Dr. Douglas Keck of the Healthcare Network's Pediatric Dental Program

Welcome to Gulf Coast life. I'm your host, Cary Barber. Today on the show, we are talking with Doctor Douglas Keck of the Health Care Network's pediatric dental program. The program recently earned a certified Autism Center designation, which means that their staff has completed specialized training to support autistic and sensory sensitive individuals who come in for dental care. Doctor Keck is here to tell us about the practice. Doctor Keck, welcome to the Gulf Coast life. Thank you very much. It's great to be here. Yeah, great to have you. Let's just start. I feel like this is a topic that a lot of. If you don't have a an autistic person in your life, you might not have thought of. But what are some of the challenges in a dental office for somebody who's, a very sensitive or on the spectrum, etc.? The challenges probably are pretty much the same as even individuals who don't have sensory sensitivities, meaning that there are different smells than you usually smell. There are different tastes that you might taste when you're getting your teeth cleaned. There are bright lights. There are people that you don't know. There are. Just pretty much every single sense that you have is affected by going to the dentist. Yeah, it's not that much fun for anyone. I guess. Except maybe the dentist. And I read a statistic about 1 in 54 children is diagnosed with autism. Do you agree with that? Or what's how common is it? So, it probably depends on the health care systems that you have throughout, you know, the world. In the world, the statistic is 1 in 100. In the United States, where our health care system and diagnoses, of autism or ADHD or, any sensory sensitivity has that ratio at 1 to 31. So it is it is, quite common diagnosis to have. And how, how might a patient respond to, like you said, the bright lights, the noise is the tastes. So, children that have sensory issues, can respond. Behaviorally much different than, some other younger children who are at their age and do not have those sensitivities. One would or might describe it as poor behavior, but it is behavior that has to do with how the children are processing these sensory issues. That may include. Many patients do repetitive behaviors. Many can't sit still in the chair. Sometimes there's noise. Crying. But the objective of all of it is to make the, the child comfortable in the situation that they're in, and that may take more time than with a quote unquote normal patient. But that was the whole reason and purpose of us becoming a certified autism center was to, kind of meet the children where they are. And whatever spectrum of life that the Certified Autism Center actually helped us. Not only be more aware of, issues in behavior guidance, for children that do have special needs. But, those same things help with any child. Yes. I was going to say it's it's can be a little bit of an assault on the senses for for everybody. What did your staff have to do? Or can you kind of walk us through some of the training to get the designation? Most of the training was online. And at the end of training, about a month or so later. An individual who is with IB, CCS, which is the International Board of Credentialing and Continuing Education Standards, came and went over. Individually, not only with the dental providers, but front desk staff, any patient facing staff. But, most of the training was online and was reviewing, different neurodivergent issues. With us and the people that, made the online program were, experts in the field of neurodivergent, see, actual patient advocates who were autistic or had neurodivergent see, as well as their caregivers and, and caregivers are kind of an important, method to find out because each child is different and the caregiver, is the best educator of our staff. And, because as I said, everybody has their own individual issues. Yeah. And you're coming to each kid, each patient sort of open where they would know, like, oh, he's not going to like yes. Yeah, yeah. And can, can you walk me through like what, what might a staff or do if, if they see that a patient is having like not a great reaction or they're uncomfortable. As a part of grant funding that would we've received not only to achieve the, certified Autism Center certification. We purchased, individual equipment, from a little box of hand-held toys that can help, with children that have touch sensory issues to, mobile machine called the vector machine. You may have seen these at, local children's hospital. It's a machine that has a bubble machine, has different lights. It's, type of distraction. For kids that have certain sensitivities. We also purchased a projector that could project things onto the ceiling in the dental operatory as a distraction agent. And sometimes calming music or just dimmed lights actually help. Yeah. Yes. Oh, that's a great idea. Yeah. It's, it's great that there's all this technology now that can help me. Yes, absolutely. What a. Do you ever have a patient that just can't can't, you know, won't calm down or, you know that it's best that they not have the procedure? The answer to that is absolutely yes. And it's one of the things, as part of our pediatric dental residency program that is taught to all of our residents, believe it or not, and this is a hard thing to do because medicine and dentistry are so very different. But dentistry is a surgical specialty. And most of the time, surgeons, if you think about it, are taking care of knees or shoulders or hips. But the children or the adults are under general anesthesia. Dentistry is a surgical specialty. Maybe not doing large body parts, but working on very tiny teeth in, an awake patient. So part of our training of the pediatric dentistry residents is to be able to provide behavior guidance for children on any, you know, level that that is necessary from autism to, asthma to anything, that affects the child. So some children just can't adapt to the dental environment or are too young to even cognitively be able to provide behavior guidance to those children or adolescents sometimes require, sedation dentistry, which is either administered intravenously, orally, intranasal. Lead that doesn't put you entirely to sleep, but provides the stillness that the dentist needs to be able to do the treatment. Yeah. Those that have very specific behavioral issues, or that have medical issues. We do take them to the operating room at Children's Hospital, Golisano Children's Hospital. So yes, there are patients that cannot be treated in a normal, quote unquote, normal dental setting. Yeah, that we provide, alternative resources. Yes. Oh, that's interesting. Yeah. It's, I was going to make a joke that I would like to be sedated, adds dentist, but that's not really funny. Or did you make any permanent changes in your office, like, once you were getting this designation, did you did anything occur to you like, oh, we should change these lights. Permanently. So the answer to that is, the alternatives were number one. There are many dental programs. At least residency programs that have what's called a sensory room. We decided to go the opposite direction and make every dental operatory a sensory room by having the equipment be mobile. Great. So things can be wheeled into the room. As I said, the projector is a very small one. You can pick it up, plug it in in any room. We did make some permanent changes in the waiting room and provided some sensory equipment on the walls. You know, almost like, so called light bright when we were growing. Up. Where you can touch and change the colors and, there's an alligator that has some different types of sensory, you know, soft Lego like areas on the alligator. So, yes, we did make some permanent changes to the waiting area, but decided, because not, as I said, only children that have sensory issues, but any child might appreciate having something to hold while they're. Yes. Having gentle treats. Yes yes yes. So we're mostly talking about children pediatric ear practices. Yeah. So can you talk a little bit about why it's important to get kids into the habit of getting dental care, and you know, why it's important for them to feel comfortable at this age. To put them in good stead. Yeah. That's a great question. And one of the reasons why I chose pediatric dentistry, was I speaking for myself. The thing that makes my day interesting is not fixing teeth per se, but it's, in the challenge of getting the child to be cooperative. The other reason I chose pediatric dentistry is, education is very important in all of health care, not just dentistry, but, if you can provide an environment, for parents to be able to learn children, to be able to learn about oral health care, I think that provides, pathway, for the rest of the life so that, you're not going to the dentist only when something hurts. You understand? You know, the pathway to prevention is the key to dentistry. That going every six months to have your teeth cleaned and examined and, provides a much more stable, environment so that when you get to be an adult, you aren't afraid to go to the dentist because you're not going to the dentist to get a tooth removed or to have a filling done. You're going to the dentist to have your teeth cleaned and re go over the educational component. So that's the first reason. The other reason for pediatric dentistry is, I've found that I not only help children, but I help families. So the education that they may or may not be receiving at their own adult dentist, they're receiving along with the child, and I think it provides, not only individual health care education, but, hopefully somewhat of a community type of health care education, which is another reason why I chose to move from private practice to educating residents and to, work at Health Care Network. Is for the community health that we can be able to provide and. Tell the parents before they get to a visit. So you brought up a very, very good point, and one that I think is important for parents to know, providing that pre education to the staff and, staff. You asked about changes in the office. Are now, as a part of the intake call actually inquiring if there are any behavioral issues. I think that's the best way to start is to start on a level playing field. Meaning if your child has known behavioral issues, it's helpful to the staff to be able to prepare the room and prepare the dental hygienist who might be cleaning the teeth, or the dentist who might be doing, a filling or a restoration that there are sensory sensitivities. The second thing I would say about that is that once you can provide that, you can also provide the best time of day to see the child. Generally, children under the age of six do much better first thing in the morning, and we try and reserve afternoon appointments for the adolescents, for children that might be on ADHD medication, having an appointment time where their medication is helping them the most. You know, you know, mid-morning is kind of a better time for those children. So time of the appointment is good. To know lastly, once you make those accommodations and, you know, allow the dentist into the child's life a little bit, as a parent, there are YouTube videos. There are children's books about going to the dentist. I just encourage there always to be positive language that's delivered to the child. Because. You know, when I was your age, I had to have a tooth pulled. Is not exactly the way to interest the child in going to the dentist or behaving well. So, so positive language and positive reinforcement are always good things from the parental side before. Yes, yes. Fear is not a yes teaching motivator. Yeah. What about, keeping up with dental hygiene at home? I imagine some, some patients may also have a challenge with that. Yeah. Can you say more about that or. I absolutely can. I don't want to say many years ago, but it is many years ago, I was part of a study with a resident, in Connecticut where I had my private practice, developing a YouTube video and testing this YouTube video for children that had sensory sensitivities. And they'd watch the video and then brush their teeth afterwards. Since that time, there have been other evidence based studies, that dentists have conducted. But, the the same way we go about treating the patient in the office, I mean, children that process best with pictures, words, you know, whether they process things better with audio visual, the long and short of it is we were studying to see if it increased, the children's, engagement in the tooth brushing process. So the answer is depending on, The child, as I said, you know, watching a video and, you know, just positive reinforcement about doing what's on the picture. There are social stories that, many schools of autism use, like pictogram from step one to step, brushing the teeth. So there are multiple ways to help, encourage children to do a better job of brushing. And, I will also say that, We are working with, charter autism school in Naples. We're seeing all of the children at the school. Education on our mobile unit will occur with these children, k through 12. So, as as it's the resources part and the capacity, to be able to see the children, but, I think from that standpoint that you're talking about is, going back to meeting them where they are, if they need something visual. Yeah. To encourage them, if they need to hear something, if they need to look at a story in front of them. Yeah. Those are all ways to encourage children to brush better. And did you you said your mobile unit, do you have like a van that goes out? Yes. We've received some grant funding for the mobile unit to go to the, charter autism. School. Yeah. And we are putting some of the same equipment in the mobile unit to, encourage or help children, at the autism school feel more comfortable coming into the mobile unit to have their teeth looked at. And I guess I'd like to say that that's kind of the ultimate of meeting children where they are, because you're actually going to their school. Yes. So, and it will also help because. Trust is is really a good thing. They'll probably come out with either their teacher or the school nurse, you know, people that they're familiar seeing to take some of the fear and anxiety away from walking into a place where, they know nobody. Yes. They've never been before. Yeah, yeah, yeah. So. Oh, wow. That's great. Do you offer this at all for adults or. No. Because you're at so. One of the, the thing. I'm a member of the American Academy of Pediatric Dentistry and, they just, received a grant last year for the transitioning. So, so there are some pediatric dentists that do take on adult patients that have special needs. But one of the things that we're trying to do on a national level is to be able to transition children that, that have special needs to adulthood. Because it is not one of the dental specialties like oral surgery but perhaps should be. And, and one of the things that we've found is that, it has to start at the dental school level. Not the residency level. You know, dental students before they become dentists need to be provided in education. Which is also part of the reason why we're doing what we're doing at Health Care Network is eventually hopefully in our residency program, we will have dental students rotate through our facilities to be able to learn some of the things that they need to know about treating patients that have sensory sensitivities. Read. That's very. Exciting. Haven't started yet, but but, that's where we've found on a national level that we need to start earlier. And whether it ever becomes a specialty or not, we need to be able to train those who are going to be dentists to take care of people with special health care needs. Great. Well, I'm sorry to say we're out of time, but Doctor Keck, thank you so much for being here today. This is Gulf Coast life, and I'm your host, Cary Barber. Thank you for listening. We had production help today from Emma Rodriguez, Mike Kiniry, Matt Krause and David Oquendo. This is WGCU FM, Fort Myers 90.1, WMKO Marco Island 91.7 FM NPR for southwest Florida.