Mikyla Smith flashed a luminous smile while having her teeth cleaned. She rested comfortably in an adjustable bed covered with polka-dotted sheets. While gloved hands busily worked inside her mouth, Mikyla watched her favorite episode of “Little Einsteins.”
Mikyla, 12, has Rett syndrome, a rare neurological disorder that renders her nonverbal and quadriplegic. Heading anywhere, let alone the dentist’s office, requires a significant amount of planning.
Mikyla’s mom, Annie Smith, must ascertain if the office building is wheelchair-accessible and if there will be a place to change Mikyla, who weighs 55 pounds. She also must remember to pack liquid food suitable for a gastric tube and her daughter’s seizure medication.
One time, Mikyla’s tooth got infected, and the dentist needed to sedate her.
“[It] came to be a huge project,” said Smith. “I felt like the time alotted that we needed and her comfort level was just not happening.”
With Kim Farrell, their traveling dental hygienist, both mom and daughter are able to enjoy the comforts of home.
“She’s like Mary Poppins on steroids,” said Annie Smith.
Farrell, who arrives at appointments with a portable 80-pound dental office in a suitcase, is a RDHAP, or registered dental hygienist in alternative practice. Her specialized training allows her to provide services to people who typically have difficulty visiting a traditional dental practice.
Instead of spending 9-to-5 in an office, Farrell is able to explore every corner of Orange County, servicing homebound and disabled children and adults, as well as clients in nursing homes and other 24-hour care facilities.
At just 11 years old, Farrell was entrepreneurial and interested in making some extra cash. She found herself a job raking leaves outside of a local dentist’s office. The more she learned about the work inside that office, the more fascinated she became with the dental hygienists. Eventually, Farrell received her associates degree in dental hygiene.
After working for several years in a typical dental office, she learned about a program in San Francisco that would allow her to work independently and help the neediest and most vulnerable clients. She jumped at the chance and, once licensed, began seeing patients in facilities and their homes.
“Within a couple of days of doing in it, I knew it was my calling,” she said.
In 2004, Farrell opened her private practice, Aliso Viejo-based Smiles on the Run.
Being an independent, traveling hygienist is physically demanding. Aside from lugging around her equipment, Farrell has had to learn how to position herself to accommodate a diverse group of client needs.
She’s worked sitting on the floor or bent over a hospital bed for hours. She’s worked on the mouths of those with uncontrollable, spastic head movements, as well as those with behavioral issues.
Clients have tried to bite her and steal her instruments. They’ve covered her in urine and feces. Instead of running from these situations, she takes universal safety precautions and prepares accordingly.
“I have folks who won’t open their mouths for the doctor,” said Robin Hodges, the owner of three intermediate care group homes in Orange County. “I was astounded the first time I saw her. I think because she loves this population, she’s not scared or intimidated. They just cooperate with her.”
Patients, regardless of ability level, are met with respect and dignity, according to the caregivers.
“She talks to my daughter just as if she was a typical 12-year old, which is how she should be talked to,” said Annie Smith.
And just like in many dental offices, Farrell lets patients choose something from a prize bag filled with DVDs, pens, sunglasses and necklaces.
“She’s beautiful inside and out,” said Hodges. “Of course, all the guys [in the group homes] fight to see who can go first. Then they don’t want to leave the room. They want to stay and watch her after.”
There is such a need for visiting dental services that Farrell is booked a year out for afternoon appointments, which also provide a respite for exhausted caregivers.
“Parents of special needs kiddos are running a marathon. We get really tired,” said Annie Smith. “You try to be a nurse, neurologist and cardiologist. But I just want to be mom.”