SPEAKER_02 0:29

Hi, this is Dr. Estee Hess. And I am Dr. Ann Kirsch. And welcome to once again On and Off the Spectrum Podcast. This is an interesting podcast because we reach out to families who are generally responding to life-altering diagnoses either for themselves or for their families. And we hope to create practical strategies for moving forward. One of the practical strategies that I think tonight we have two very special guests to address the concern when you have a child with special needs, there's often something called sensory sensitivity, and that could be under or over-reactivity to sensory experiences. One of the major milestones that can create sensory sensitivity or reaction to is going to the dentist. And so we have uh two wonderful clinicians, uh Dr. Michael Kleiman and Dr. Bernard Gross, who are going to be talking about their experiences in terms of how they treat uh the special needs community, all the way from a pediatric physician into uh the the general lifespan. And uh I wanted to introduce you both and say welcome and thank you for coming on our program.

SPEAKER_00 1:52

Pleasure. Yeah, great to be here.

SPEAKER_01 1:53

Yes, this is going to be very exciting for me because I was one of those kids who hated going to the dentist. And I was determined that when I had children I would make it a different experience if I could. And and I did, and the dentist did. So it's a lot it has to do with the dentists.

SPEAKER_02 2:16

So we're going to be talking about a bigger theme of phobia in terms of you know how much for a neurotypical child that has to go to the dentist for the first or you know, fortieth time, as it were. Um, and uh even more so for those who are neurodiverse. But the first thing I thought we would do is get both of your stories and find out how did you choose dentistry to begin with, and then how did that veer off into working with a special needs population? So who would like to go first? Uh uh Dr. Gross, Dr.

SPEAKER_03 2:54

Climber. I can go first. So um please. You know, um I was born in South Africa and I moved to the United States when I was 14 years old and finished high school here. And my whole life that I could ever remember from day one was I wanted to be a doctor. Um I'm not sure if it's because my parents wanted me to be a doctor or I wanted to be a doctor, but I always loved um science and chemistry and um bugs. And um, so that's kind of what set my my path. Um when I went to UCLA, I was pre-med. Uh I was a biology major, took a lot of really real biology classes. I took plant physiology, I took a lot of ichthyology, um, and I was on the pre-med track. Um I had a very close friend who I met on my first day of high school in 10th grade, um, and he um wanted to be a dentist. His um grandmother was one of the first dentists in Israel. Um, his mother was a physician, his father was a PhD food engineer. Um and I went with him to a clinic one day when I was about um, I think my second or third year of college. Um it was an LA free dental clinic, and I was assisting a new graduate from um Georgetown University Dental School, and he was doing oral surgery on extracting teeth, basically. And I was like, wow, I was I just got me very interested in dentistry. That's where my path changed from wanting to be a physician to wanting to be a dentist. And honestly, it was just that one experience that really made me, it opened my eyes to what dentistry was about. So that's how I got started in the direction of being a dentist versus being a physician. When I applied to dental school, um I sort of did a shotgun approach because I applied to a lot of dental schools. Um, and one of the schools that I interviewed at was in Richmond, Virginia, where I ended up going, the Medical College of Virginia. And the Dean of Admissions, Dr. Marshall Brownstein, who actually ended up being a big mentor for me, was a pediatric dentist. Um and he also had family from South Africa, so he and I connected right away. And he always encouraged me to look into pediatrics as a specialty. Um, when I was uh between my second and third year of dental school, I did an externship um in an area called the Delmarva Peninsula, which is where Delaware, Maryland, and Virginia all come together. And I worked on migrant farm work as children for three weeks, with me and two friends and a dentist who was barely there. And that's really what piqued my interest. And from then on, I wanted to work with kids.

SPEAKER_01 5:36

And um that's a wonderful, that's just wonderful background. Thank you so much. And Dr.

SPEAKER_00 5:43

Michael My story is a little bit easier because Dr. Gross got it started for me. Um I also always wanted to be a doctor when I was a kid. I don't know why, but I did. And uh Dr. Gross is my uncle, and I used to go to him as the dentist. And uh over some time he said, you know, I think you really like what I do. So um I spent a summer in high school shadowing and interning and observing the office, and I said, Well, I love this. I just saw all these kids coming in day after day, just having a good time, and the staff had a good time, and it was such a positive, nice environment to be in. And I said, you know what, Uncle Bernard, I think you're right. I think this is gonna work for me. So from then on, I just went straight through. I went into college and dental school, and I always, you know, had a tendency to pediatrics after that. Um and I went with open minds to see what else in dentistry interests me. But every time I went to the pediatric clinic for a day, I came home, I said to my wife, I said, Holly, I'm just happy today. This just really worked for me. And um, I just decided to apply to pediatric residency. And now, you know, fast forward many years later, we're we've been partners for over 10 years, and uh we get to work together, and our office is still positive and fun. And it's just we get to really take these these kids and start them off with such a good experience, and and it hopefully will last them their lifetime. So that's what makes me excited about being a Patrick Dentist.

SPEAKER_01 7:16

I wish you'd you had both been my dentist, and yeah, that would have worked. You had a good Dr. Gross was a good influence, it's a wonderful.

SPEAKER_02 7:25

I like that. And I'm originally from Maryland, so I I and I know that delta area that you speak of. And so I'm I'm appreciative of the work that you did with migrant children. And it is one thing to deal with little kiddos, um and even something else to deal with children with special needs. So um it's not for the faint of heart. I I will tell you. I will tell you that over my years as a specialist in autism, I have worked with kids who are so highly defended. Uh the phobias are so entrenched that either they uh have to be sedated uh to actually get any kind of dental work or they refuse. I have uh uh a young woman who I'm working with now who has uh she's now in her probably close to 30, and she has never gone to the dentist. It's just too frightening for her. At the same time, she's got a lot of pain and and you know, probably an impacted multiples of wisdom teeth and so forth. But um and then it's like here you go. So I actually asked a colleague to do me a favor and take a look at her, who was not a specialist as you as the two of you are in the context of a special needs community. And uh you know, he he tried to work with her very positively for a short amount of time, and then basically uh you know called me and said, you know, no can do. This is this is out of my my wheelhouse. This is not really an area where I can make uh a lot of headway other than to say to her she better brush her teeth. But um these kids are so highly defended uh against what they perceive as oral uh invasion, you know, as as it were. How do you approach how did it move first off from a general pediatric population to a special needs? And then also how do you differentiate between because I also know Dr. Gross, for example, you treat children all the way through an adult population, and does that change uh in the context of your techniques and and so forth? Because I think a lot of parents are desperate to try to do the right thing, sure make sure that their kids are being seen by a dentist and get stymied over and over again.

SPEAKER_03 9:49

You know, um for me, because I've been doing it so long, um, a lot of my kids that I would see at one and a half or two, three years old are now 30. So they've kind of grown up with me. Um, I don't think that I, you know, if I were to see a patient that was 30 that had, you know, significant adult needs, maybe out of my wheelhouse too, in a way. Um I think one of the things that really helped mostly is getting the patients in to see the dentist early on. Because I think that you could you can begin a process of systematic desensitization. Um these children are very I I call it orally defensive. I'm not even sure if that's that's a real thing. That's what I call it. They don't like the textures, they don't like the teeth brushing. I mean, it's not just me, it's the parents too. And I think if you can work with them from very early on, they they may not like it, but they kind of get used to it. Um I mean, I have patients now that are, you know, literally 33, 34 years old that I've been seeing since they were infants. Um they come in and uh we kind of surprisingly do quite well. You know, it is a spectrum. So some kids will do really well over time, and some just don't. You know, it it really is a spectrum. You you don't really know um how how it'll end up or what you're gonna get. But I'm you know, some of these patients, the first time I'll do an exam, I'll be in the waiting room. I'll just sit on the floor of the waiting room and take a hand mirror, barely touch them, look in their mouth, and they'll go home, they'll pick a toy and go. And you kind of work from there. You know, you really have to just um I don't have a set protocol. I just sort of take it as it comes and do what you need to do. And you know, if if if I count four teeth the first visit, then that's a success.

SPEAKER_01 11:40

What you just said really touched me because I you that's absolutely correct. You take it as it comes, and as uh as a therapist, I remember having multiple first, second, third visits with one little little girl who played, was learning to play a musical instrument. She would not come into my office. But what she would do, I said, you know, where there's great acoustics, she knew about acoustics, is in the garage. And I'll show you where I park my car. And if you can bring your trombone into the garage, and you can play, would that be okay? And she looked at me, she said, You have a garage? And I said, Yes, it's got so many cars. That was all it took. Down to the garage. Her mother came to pick her up and overheard her playing in the garage. And when she came to pick her up and brought her back out to the waiting room, the mother was in tears. And she called me later and she said, I don't know how you did that, but I couldn't believe she would play that instrument. I said, at the last minute, bring it, bring it along. Maybe she'll want to see how shiny it is. So, yes, wherever and whenever is my motto. I think that was just brilliant.

SPEAKER_03 13:14

And sometimes it takes a long time, you know? Um, but you're right about the acoustics. Being a bad trumpet player, I can appreciate that.

SPEAKER_02 13:22

So, Dr. Kleiman yourself, how did you veer into a practice that expanded uh you know, into a special needs population? And where I heard from Bernard is you meet the child where they're at, and that means you know, if however long it takes to go from the waiting room into the exam room, so be it. Um do you have any tips and strategies for parents in addition to start young if you can?

SPEAKER_00 13:53

Well, uh just you know, to the point that Dr. Gross and Dr. Kirch just said, you know, uh PF and dynastry, the reason why uh special needs is part of our training and part of what we do is because it's it's really the same thing. At the end of the day, it's just one big start one. Even kids. You have to figure out what's going to make the kid tick. Some kids come in and they're fine, no problem. Some kids are hesitant about about uh vibration, some kids are hesitant about a taste, some kids just don't like getting in a chair, and you have to figure out with each kid what it's what they need to be comfortable. And sometimes you have to say, you know, like you know, you notice they have a trombone, like you said, and you use that to get your hand, or you notice they have something on their shirt they're wearing, a character, and you you say, okay, this is the same toothbrushes, spider menus, or whatever it is. And special needs is the same thing, you just have to figure out what each patient is worried about, or what they're sensitive to, or what they're gonna react to, and you just try not to do it or try to modify what you do to avoid that. And um, so that's why special needs is really a big part of what we do as well. Um, you know, when I when I first started seeing some of these patients in residency, I was you know, understandably hesitant about it. I think a lot of people probably would be at first, but once I once I saw a few, I realized how much I enjoyed it because you really can make a big difference once you once you once you learn that you can do it and how appreciative the parents are that someone is able to help them and you know give them guidance and get in there. And I just loved it. So I'm I'm always happy to see special needs kids when I have the opportunity. Um and what I really try to do is just figure out what and what the parents help. Parents are your biggest your biggest asset as a pediatric dentist, and I'm sure in other therapies as well, because they really understand their kids and what what they're hesitant about, what they like, what they don't like. And you can, you know, I spend time talking with the parents, understanding what their challenges are, and then I can use that to help get the appointment done. And sometimes it's you know, you start very slow, like Dr. Gross said, and you don't do much, and you build onto it. Sometimes if you just kind of figure out what to what to avoid, you can get a lot done because you, you know, you you you have your your game plan. Um but same with the same with with the home care. You know, a lot of what we do is we try to give the parents guidance, make them feel that we're part of a team together. It's not like it shouldn't be a stressful thing that they they don't want to bring the kids in because they're nervous it's gonna be difficult. It's like we're in this together. We're gonna help help you, help your kid, and shouldn't feel worried about it. We'll do what we can do. Whatever happens, happens. It's nothing, nothing's a big deal. You have to just be honest about it.

SPEAKER_01 16:44

And so along that vein, do you speak with the parents ahead of time so that they can tell you uh some information about their kid, what might likely turn them off, turn what they like, you know, they happen to like Mickey Mouse, you'll just happen to have a Mickey Mouse figurine in your office, you know, that kind of thing.

SPEAKER_00 17:06

Yeah. Sometimes, you know, it again, it's every approach is different. Sometimes, you know, we'll get a sense that's important to talk to them first. Sometimes we'll bring the kid in first and see how they are and then start talking to them. Um, sometimes parents want to talk to us first because they know there's certain things um that that that that they want to discuss with us. So yeah, all of all of the above.

SPEAKER_03 17:28

Um, I don't not to interrupt, but um Michael made me think of something as is uh as a team approach. You know, one of the things that that pediatric dentists and and pediatricians, I'm sure too, is you really treat the parents as well. I always make a joke when I see that that you know one and a half-year-old kid that's coming into my office for the first time. I said, you know, this is the appointment where I leave the kid alone and yell at the parents. You know, um, the other thing I wanted to say, and I I said this once, and I I can't believe I even said it because it's so profound. Um I think Michael and I were together when I said it. I said that all kids are special, honestly, and special needs kids are just special in their special way. And so I we can get a kid that you know isn't on the spectrum, you know, isn't neurodiverse, um, and they can be a terrific challenge. I mean, more so than some spectrum kids. And so honestly, it's just a box of chocolates with children sometimes. You just never know what you're gonna get. And sometimes the parents are nervous about it, and the kid comes in and does beautifully, and the parents are so blown away, you know. So it yeah.

SPEAKER_02 18:34

I am I am very appreciative of the acknowledgement that no kid lives alone, right?

SPEAKER_03 18:40

Right.

SPEAKER_02 18:41

And the fact that you want to create a team. I'm wondering if there is some initial tips that you can offer to parents to you know, because these are kids who kids who are orally defended, all right, in terms of dentistry, tend to be the kiddos who also are very picky eaters and can't tolerate certain taste and colors and textures and so forth. And these are like I call them my you know, MM kibbs, milk and macaroni, you know, type of stuff. Correct. So their diets are poor, it reflects in terms of you know the the uh both um you know the reflection of the of the condition of teeth in terms of what they uh will tolerate. They may not tolerate hard foods, they may only want to chew hard foods, you know, and so forth. How do you what what would you guide parents kind of as a primer, you know, to say, let me give some strategies that you can start doing to exercise at home. Yes, start early, but um doing what?

SPEAKER_03 19:50

Let me take that out. Um you know, I I think one of the things that that help is if the parents have an understanding of you know elementary caryology, what causes decay, how what foods to avoid, the concept of um frequency and duration of the carbohydrates on the teeth versus the food itself. And I think that really helps too. You talk to them about avoiding certain kinds of foods, sticky, chewy foods, raisins, things like that. So you you kind of, as long as the parents have an understanding of um certain things to avoid, you give them strategies. Um and one of the things I I like to say is, you know, as hard as it is to brush your children, your child's two teeth, and as hesitant as you may be to force them to do it, it's harder to fill cavities. So um I think it's important that from an early early on, you you really get in there and do some oral hygiene. Um, and and I do, I am empathetic, I do understand that it's difficult because it's difficult in any one-year-old, truthfully.

SPEAKER_01 20:58

Sure.

SPEAKER_03 20:59

But it but it may I think it helps. Oh, excuse me.

SPEAKER_01 21:02

I was gonna ask if either of you um give uh talks to the public. Do you go to synagogues or churches or public spaces where parents can come and listen to you say that? Because most parents of any child will never think of bringing their one-year-old to a dentist. Right. Just to acclimate them to what that looks like, going in a waiting room, seeing toys, you know, they may know it. They're they're one, they don't know much about the outside world.

SPEAKER_00 21:40

So we don't we we we don't really get out much to speak in the community that way, but um I mean the the the guidelines from the American Academy of Pediatric, Dentistry, and Pediatricians have been for a number of years now to recommend the first visit by first birthday. That's that's what they recommend. And many pediatricians. um are telling their you know their patients uh to to try to come in in that age range so the word is out in that respect and you know we we feel it's so important to get them in early if we can just to give them the education and set them off on a good routine because so many of the issues that kids can get with their teeth are so preventable if you start with a good routine so we we'd love to see them that age if the patricians will sp will send the word out and you know even to this extent that if if someone doesn't have insurance or whatever we'll see them for for no charge under under 18 months just to be able to get them in and get that get that information out to them whatever happens afterwards happens afterwards you know you know this reminds me it it was only a few years back that airlines began to introduce understand uh children's phobias and begin to introduce the concept that you could with permission go through the TSA line to see experience what that is to actually go through into uh the cockpick to go sit in the in the the seat and put on a seatbelt and everything other than the plane taking off.

SPEAKER_02 23:10

I like this concept of giving a primer to families to say come into the dentist's office whether we actually even get a chance to examine the baby's teeth or not just let's take a look at what goes on inside a dentist's office. Let's take a look at uh you know the prizes let's go see what the chair looks like let's go hear the sounds and and so forth and the lights and as you said get accustomed to these kinds of new sensory experiences until it becomes in some fashion normalized.

SPEAKER_03 23:44

Right especially with um the special needs kids if they come in look at the office and pick a toy and go that's great they're happy to get a toy and and and the next time they may sit in the chair and get a toy.

SPEAKER_00 23:55

So yeah I want to add a point just that you know I think from what I've heard over the years from parents a lot of them after they came in and and went the deployment went out went when well they expressed like oh my gosh I was like so worried about this and I didn't want to come and I've been pushing it off and I'm so glad I came and I just you know if I could get a message out to any parents who are watching who are thinking these thoughts come in don't be worried about coming in we're we're not gonna uh you know make it difficult for you whatever your kid is is ready to do that's what the PF Dennis is going to do but you'll be able to get your kids started with the getting comfortable more importantly it gives us an opportunity to work with you to figure out what can we recommend to do at home what's really important what is what is in your kid's case going to be the best thing to focus on to help them have as healthy teeth as possible and it's gonna be different for different kids but if we never get a chance to talk with you we can't help you but you know we can we can do a lot by bringing the kid in whether we clean their teeth or not whether we check their teeth or not whether we take x-rays or not whatever whatever far we get there's gonna be a benefit and you know people should realize that it's not just about getting every single every single thing done that we typically would want to do an appointment but whatever we can get done is going to be building on you know the comfort for the kid and giving really important guidance that can be very helpful.

SPEAKER_02 25:26

Now I'm also thinking in almost in reverse if you get a child who is now comfortable with going to the dentist I'm wondering if that might expand other areas of comfort whether it's food choices or tolerance for different sensory experiences and so you have um actually greater flexibility because they went to the dentist you know as as as a positive I am very very pleased that you've come on and to to spread the message we only have a couple more moments left but I'm wondering is there anything in particular in addition that you want to add to because we're obviously talking to families now we're talking to parents we encourage different strategies meet the kids where they're at start early um any kind of words of wisdom that they can take away with because I think a lot of parents when uh especially if the uh the child that they're they're experiencing is one of their first and so they don't have the previous experience of of knowing how to normalize a child's behavior um how do you guide what would you what would be some of the thoughts to assist in choosing both the right dentist and just the the right experience to make this a positive overall uh achievable goal you know one of the things um we find is that adult dental phobes would traumatize as children in the dentist's office and something Dr.

SPEAKER_03 26:59

Hess said about her experiences I think it's important to let the parents know not to let their anxieties and their hesitations get in the way of providing a comfortable caring positive experience for their kids because a lot of parents come in with their own baggage and it does get transferred over to their kid in a way. So I think and and I do understand that's a difficult thing. Because a lot you know a lot of the time I'll see the father sitting there white knuckling it a little bit and the kid's doing great you know so um that's one thing.

SPEAKER_01 27:33

And that's a good point because whichever parent is the better parent to bring their child is the one that should do it. It's not the mother's job or the father's job it's a parent job. Perhaps not the white knuckler's job.

SPEAKER_02 27:49

Not the white knuckler it's it's really been a pleasure for both of you coming on and sharing this wisdom and normalizing I think both the pediatric and adult special needs dental experience together. I want to tell you that I it you you you have given a lot of the families that I know that we see hope which I think is a a great gift uh and and direction and uh we can't thank you enough.

SPEAKER_01 28:18

It's our pleasure because um you're our first dentist and it's a unique experience I think for everyone listening and everyone who will find out about this episode because there's always in my experience a parent who's been nervous about going to a dentist and a child who has picked that up as you said um this is wonderful information and the kindness coming from both of you is such a wonderful selling point to dentist so this is this is Dr.

SPEAKER_02 28:58

Estee Hess and I'm Dr. Ann Kirsch and this has been a wonderful episode of On and Off the Spectrum podcast. If you liked what you hear please go ahead and subscribe follow us and tell your friends if there is something that you feel you can add by becoming a guest on our show please reach out at the same time we want to thank both Drs Gross and Kleiman for adding their dental wisdom their kindness and just their overall sensitivity to this very sensitive subject to help us move forward and we again express our thanks. Yes thank you both so much okay take care of the