hello and welcome to navigate autism with jane lynn i'm your host jane lim britain and today you're going to meet one of the most charismatic dentist that you've ever seen or heard speak and he focuses on the field of pediatrics this is very important just think of it for yourself do you like going to the dentist is something that most of us are afraid of doing so how do you overcome that and take it one step further you have a child with autism that adds another level of complexity and i'm going to start by telling you my story my son william was four years old and i went to the dentist it was a fairly big practice and he's a toddler so that in and of itself is very difficult but add on to it autism they couldn't clean his teeth when they came to me and said that they needed to put him to sleep to clean his teeth and that was our only option i knew that wasn't going to work so what did we do we stop going to the dentist william is allergic to everything chemicals environmental things everything how could i say yes we're going to put him to sleep twice a year just to clean his teeth but i was afraid what do i do i wanted his teeth to be healthy i wanted him to be healthy so i prayed and i cleaned his teeth myself and then about five years later he started doing something really interesting he would go into the freezer and find the ice packs and hold it up to one side of us now and first i thought he was playing and then i realised he was doing this a lot and i started getting scared what do i do he's got a dental problem where am i going to go and i really so scared my husband had to call me down it was a saturday almost everything was closed and i was even more nervous because of that so i went to the internet and i looked up pediatric dental practices who focus on special needs and i found about five in my area and the advertisements looked really nice and calm and loving and supportive so i started calling everyone i call it was not friendly put me at the bottom of the list said maybe we can work you in later in the week and didn't really seem to care about me or my son i didn't know what i was going to do until i called the fifth one and that person stayed on the phone with me for at least twenty minutes not only assuring me that they were going to work me and on monday morning but really spending time with me calming me down giving me ideas of what i could do to help my son and i knew i had found the right place so he went in on monday and of course i was nervous and william was nervous but we got through it and we've been going there ever since and we have a fantastic experience so i knew that i needed to introduce you to the man who created this phenomenal practice d you you're welcome and now let me tell you about algebra so not only is he a dentist but he started off as a sixth grade teacher and then he was a science teacher and then an assistant principal and you can tell he loves children because as he became a dentist to them focused on pediatric pediatric dentist three he's also the chairman of the new jersey dental association and as if that's not enough he has started a pediatric unit with rutgers so you're very active in pediatric dentist and we're very grateful thank you thank you for having us here kids dental on their representative yeah what an inspiring story to hear you tell your story as one individual our practice has been dedicated from day one to trying to respond to the needs of the people that we serve years ago i heard that we should do want to others as we want them to do want to us and i kind of disagree with that because as a provider of dental care for children and their parents we believe that we should do want to others as we know they want us to do want to them because our practice dedicated to them it's not dedicated to us we want to do everything possible take care of the child and the parent and that's why we found that what it is today is not what it was in one nine hundred eighty when we started it has evolved it continues to evolve it's constantly changing to the meet the needs of our patients and that's kind of how we ended up taking care of autistic children i was going to ask you that and but before we do that could i ask you how you chose dentistry and you were in the field of education and then you went what led you to be a dentist well it was interesting i was teaching science i've always loved science i was working on my master's in physiology at night while i was teaching elementary school and working as an assistant principal and i actually met a lot of people who were going to medical school dental school pharmacy up the mala g because we were all in the same health care program and just spending time with inspiring people directed me towards dentistry because a number of them were telling me why they were going and i kind of fell into that feeling with them so never really had a plan in the first place and i counsel lots of young people and tell them you don't need a plan what you need to do is just keep going forward and make today a better day than yesterday and everything that you do and the end result will be that you'll find what you want to be and that's got to keep going i believe i was lucky i ended up in dentistry  i was really fortunate to pick pediatric dentistry i mean that to me was very powerful simply because of my background elementary education child psychology it had to be applied somewhere and i believe our whole approach to children's dentistry is founded on that education it really is because i look at it as a holistic practice that you have any you know most of what you heard me say was yes we took care of william but that was just one small poor right and it was mostly may yeah that got me over the hurdle and have told you that i do a lot of role modeling for him you know i want him to feel comfortable to let me do it first me feel comfortable and he can feel that yeah right and then he sees that yeah this is a cool place my lawn feels good yeah excited he relaxes and everyone thrives in the process so i had a faculty member years ago who said to me don't forget to touch to every two three or treating as a real live human being now we've learned that a touch that real life human being child there's a parent equally involved and we are caring and treating the entire family with every child that we treat and it's very important in fact i get most of my lead on how to manage the child from the parent i have questions that i asked i have a behavioral assessment concept where we interview the parent before we see the child particularly powerful with the autistic population because we need to know who that child is before we go near them so the first five or ten minutes of our meeting is parent to doctor and the child takes their time to acclimate themselves to the to the environment familiarize themselves with us and get used to us we don't get in their face in fact when we go into the room we sit on a chair lower than the child we don't want to be intimidating we want them to become comfortable with us as anybody with an autistic child knows they pretty much direct what's going on you kind of just assist a long the way but most of the time we let the kids get familiar with us while we interview the parents we get a whole lot of good information and then we can proceed with some guidance it's a really good way to do things it really is because you're creating that warm comfortable environment that you're building trust absolutely and to get them into that young where you have to help they need that trust from the parents yeah  written script concept of introducing yourself to an autistic family the part that involves a parent is referred to as the trust conversation it's very important that the mother know that they can trust you and and follow your guidance and go down the path that you wish to bring them towards success and health care for their child because it's a very complex world for all children not to mention children that are diagnosed with autism but every one of them is unique and requires their own custom tailored approach so that they can be successfully treated and that's kind of how we've evolved right they didn't teach me this in dental school that way and no i well i'm sure they did it because i the thing that really sticks out in my mind and i know you live it is you're asking the parent about the child because so many times we don't get that it's like i'm the professional i know my craft right let me tell you the best way to do it and we know so much i can tell you what will motivate william to sit in that chair and what won't you have and so when you're listening and your dentist listen it creates a successful experience yeah absolutely and my listening has been very beneficial i've learned so much from parents some of the children that we treat we need to give them a mood altering medication this is a mild sedative just to take the edge off not to put them to sleep but to help them deal with the issues that we have to deal with and sometimes it's a liquid sometimes it's a pill and i always asked the mother how do you give your child medications and one said give me a straw and she would put the straw in the liquid put her finger on top lifted up put the store in her child's mouth down the back of his front where there is no taste and down goes the liquid she had trained him with but she said i did it with fruit juice are mazing how people are willing and creative enough to come up with solve every issue that's necessary for their child the fact is i love area and you're learning and will every day gather yeah so what is it that led you to autism because i mean obviously you know a lot about children but i've seen how you actually take well i think a little bit different approach with the kids with audience thought that took some some inspiration and does and they are truly did inspiration desire and experiences some positive some negative but i can tell you this i graduated dental school in one thousand nine hundred eighty nine i specialized in pediatric dentistry and i specialized in dentistry for special needs children i never heard the word autism till the mid nineties i had already been practicing fifteen years before the word became part of the vernacular of anybody dealing with kids with special needs and so the evolution occurred at that time because i have a requirement to provide health care services to every child who comes in my office and i need to figure that out there's nobody but us that does that so i came out of dental school learning how to take care of teeth i learned after dental school early orthodontic care for kids behavioral management sedation dentistry more advanced concepts and that evolution led me to the point where i'm now allowed to provide all care to all patients in my office and that's been my driving force autistic children arrived in my office i am now obligated to learn everything i can about them and how to manage them and how to successfully deliver dental care and that's what we do well i love that you say obligated but i i see it as more you are you feel just inspired to do it and it's  want to be the best that you can you know and you're doing that through your love of kids i want to live in the best care i can tell you the most life changing experience in my professional development was learning to manage autistic children because everybody in my practice has benefited my staff is inspired and they're now champions for the cause my patients that come in are better served myself i learned so much from the autistic community that i apply it now to all patients because all patients have the same needs and they're all just at different levels everyone has unique communication systems verbal systems everybody has levels of pattern ism and repetitive behaviors and we kind of kind of go into that area and use that as a power to assist parents and children and managing their lives so that's been healthy for us every really is amazing and then the things that we i homeschooled my son for eight years and it's everything that i learned to do for him i have a daughter and when you think college yes i would kind of do it with her and it worked just as well there you go so it's really i think it's about how to connect with people yes how to understand that we are different we have individual needs and and  interest and things that work best and you're open to listen and learn and go with that as as a teacher of young children we learned early that modeling is the most powerful tool for children to learn and if you provide them with a really strong environment that is disciplined and directed towards goals children are going to by nature follow them very visual the very vocal and they're not very verbal and i find so many of my parents and this is really to the public out there trying to talk with words to explain behaviors to children and it's really a process that doesn't do well with young children because of the fact that they're visual and they're vocal it's the the tone of voice that you use it's the way you get caught up in what you're saying with them or directing them to that they pay attention to not the words so as a teacher we develop systems we call it tangible education get children to be physically involved with what's going on get them to be part all doing all kinds of fun jalen and you dress up for halloween i mean we dress up for everything you name it well that's good because it creates a fun loving environment one of the things that i think was really interesting for of systems that we use what is called t s d tell show do we tell them we're going to brush your fingers we show them the tooth brush and we brush their fingers it's very innocuous it's very simple and it's certainly not threatening and it is only a tooth brush however in the autistic community will frequently get a pullback now that doesn't stop us because we also apply the principles of applied behavioral analysis the a b a system of going one step forward one step back two steps forward one step back it's a progression leading towards a desired goal our goal is simple we need to get into the child's mouth we need to get in there and find out what's going on and we use that process to assess their behavioral response so we have a grading system we begin with the fingers we work our way through it's called gradual systematic desensitization it's kind of rapid the kids get it because they're used to it from school in most cases and we can rapidly go through the process of getting the child's mouth examined and their behavior assessed once we've done those two things we don't know what we need to do to make this child healthy and we now also know what we have to contend with and then we match that to the system of behavioral modelling is that we have available which range from simple things like just brushing their teeth and cleaning their teeth perhaps using a mouth prop to help open their mouth maybe using some light gentle wraps to control their arm and leg movements which they're very very comfortable with because they're out of control when they're not comfortable and we watch the kids relax when we do that maybe we'll give them some oxygen mixed with laughing gas to relax we can also use my of sedatives and we also have for the most advanced situations i of that's available in our office you don't have to go anywhere else in addition we have a very advanced orthodontic the provides early orthodontics and advanced orthodontics all the way up to adulthood and we can then provide the orthodontic needs that these children have as well based on their behaviors of course right and i think i remember talking to you earlier because i mean a fear of mine is what if william these braces and and he want to put a band a band a surface scan yeah what's he going to try to do with th but i remember you saying will start early yes and get used to different things in your mouth run different feeling and you build to that and you've had success we've had great success with children bringing them to the highest potential that they have within themselves and this is all kids the key is to start early and be repetitive and be pattern a stick and play into the strengths of children how that creation requires repetition you can't just say i walk into the dentist when my child's got a problem and now you need to fix it that's not that's a little too magical for me we need to be a little bit more systematic kids need early dental intervention just like they need early intervention for language and behaviors dentistry isn't required necessity of life so you need to start the kids early you need to keep coming consistently and you need to build on the strength of that with good luck we can provide orthodontic care but in many cases you can't and we know that that's not going to be a possibility so we have developed in kids then a unique approach to that when we identify that a child is not capable of having all those appliances in their mouth for two years with monthly adjustment turns and twists we go into a process called systematic extractions it's a sequence of removal of certain baby teeth that allow the permanent teeth to grow into the more correct position so we capture the force of nature in the growth and development of the child and we actually guide the permanent teeth into the right place over time interesting but the key for this you've got to start early you have to get into the program and you have to go through that sequence which usually starts around seven or eight years of age and finishes by age nine or ten by then the adult teeth are coming in into a better around goes around your head goes inside the mouth so as long as we can get a child to stand still tan by hook or by crook and we can also do it in stages where we do the right side and then the left side so we can do that in addition we now have a portable handheld unit so we can actually take the pictures anywhere you are in the building so we can see the child down at that site share with them and not be so threatened and we can put a film on the outside on this side and shoot from below here and get the picture on this side so they would like something they don't have to something i've been reading about blueberries we all know the blueberries are so healthy but did you know that live areas from maine actually help the brain but i've been reading is that they can help for alzheimer's not the big ones but the little tiny ones that you find in those lower bushes so when you look for them be careful don't buy the ones that just say blueberries remain in because they could be distributed from maine come from another country like canada make sure you get the ones that are grown in maine and i don't know about you it sounds pretty amazing and i'm definitely going to try what i've also i would love for you to share some of the things that you've done in your office to make it more sensory friendly because a lot of our kids can't handle the noise and run the lights and other people yes so you've got quite a few things we have done a number of things but it really begins with the phone call we have a script so we can ask the parent about their child so we can match them to where in the office we're going to see them some of our kids are totally mainstreamed in the typical population which a lot of peer parents desire that but we need to identify that on the phone so we can schedule them into a mainstream location others require total privacy with a very experienced practitioner to do the exam so we identify that on the phone now if somebody requires solitude quite away from the crowd we have a special separate part of the practice the totally secluded very quiet private waiting area and those children can be in a peaceful place we've also surrounded the facility with adaptive interactive games and toys we have been back shares we have squishy toys we have big games we have all sorts of things that captivate the minds of our patients and relax them and we learned about all of that from the world of autism you just have to go on amazon and look at all these things are adaptive toys for autistic children you'll see all of those types of things and they're very very beneficial and my guess what they are and occasionally might not be right but as long as someone speaks up and lets us know it goes into their permanent record and we're going to stick with that and follow that protocol because the reason we're doing this is because the behavior of the child is determined by that and we things that parents can do right now and they have a lot of videos on your website yes we do which is great yes showing how to brush teeth how to keep their arms down yes so could you share one or two things right now i can we have a brochure in our practice  and it's our special needs dental care brochure we realize that autistic children and specialized special needs child is at an increased risk for dental problems now one of the things we know is they're very or really sensitive consequently they don't permit brushing or flossing so we need to come up with tricks that help us get through that impasse because we do know this dirty teeth get cavities so we've got to get the teeth cleaned not just the outside of the teeth but in between them as well and sometimes that's totally impossible so how do you get into that area brushing a child's tooth you take a tooth brush you brush their fingers you brush their front teeth no toothpaste just a wet brush you see how far you can go there are fluoride rinses that you can buy that are all different flavors you can dip the brush into florida or insensitive to face and brush but i can tell you this you can brush your child's teeth with chocolate syrup and clean them very very well because it's not the syrup that causes the cavities it's not the sugar it's the bacteria on the teeth so if there are flavors that your child likes that's a great way to introduce yourself into brushing by making it seem as if you're actually giving them something they like i never knew that if you convert that into mixing some fluoride with that substance you know giving a florida i did for a dated flavored homemade paste that the child likes because we need the teeth scrubbed get those teeth scrubbed that's key if you can't get past that then we recommend that you keep the sugars out of the mouth because the bacteria on the teeth are eating the sugar that's what causes the cavities so that's something that a parent can control and to me that's where we really have to get into caring for kids the only drink that should go in their mouth is water and it's interesting a child is supposed to get fifty percent of their weight in ounces and water per day so one hundred pounder is supposed to get fifty ounces taking an eight ounce glass what's out about seven glasses of six or seven glasses of water a day that's a lot of water that's what it does it helps your immune system right it causes your gut it reduces weight gain and it takes away hunger and it takes away appetite in between meals so we need to get into the old world of how people ate when they were really healthy and not live in the world of our modern sad american diet the standard american diet so break away from liquid sugars break away from sugar snacks we have a lot of parents who leave little plastic containers of different healthy snack foods around the area where their child plays or spends their time you could put cucumber slices grapes carrot sticks sliced apples and just leave them there don't say a word to gravitate to snacking healthy snack that's how you do it so these are some of the things now another item is that we find a lot of parents are afraid to take their child to the dentist because of your preconceived beliefs about how that child might behave bring them to the dentist will help you deal with that you will get you over that and get you into a real approach to caring for your child that is key i love that i wish we had more time but we know now there is so much that you can immensely and thank you not for what you're doing with navigate autism which is amazing but for welcome me on board your ship and taking me on a journey to where we all need to know we have to go we need to care for others that's the best thing you can do in your