Autism and Accessible Dentistry

Dennis Dunne, DDS, and STAR trainer (and parent) Julia Rockwell share stories and tips on dental care for children on the spectrum.

Transcript

00:00:00 Johnandrew Slominski 

Welcome to this episode of the Autism Annex Podcast. I'm your host, Johnandrew Slominski.  When was the last time you went to the dentist?  A recent report by the Cleveland Clinic estimates that nearly half of us have a fear of dental treatment. So if you've been putting it off, well, you're definitely not alone. 

00:00:25 Johnandrew Slominski 

It probably comes as no surprise, then, that this statistic is even higher among children with autism. My two guests today bring personal and professional perspectives on how to best support children on the autism spectrum when caring for their dental health. And all of this starts well before the first visit to the dentist's chair. 

00:00:48 Johnandrew Slominski 

Dr. Dennis Dunne and Julia Rockwell, welcome to the podcast, and thank you both for being with us today.  Doctor Dunne, I'd like to start with you.  Tell us a little bit about your dental practice here in Oregon. 

00:01:03 Dennis Dunne 

So yes, I'm Dennis Dunn. I am 27-year clinical practitioner in pediatric dentistry. I got my undergraduate degree at Creighton University and Dental school and then went on to specialize in Pediatrics at Texas A&M and Baylor. I have been in a partnership practice for about 8 years and then I was solo for the remaining time and I practiced here in Eugene and have been here really since I began. 

00:01:32 Dennis Dunne 

And I see all children, and we just provide overall comprehensive care, dental care, oral care for the community here in Eugene. 

00:01:44 Johnandrew Slominski 

Julia Rockwell, I want to bring you into the conversation here. You're a trainer with STAR Atuism Support and also the mother of Abby, who's on the spectrum. Abby isn't with us on the podcast today, but her story is a big part of this conversation.  Could you introduce Abby a little bit? 

00:02:03 Julia Rockwell 

Yeah, well, she loves going to Doctor Dunne's office. Now it's a celebration. She's 15. We started our dental journey when she was three years old. She was diagnosed with autism and two at 2 ½.  We call her well, when we refer to her autism, we say she's wonderfully autistic because she is just wonderfully autistic. She loves to jump. She loves Disney. I always joke that I'm raising a Disney adult because she is a Disney fanatic and I just want to share that she is a joyous and very social and a joyful person to be around. She loves the Oregon ducks. So for a long time, she was all about the Oregon Ducks. So she had Oregon duck, you know, everything. And she was really into puddles and that kind of transitioned into Donald Duck and Mickey Mouse and things like that. So that's her favorite.  She will make little play characters of Disney characters.  She draws amazing. You know, the Disney Castle and things like that. So she's very much into art and things like that. 

00:03:27 Johnandrew Slominski 

And Abby, if you're listening, thank you so much for letting us learn from your experience. Julia, you mentioned that Abby loves going to Doctor Dunne's office now, but there's a lot more to this story in terms of getting here.  How did you connect with Doctor Dunne initially? 

00:03:46 Julia Rockwell 

When she was three, I knew when children hit three I need to take them to the dentist. And so the obvious thing to do would be to get online, which I think at that time I was like, on Myspace, which, like, will really date how old I am. I think it was like a Myspace moms’ page and I was kind of poking around to see if anybody knew of any dentists that had worked with children with special needs, and Doctor Dunne's name came up.  And then also, I got from other moms that I was going to a parent toddler class, and they also recommended Doctor Dunne.  And so I called him up and made an appointment for Little Miss Abby May. 

00:04:39 Johnandrew Slominski 

So, take us back in time, if you would, to when Abby was three.  What was that first visit like? 

00:04:48 Julia Rockwell 

Oh man, I was actually reflecting on this earlier today. That first visit with Doctor Dunne, and I remember we couldn't even get her to sit in the chair, like that was the hardest part. It was like, just please sit in the chair so that that was like what our first visit was like. So finally, I got her to sit on my lap and I was able to like, hold her hands and she would put her head back. And then Dr. Dunne could get a little look in there. But that was like, as far as we could go with that first visit, you know, because of the fact that Abby was not ready and it was a big wake up call to me as like, whoa, we have a lot of preparation to do prior to visiting the dentist again. 

00:05:36 Julia Rockwell 

And the tricky part about going to the dentist is they're not things that happen every day, right? They only happen twice per year, typically for children. And so, we have to practice, right every day or, you know, insert this practice somehow into their play into their daily life to make it, you know. So it's not so new and big and shocking and scary for them. But her first visit, I will admit, was I I felt like it was disastrous. I don't know if Doctor Dunne remembers it, but I felt like it was disastrous. 

00:06:21 Dennis Dunne 

You took such an integral part in that first visit and you know, we know children with autism, they'll have a greater chance for having cavities, and they just typically will not do that very first, “Hey, let's look in your mouth.” Depending on how severe, and in Abby's case it was, it was a little more severe, and it was really nice to have you there and to be able to hold her and to be with her because that was a specific need for her. She really needed that.  And the familiarity of having her mother there, you know, that ends up being important for transition in the dental office too, because there's so many elements to her process. There is so much in the dental office, the sounds and the smells and you know the sights. 

00:07:14 Johnandrew Slominski 

And as you point out, all that sensory input can just be a lot to take in. With that in mind, what are some things that you've found helpful in your practice when it comes to making sure that parents and caregivers, as well as the children are prepared and as safe and comfortable as possible with the process? 

00:07:34 Dennis Dunne 

Yeah. So one of the most integral elements to children being able to transition to the dentist is really the desensitization. And like Julia said, you know, doing the role-playing and modeling some things and seeing videos and, you know, all of those things. And each child is really specific. And the parents really know that one of the greatest things I learned in a residency is, you know, you think you know everything, but really parents know everything and they're familiar with their child, and that is absolutely the case with Abby and Julia. Absolutely. And so, I typically will let parents take over because as you can see, Julia was really good about kind of modeling some things. And then this process changes and evolved. I've had children with Down syndrome where I actually was doing a filling because the child was so afraid of getting in the chair, and so I had them sit in the chair with the mom and I moved all my hand pieces over to where the child was sitting. And we used a little bit of oral sedation before he came in and I repaired his front, the fracture on his front tooth sitting in just a regular chair, not even the dental chair. And by the time he graduated my practice, you know, he was showing us the dances that he had performed, you know, at the school talent show his senior year. So it was, it was, it was night and day. And children, you really kind of play it by ear you see these massive changes, and especially with children with autism. Absolutely. They're they getting in the chair and having a mirror in their mouth, as you can see with Abby's scenario, that was difficult in the very beginning. But as they become familiar with the environment and trust because Julia was trusting us and we trust that the process is going to actually pan out over time, then eventually she can do some things that you know previously she couldn't. An I honestly, I also think that there's an element of experience that that kind of plays a very important role in this because if you, if you see enough of the population with children with special needs, you really learn from parents and families. And so to come to the dentist the first visit and feel like, OK, this is a safe place and these are some things we're going to do that you're not really familiar with and then to see that progress as time goes on, it's wonderful. It's the greatest thing. And I just think the experience of being around Abby and kind of being familiar with what her needs were and and feeling really good about it and feeling like she's safe. You know, Abby, the very first visit is, Oh my gosh, it's a victory if we get in the chair or we have the mirror in her mouth and I can actually see it. 

00:10:19 Dennis Dunne 

So getting to your question, children on spectrum, there's so many different things that we're looking for, but specifically you know development and making sure that we have all of the teeth that there aren't any issues. So being able to see a visual is very important. So what happens if you can't so? 

00:10:39 Dennis Dunne 

That then goes back to the hey, maybe we can desensitize before we come. And that's how parents can prepare their children. So, you know, even getting a pair of rubber gloves, non-latex rubber gloves at the grocery store and just kind of moving your finger on the outside of the teeth between the cheek and the teeth and just doing that like three times in each quadrant and then doing it repetitiously. Well then it becomes a little easier. Or in the case of Abby, if we have home care where we're actually brushing well, sometimes the children will come and they'll brush and you can use a dry brush or just water because fluoridated toothpaste or toothpaste all by itself might be difficult for children on spectrum. They might have an aversion to taste and flavors, and so just using water is sufficient. It's kind of funny. The studies have shown that that fluoride is not necessarily (fluoridated toothpaste) is not significantly different from, you know, 80% cleaning with water. So if you have children that really have an aversion to toothpaste, well, then you can use that as an alternative. Just water or dry brushing. 

00:11:47 Johnandrew Slominski 

You've also been really intentional about the environment of your dental office, the physical space. Tell us a little bit about what we'd see if we paid you a visit. 

00:11:59 Dennis Dunne 

So, when I went solo in 2006, I designed my office a certain way so that I would have rooms that were carpeted. So, it wasn't a sterile environment and we had color. And then I tried to bring in artwork that would be a little bit more kid friendly, you know, Doctor Seuss art or some other local art that we have. And so, kids would feel more familiar. And it's interesting because I moved my office in 2014 and I redesigned the office with the very same carpeting, the very same chairs. This very same coloring of the walls. 

00:12:33 Dennis Dunne 

Julia knows because she was with me at both offices and I tried not to change anything because of my children that were on spectrum because they have to have that familiarity to make a transition, otherwise it would be a whole new experience for so many of these children.  And I have not designed this office specifically around just Pediatrics, but more so around children with spectrum or on spectrum. 

00:13:01 Julia Rockwell 

I want to say a little bit more about the environment that Doctor Dunne has created. So, when you walk into his office, he has a little tiny door for his tiny humans, which I think is adorable and it's welcoming. You know what I mean? So, you see a lot of even the big kids use the little tiny door and then, you know, there's color, but it's not like overwhelming sensory wise. His waiting room has, like, these really cool, like retro arcade games in it. But it's also partitioned off, so if they bother, you know, some of the patients there, you know the sounds and things from those arcade games, they're partitioned off. So, they're not as loud, which is really helpful. After the pandemic, Abby really struggled. Or during the pandemic, Abby really struggled going to the dentist because everything was scary then, and I remember it took a lot to get her up that elevator and into the this, and I remember the dental hygienist coming out and she offered Abby a pair of sunglasses and told Abby she could wear I I think she wore a hat over her eyes too, and the dental hygienist was like, that's cool, girl. Like, come on, come on back. 

00:14:25 Julia Rockwell 

And so all of the patients wear sunglasses, which I know is for safety, but also for sensory wise that can be really helpful with all those lights and things like that. And then also those offices have, or he has like individual treatment rooms. So, I remember Abby for the longest time was in one of those individual treatment rooms because it was too hard for her to be around all of the other patients. And eventually we were able to transition her into the big room where all of the other patients were being treated. So, she's made these huge gains. But I think it really was the environment that Doctor Dunne and his staff have set up and also just they, the way they approach each patient is just with positivity. There's lots of reinforcement, like every time they go and get their visit done, they get a little gold coin that they get to go and pick out a prize. From this like, I don't know, it's like a what are those called?  The treasure chest. Treasure tower. Yeah. So it's just thoughtfully done. Sensory wise, it is lovely and wonderful. So I just want to give a lot of gold stars to Doctor Dunne and his thoughtfulness in putting that all together because it's just very well done. 

00:15:54 Johnandrew Slominski 

Julia, I know that when Abby was little, you did a lot of creative things to help prepare her to see Doctor Dunn for the first time.  What did some of that look like? 

00:16:05 Julia Rockwell 

When I look back, when she was young, young, so she was three, we did a lot of sensory play with, like, toothbrushes. So we were like painting with toothbrushes. I let her brush my teeth like we were being really creative. And, you know, incorporating a lot of like, play dough, I don't know if you all know that like play dough, like dentist, Doctor Dunn probably knows what I'm talking about. But you, like, make little imprints of teeth and they have little dental tools that you can like, you know, clean the teeth and things like that. So I’d try to think of a lot of sensory based activities and play based activities to help just expose her to it in a really positive way. 

00:16:56 Julia Rockwell 

And I also found this was very successful with my students as well when I was a teacher for quite a long while and I had a whole month that was just dedicated to going to the doctor and the dentist because these are such important things for our students to learn in early childhood.  I'm thinking, you know, three to five, like that's kind of the age that we want to target to start working on these routines. 

00:17:24 Julia Rockwell 

So I always started with the play and then we also we sang songs. We also watched videos on YouTube of other kids going to the dentist and them having a really positive experience and things like that. For Abby, it was always helpful to do little mantras. So I would, you know, always tell her like it doesn't hurt, you know, they're just going to look, you know, so giving little bunches and saying it over and over again. And. And as she grew older and started attending to visual supports and social stories or social narratives and things of that nature we kind of, you know, grew and grew each step of the way and recently (I shouldn't say recently) but I think like a year ago she had a cavity and prior for her, doing it without sedation. Prior to that, everything was sedated, like as far as like dental work, right? Like if she had to have a cavity fill or anything, we had to do sedation. And Dr. Dunn turned to me. And he was like, he's like she has a cavity. And I'm like, OK. And I'm like, I have my phone. 

00:18:42 Julia Rockwell 

I'm like, I'm ready. Like, what do we need to do to go? And was a great celebration because he was like, no, she's ready, is what he told me. She's ready for a non-sedated cavity fill and he was absolutely right, much to my surprise. So it was really nice to get that little bump from Doctor Dunne to be like, she's ready, Julia. 

00:19:06 Johnandrew Slominski 

You've both given so many wonderful tips for parents and caregivers to consider, and I wanted to ask you, Doctor Dunne, what suggestions you'd have for other dental professionals if they're looking for ways to make their practice more inclusive, to serve children with special needs, including autism. 

00:19:26 Dennis Dunne 

The advice I would say is listen to parents and as Julia was saying, you know, parents know—they literally know everything about their child. They've been with them since birth. They've watched them change, they know what their needs are, and it's good to understand that first and have a consultation with parents before they bring in that child. 

00:19:48 Dennis Dunne 

And maybe have a discussion on the phone and if they've decided they want to bring their child to me, we'll have a conversation before and say, what is it that that they like? Ohh. They like blue? Well then blue is something that I'm going to focus on. I have one patient in particular who has a blue blanket and loves to twirl this blue blanket and has a little stuffed animal. He will hit this stuffed animal with his blue blanket as he's whipping it down the hall and I don't know how he does it. I think he's amazing and fascinating and he's completely nonverbal. But I know that whenever he's here, that's what we have to focus on the stuffed animal and the blue blanket. Oh, and by the way, I'll do an exam when he's here. So yeah, that would be, that would be my goal. Have the conversation with parents. Become familiar with this community and all of the uniqueness, you know, it's called spectrum for a reason. 

00:20:47 Johnandrew Slominski 

We've talked about how important it is to start kids on the path to healthy teeth really early, and that extends to Pediatrics in general, but for some parents, there are some significant barriers to accessing that care, whether that's financial or an insurance issue or just the act of navigating the healthcare field with their child. What resources are out there to help and what would you recommend? 

00:21:15 Dennis Dunne 

You know, I just wanted to add, there are some parents that have children with special needs and they're wondering where they can because from a dental perspective, I feel like parents need to understand that it's good to get to the dentist, but sometimes they don't have the financial means.  In Oregon, you know, there are various avenues that parents can take to get funding for their children.  And I hope that parents don't neglect that because they just don't have the financial means. And in my office I, you know, I don't care either way. I would—I would rather have the children come and be seen because if that ends up being a priority over having their child receive some sort of dental care or medical care for that matter. Then there are solutions. 

00:22:07 Julia Rockwell 

So, I know in the state of Oregon it's developmental disability services. So DDS is what can connect you to access you know the insurance you know, even if you're over income for it. So some parents might find some relief there. Not all states work the same. So, the best thing to do is to call the disability services in your local county to find out, you know, what services are available for their child. It can access a multitude, just multiple services to help your child at home as well with the medical and dental related things. So yeah, definitely look into your developmental disability services for your county would be the best way to look for that. 

00:23:02 Johnandrew Slominski 

Julia, you've given a ton of insight as a parent, and putting your teacher hat back on for a moment, what final thoughts do you have for educators to consider around preparing students for the dentist and maybe even other community routines? 

00:23:18 Julia Rockwell 

Yeah. One thing that I forgot to mention during when we were talking about teachers that I don't want to get off and not say is the use of visual supports and the importance of visual supports and video models and things like that. That was a big part of my teaching. It was a big part and I kind of left it out because I'm like, oh, it just comes with it, right. Like, I know to use it, but not all teachers know to use those supports. They're very important supports to use for parents and teachers and teaching routines so access those. I believe that STAR is going to have some put together specifically for the podcast. 

00:24:04 Johnandrew Slominski 

Well, I'm actually really glad you brought that up, because we do have new resources that will be available in this month's newsletter. And that actually includes a video model specifically for brushing teeth. 

00:24:17 Johnandrew Slominski 

Julia and Doctor Dunn, thank you so much for being with us today on the podcast. 

00:24:23 Dennis Dunne 

Yeah, I'm so grateful. And honestly to both of you, I really am appreciative of this in disseminating the information. It's great. 

00:24:32 Julia Rockwell 

Thank you, Johnandrew; thank you Doctor Dine. 

00:24:36 Johnandrew Slominski 

And a special thank you to Abby for allowing us to share your story. 

00:24:42 Johnandrew Slominski 

As Julia mentioned, this month's newsletter from STAR Autism Support includes some great free resources, including a social story on going to the dentist, visual supports, and a toothbrushing video model. Be sure to check your inbox if you're a subscriber, and if you haven't subscribed to the newsletter yet, visit starautismsupport.com and click on newsletter signup at the top of the page. 

00:25:10 Johnandrew Slominski 

Thanks as always for listening to this episode of the Autism Annex Podcast. I'm Johnandrew Slominski, and until next time, take good care of yourself and one another.