dental visits, a rarity for patients with her condition.

"I have known lots of people with this condition over the years who have lost their teeth in their twenties because they didn't have adequate dental care," says Novelette.

Similarly, 35-year-old Sotiris, who exhibits involuntary movements due to Huntington's disease, presents unique challenges that many dentists would be too intimidated to address. Dr. Cascone's unconventional but effective techniques, such as engaging Sotiris in a playful "dance" during treatment, have made all the difference.

"Sotiris was originally referred because he needed a filling. But using anaesthesia is dangerous because, due to his motor issues, he has no ability to protect his airway," says Dr. Cascone. "I decided to try doing a little bit of a dance. I said 'When you stop moving, I start drilling. You move and I'll stop.' You know, we fixed that tooth - no problem."

Despite the demanding nature of their cases, Dr. Cascone and her team persist, offering unparalleled support and expertise to patients and families. Reflecting on her experiences, Dr. Cascone shares, "People think I have a magic wand. I clearly don’t. I just do whatever is needed - even if that means crawling into the backseat of a car to help a patient who is terrified of the clinic." Treating patients with special needs means constant improvisation to offer compassionate care that meets the person and their family where they are.

This unparalleled patient-centred care and flexibility is evidenced by a multi-year waitlist of patients desperate to access its services. Enhancing its capacity with new initiatives like the Special Needs Dentistry Fellowship are critically important. Training the next generation of dentists in these specialized techniques and strategies will ensure more patients can receive the care they deserve at Sinai and beyond.

As Dr. Cascone aptly states, "It's such a wonderful program. All we get are thanks from the families who have waited so long to get in because now they can finally be taken care of."

How you can help

Today, Dentist-in-Chief Dr. Michael Goldberg is leading this vital national resource into the future. But with soaring waitlists, sustainable funding is key to advancing our groundbreaking care, research and training capabilities to help meet the colossal need. Join us in our mission to ensure a place where all patients receive the dental care they deserve.

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