Dr. Caren Cajares is a CRNA currently practicing independently in the seven cities that make up
Tidewater, VA. She provides anesthesia services for plastic surgeons, gastroenterologists,
ophthalmologists, oral surgeons, and partners with a dentist in a specialized practice. She is a
veteran of the United States Army, which she includes among her greatest accomplishments,
along with her marriage, motherhood, being a grandmother, and her anesthesia career. Prior to
becoming an anesthetist, CC's passion were her NICU, PICU, and ER patients. It was on a shift
in the ER where she met her husband and business partner, Carlos.
Together they have raised 2 sons and one daughter who is thriving even with her diagnosis of
Autism and complex medical issues. Their partnership in life and work and passion for
advocacy and care of the intellectually disabled, has led to the development of The Dream
Center, LLC. This is the only free standing office based dental sedation clinic providing services
exclusively to the special needs community in the seven cities. In addition to the intellectually
disabled, she sees patients with chronic pain, anxiety, autism, Alzheimer's, PTSD, CP, and rare
syndromes that prevent the patient from undergoing routine dental care without sedation.
CC's love of dogs and quest to transform stressful appointments for her dental patients to a
calming pleasant experience led to animal assisted therapy research during her doctoral work at
Old Dominion University in Norfolk, VA. This work earned her the ODU advocacy award, and
has garnered requests for presentations of that work at the national Special Care Dental
Association (SCDA) meeting in Denver, the international SCDA meeting in Chicago, a poster
presentation at the Eastern Nursing Research Society, and panel discussion at the Emswiller
Symposium for inter-professional collaboration at Virginia Commonwealth University in
Richmond, VA. This research was published this year in the Journal of Intellectual Disability
Diagnosis and Treatment.
Currently, CC and her partners are continuing to perfect the inter-collaborative practice model,
"The Cajares Model of Advocacy and Inter-professional Collaboration ©, which they've
presented to stakeholders in Virginia for the Department of Behavioral Services. The model is
being piloted at other special needs practices throughout the state.
Abstract: Purpose: Individuals with intellectual and developmental disabilities (IDD) suffer from poor oral hygiene and periodontal disease that may predispose them to systemic diseases. In order to receive dental care, the assistance of a certified registered nurse anesthetist (CRNA) is often needed. The role of the CRNA is to provide sedation to reduce the high level of anxiety demonstrated by many individuals with intellectual disabilities in the dental suite. However, this can become a challenge with patients that are anxious when they arrive. The purpose of this paper is to describe an interprofessional dental team that added a certified therapy dog and handler to reduce anxiety of individuals with IDD when they arrive in the dental suite.
Methods: A convenience sample of 30 individuals with intellectual disability seen for dental care in an outpatient setting met with a therapy dog prior to receiving preventative dental care. Comparisons were made between observed anxiety levels and behaviors measured by the ADAMS (anxiety scale) and a researcher-developed behavior tool prior to and after the interaction with the therapy dog.Results: This program suggested that the addition of the therapy dog to the interprofessional team prior to sedation decreased anxiety levels and improved the behavioral outcomes of the individual with intellectual disabilities.
Conclusions: The incorporation of a certified therapy dog and handler as part of an interprofessional healthcare team in the dental suite may pay great dividends in improving the compliance and comfort of the individual with intellectual and developmental disabilities during dental care visits.