Neurodiversity at the Dentist, with Dr. Allen Wong | EXPLORING DIFFERENT BRAINS Episode 16


 

In this episode, Hackie Reitman, M.D. welcomes Dr. Allen Wong, professor and director of the Hospital Dentistry Program at the University of the Pacific Arthur A. Dugoni School of Dentistry. Dr. Wong discusses his career in special care dentistry, the importance of dentists understanding neurodiversity, and options for how patients with sensory issues can have successful visits to the dentist.

For more information about Dr. Allen Wong, visit: http://www.dental.pacific.edu/The_Dugoni_Experience/Our_Family/Allen_Wong.html

 

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HACKIE REITMAN, M.D. (HR)

Hi, welcome to another episode of Exploring Different Brains. I’m Dr. Hackie Reitman, and today we have my friend Dr. Allen Wong from the University of the Pacific from the Dugoni School of Dentistry out there, Allen is the director as well as a professor, and welcome Allen, how are you?

ALLEN WONG (AW)

I’m doing great Dr. Reitman, how are you today?

HR

I’m okay, but you call me Hackie. Now listen, Allen, you’ve devoted your life to taking care of the dental patients whose brains might be a little bit different. The neurodiverse population. How did you get into that?

AW

Well, it’s been a passion of mine to always take care of people that have a great need, and this population in particular, both the neurodevelopmental, as well as the medically compromised, has always been my passion. Dentistry is easy to get set in for all of those, except for the population that often suffers in silence. So it started at a very young age.

HR

Tell us about the program you have going there at the University of the Pacific.

AW

Well we have multiple programs, one is at caring for the patients with special needs has been always are concerned because dental education does not have a lot of time to dedicate into its education. So here at Dugoni we have a special curriculum designed to help our new developing dental students to have more background knowledge, as well as clinical experience. So we have a special care program here that allows for the dental student to actually work with patients in a mentored environment to let him or her cope with the work the graduate. Most dentists who graduate do want to take care of people of all different backgrounds including the neurodevelopmental, but they’ve never had a lot of hands-on experience, if you will. So we have a pre-doctorial experience, we have a post-doctorial experience in our residency program as well, as well as hospital dentistry experience for those that really need to have that additional care that are not cooperative in a routine setting.

HR

Now do you find a generational difference between the doctors, dentists who are training today versus 20 years ago?

AW

In some ways, yes. Dentistry has become more complex, but at the same time there’s many new innovations in terms of prevention that have not been sort of popularized, and I think that the newer generations are at a great advantage of the newer sciences and research that we have available. So I think that there is a greater awareness, a greater compassion in the new generation. Im looking forward to working with many of them here at our schools and across the nation in our residency program. So I think the heart is there, I think the word is there, I think programs like yours and awareness in education and all different discipine, interdisciplinary, I think that is sort of moving the progress, albeit slow but moving in the right direction.

HR

Allen, you and I met out in Los Angeles when I was lucky enough to have been invited to the AADMD organization, co-founded by Steve Pearlman, our good friend Steve. And I was lucky enough to give a keynote there with Tim Schriver and everything–why don’t you explain to your audience, because you belong to so many different organizations that really try to help those of us with different brains–tell a little bit first about the AADMD.

AW

Okay, well, Hackie as you know, and you identified, there are many organizations trying to do the same thing. Increase awareness, increase competency and taking care of our friends with special needs and their neurodevelopmental disabilities. The American Academy of Develomental Medicine and Dentistry was founded for a couple of reasons; one is to integrate both the medicine and the dental discipline and being aware of each others needs and desires to better care for our friends, and we are blessed to have many very qualified practitioners in the field of medicine and nursing and dentistry to collaborate and find out whats the best care for our patients as well as what can we do for the future and how can we integrate that into the curriculum into the medical, dental and nursing curriculum as well. So that organization did a fantastic job.

Where we met at the special olympics is sort of the center point of how a lot of information has been gathered by collecting data through screening and surveillances for finding out the impact of how bad problem has been. And not only in America, but all throughout the world. SO THIS is not an isolated problem, its been a worldwide problem for ages and no were starting to shed some light on it. Organizations like the American Academy of Developmental Medicine in Dentistry, special olympics special smiles program, and the Special Care Dentistry Association have been great organizations to partner and to bring forth the knowledge, the experience and the attention greatly needed.

HR

feel very honored to be talking to you. People like yourself have been devoting your whole lives to this population and here’s a Johhny-come-lately like me, and I’m going to be lucky enough to be giving the Max Bramer Memorial Lecture out in Chicago at the combined meetings of the special care dentistry association with the IADH. Why don’t you tell our audience here at exploring different brains from Dr. Allen Wongs point of view about those two organizations also?

AW

Well, terrific. Well Special Care Dentistry Association has always been dedicated to helping advance dental progress, dental information, dental needs for practitioners and better taking care of people with special needs, and theyve been very good in terms of concentrating on three categories. Those are the geriatric, those are intellectual disabilities and the children or persons with disabilities in those areas so they’ve been focused and they are the footsoldiers, if you will, that bring experience and knowledge from their backgrounds and help educate the next cadre of practitioners. So the Special Care Dentistry Association has been wonderful in terms of that, as well as trying to work on political pieces that will help promote research and care and policies that effect those patients.

The IADH is a wonderful organization in terms of doing the same thing in an international scope for working with people with disabilities of all sort, and they bring a worldwide awareness as well as a collection of information, so that’s another wonderful organization. Hackie, I cant find, or think of anyone better than you to bring this message, you as being a fighter of sorts, to really a champion, if you will, with a topic that really needs to be brought to light, and we need people with your passion. I dont think of you as a Johnny-come-lately, but I think of you as Johnny. Any time, coming to bring this enlightenment is a wonderful thing, so we need everyone to be like you. Fighters with a passion to bring the message forth.

HR

Allen, what message, if you had to give one message on the podium to the participants at that meeting in Chicago, the combined meeting of the IADH and the Special Care Dentistry Association, what would that succint message be?

AW

The succint message is this: That we need to think things differently, through a different paradigm; our patients with special needs, we need to focus more on what we call caries management by risk assessment. Many of the problems that are faced with our patients with dental problems are preventable, and if we capture them early and use some of the prevention strategies such as the fluoride brushes, and now we have a new method of silver-diming fluoride that might be something to look at. If we work on the prevention area earlier, we wont have to have the patient suffering of dental disease. So I think we need to all work together concentrating on more research of the prevention. So we can capture our friends at an early age and hopefully help them to not have unnecessary teeth flaws so that they can function and participate inside without having to have be silently suffering in pain. So my passion is, let’s work together in prevention, and lets work together in caries risk assessment.

HR

Well that’s great. That was a great, great statement, because oftentimes, we physicians and dentists get so caught up in the day-to-day logistics of the office, we forget that word prevention sometimes. And that old adage about an ounce of prevention is worth a pound of cure, in the dentistry world, based on my limited understanding, its a ton of cure. Can you elaborate, and I know our friends also at the tooth fairy, also America’s Tooth Fairy and the other people all doing a great job in prevention–could you elaborate on some of the specifics of prevention?

AW

Well, certainly. I’d happy to. And you mentioned, also, another great organization, America’s Tooth Fairy, they have done a tremendous amount of support and–so I cant say enough about them, theyre a great organization too. But in prevention, its not a one thing that causes cavities or gum disease; its a multiple of things. So I think in terms of being aware of things and looking for misconceptions. For example, many of our patients take medications; some for anti-seizures, sometimes for anti hypertension, anti-neuroleptic, all of those medications have side effects. One of the major side effects is drying of the mouth. And the drying of the mouth causes a stomach effect that increases cavities–its all about chemistry. So whenever our saliva is decreased or changed, the PH is also altered, it becomes more acidic. And a lot of our patients have multiple medical problems that have side effects that have gastric reflux. That also brings acid to the mouth and that also weakens the teeth and makes them more prone to cavities.

Those simple things working together in an interdisciplinary approach, and saying is this the right medicine, and what is it doing to your mouth, if you start thinking in those terms and saying we need to do things that counteract it; either neutralize some of the acids in the mouth to minimize the cavity disease process, or that we need to garnish the teeth or seal the teeth at an early age so that they are more resistant to cavities, those are the things that we think about; your brushing and flossing is helpful, but its not whats going to solve the problem, because really understanding that the chemical change in the mouth, whether its lack of saliva, decrease of saliva, increase of sugar intake–so the nutritional concept, the hygiene concept, the salivary health is all important things that we should be thinking about for the patient.

HR

Allen, you know I’ve been meeting a lot of people–neuroscientists devoting their lives to all kinds of different brains, and one of the more interesting aspects of this multi-factorial process, and there’s so many wonderful people, whether you talk to the people in dyslexia, or autism, or ADHD, PTSD, you name it–they’re really really focused. But to me, probably because of my fresh set of eyeballs to the whole thing, it all seems to be one continuum. One continuum where I don’t see a whole lot of things occuring in isolation; like you just mentioned seizures, and we can talk about anxiety, we can talk about depression, we can talk about autism, asperger’s, ADHD, one in 13 Americans with PTSD, and the list goes on and on and on and on. Now, if I’m a dentist in the office, which I’m an orthopedic surgeon by trade, but if I’m a dentist, alright, and I have not received the special training yet, like you’re giving out at the University of the Pacific in your university out there. With these special programs, how do I catch up in order to get comfortable with working with these adult and pediatric individuals?

AW

Well, I think you’re right Hackie. There are a lot of resources out there. The website for the FCPAonline.org, the AADMD.org are terrific tools; within those are free resources as well as continuing ed courses, and I’m not trying to praise them, but there are a lot of free resources on there as well, just to get comfortable. Theres a lot of mentorship, so people are truly interested and can contact any of the members of both the AADMD or Special Care Dentistry Association members, and many of us are more than willing to talk mentor if they have questions, in terms of how should we treat, because everyone is unique and everyone is different, and just like different minds, there are different practitioners with different experiences, some good, some bad, but we learn from one another. And as long as you’re willing to try–I think they added to the special olympics halves, this motto that I think is beautiful, is “let me win; but if I cannot win, let me be brave at the attempt.” And that’s my motto that I adopt from me to my patients and physicians who want to take care of people with special needs, you know? You should try to take care of as many people as you can, but if we cannot, let’s be brave in that attempt.

HR

Well you’re very inspirational, Allen. And you know, you just brought back a lot of memories to me about fear and anxiety, and how some of us think that courage is the absence of fear, and its not–its doing what you have to do and overcoming your fear, and I have to tell you, I learned so much when I was out in LA with you and Steve Pearlman and Rick Rader and Matt Holder, and the whole gang of great people out there, and Fern Ingber, from America’s Tooth Fairy and Beeky Crepps, and all of these wonderful people from all over the world, and I want to compliment you and the other pioneers and the other giants in the Special Care Dentistry Association. Everything for all that you do. And I thought that might be a good segway for you to just mention a few of the–a few of the real pioneers that you look up to in this arena?

AW

Well you’ve mentioned most of them right there. Steve Pearlman is the top of my list; I know no one of greater conviction or passion and he inspires me. I talk to him on a regulalr basis, and especially when were in this field, sometimes we feel like the only ones in this field, but its people like Steve that reaffirm the passion and the need for us to be there, so he brings me great inspiration. All of the other ones you mentioned; the Matt Holders, the Rick Raders, the Henry Hoods who have been the primaries in the beginning that were out there yelling–screaming into–it seems like, in the silence of everyone else, but they’ve always been great pioneers and doing the right things; creating an environment of learning and cooperation and collaboration. There’re many other names that come to my mind, Seth Kellers, there’s Steve Zalinksys, I wish I could go on but you caught me offguard a little bit on the name list of people, but you’re right there were many pioneers before me that have sort of paved the path, and I think that its our job and our obligation to continue that genuinely, and continue spreading that great word, and I agree with what everything you said about the fear. And sometimes, we don’t want to do things because we dont think were going to do as well or do it right, but our heart well call us to do the right thing, and I think that people like yourself bring light to a dark subject, and thats what we need. We need more attention and we need more–more people like you.

HR

Well thank you–and you know, part of my job is to get you in trouble with everybody whos name you didn’t mention.

We’re speaking here with Dr. Allen Wong, from the University of the Pacific, the professor and director of dentistry there at the Dugoni School of Dentistry who does so much with the SCDA and all of the other organizations taking care of those of us whose brains are indeed different. Allen, I’d like you to touch upon the legal stuff going on with–that refers to, you know–restriction of movement and so on and so-forth, and you can give all the jargon to it, but tell us whats going on in that arena?

AW

Okay. I will do the best I can. I am not a legal scholar, but in dentistry, most of us that can sit in the dental chair are fortunate sitting on the chair, can give consent, and we can control our muscular activities. We have populations that unfortunately cannot due to syndromes where they cant control their muscular control–and therefore they have some phonic, tonic type spastic movement, and you know when youre working in the mouth, its a very small area, and this is when precision needs to be done, otherwise you can hurt things inside their mouth, and the patient. So, at times its important that the patient is stable. but when the patient is not able to stabilize themselves, we need to help them, and we need to do it in a very loving manner, not in a torturous setting, but to stabilize them, so they don’t hurt themselves. So right now, theres a lot of talk about immobilization, or some people call restraint.

We dont call it restraint, because were not trying to do something thats harmful, were trying to do something thats helpful–so theres different types of immobilizations–there’s the physical type where you’re supporting the head and supporting the patient, or sometimes wrapping them up in a blanket of some sort, and help them to stabilize themself and it can comfort them at the same time if done properly, and if done with supervision it is very safe technique. There are a lot of people now who are trying to argue that it is an assault on the patient, making them do something they dont want to do. And thats being discussed in different arenas at this time. My personal feeling is that, if done in a loving manner, it is perfect, it is safe and helpful for the patient. The other option is to immobilize someone with chemicals, putting them to sleep with drugs so that they’re fully unconscious. Well, there are some side effects, well not side effects–there are some negatives to that, it’s very costly, you have to use it in a hospital and it might be stressful on the body, all we have is general anesthesia. So us, in our community, we want to be as mentally invasive as possible–so if we can kind of do something thats not torturing the patient and doing it in a very friendly, loving manner, quickly, we’d rather do that than to put someone under full general anesthesia. I’m not sure if I answered your full question on that–

HR

No, you have. You have answered it, and its a very, very very tough area, tough area–tough decision-making, and when it’s a child do you have the parents in the room?

AW

Oftentimes we do. Often we do. Sometimes the parents choose not to be in the room because it can be very emotional, to do. If your child fell and they broke their arm–well no one likes to see that. No one wants to–to think about things like that, but those things sometimes happen and if you don’t do something, worse things can happen. So whats the most loving way to do it at the expedience thats going to be best for the patient; were trying to get that in mind, so its–we realize that in this community there is a lot of self-advocacy, there are different minds, different thoughts–were trying to be representative, and were trying to be thoughtful about that very much, and I guess the day will continue on–

HR

And you use a key word that I made the final Aspertool in my Aspertools book–unconditional love. The loving manner in which you treat your patients and people like Steve Pearlman, and the wonderful people who are doing what youre doing is extraordinary. But another thing I like to talk about is the neurodiverse people–the patients youve treated that you didnt get or recognize as their brains being different. And I said to the orthopedic surgeons, the same can be true in a dentists office, but the orthopedic surgery examples I gave, which I feel more comfortable with–yeah, remember that kid who wouldn’t stop screaming when you were using the cast-saw to take off his fiberglass cast? And you thought it was bad behavior and poor parenting? You didn’t know that all of his senses were hyper, and that you could have saved yourself a lot of trouble and time in the office if you had used plaster and had them soak it off, as an example–just one example. If you start going through the different types of patients and staff and colleagues were not recognizing how their brains are different. I mean I’d like to get Rick Rader’s brain under a microscope, I don’t know what we’re going to find there. I don’t know what you’d find in my brain–I got expelled in the first grade and the tenth grade, you know?

INTERVEWEE

You know, the thing that comes to mind, Hackie, and I tell this to my dental students as well as everyone else, is that you need to understand the person before you perform any kind of procedure–and the classic example I usually give is a patient with autism–many times they will call the office and say, will you see my child? My child has autism. And some offices say well, yeah, come on in and try–and the very first thing that we do to a patient usually, is what do we do? We bring them in a room, we sit them in this cold chair, we put this thing around their head and chain around their neck with a bib, and then we immediately recline the chair and then turn on this very bright light so we can see the mouth, and that’s almost the anti of everything we want to do basically. If you understand a patient that has autism, every sensorary perception they have is intensified, so I usually give examples to the counseling–I say you have to understand the person, walk in their shoes with it, and you will understand why they do what they do.

I said if you can imagine this–if I put you on a very cold metal table that’s freezing cold, it’s not comfortable–you dont like it. If I put this cold chain around your neck and this bib that has a weird texture that feels really uncomfortable for you, you don’t like that. And then if I invert you, suddenly–and then shine this very bright light in your eye, you wouldn’t like that. So no wonder the patient who walks into your chair and sits down, that has autism, and then you do all the stuff–they yell, they scream, they cry and run out of your chair, it’s no wonder that it’s like that. And it’s no wonder they dont want to go back there after because now youve created an environment where youve created trauma, and its so hard to reverse that. But if you understand the situation ahead of time and desensitize the patient through each step of the way, and maybe take that couple of minutes, then you will inherently have trained them that this is not a threatening environment. You show them things, let them touch things, let them feel things and then things will be okay. If you just take a little time to understand the mind before we treat the teeth. Then a lot of things can be really resolved at an early age and they become great patients. I mean my patients can work my chair better than I can sometimes–its just–its a wonder.

HR

Thats why you are who you are. You get that. It’s about the individual. And Angelo Dundee, I used to work out at the 5th street gym down there. He always said, “You can only work with what you’ve got. You have to know each fighter. You’ve got to know what they’re about because theyre all motivated by different things–theyre all different.” And I think we as physicians and dentists sometimes forget the most important thing is youre not treating a test, youre not treating an X-ray, youre not doing the procedure, youre treating a human being and everyone one is different, as my daughter, Rebecca, taught me so well. Every brain is like a snowflake, no two are alike, and I believe you are correct.

Once you get in that mind set, that Im going to take a walk in the other persons shoes, you could say the same thng you were saying about going into the doctors or dentists office, you could say the same thing about any environment to someone with hyper senses. They get told, “Youre going to love this restaurant. You have to come.” They dont want to go. They go, theres a big crowd, theres all kinds of smells, fluorescent lights they can see the actual flickering, they can hear everything, people are hugging them they dont know–so what you do is, in a doctors office or dentists office or taking a neurodiverse individual to a restaurant, is take a walk in their shoes and do the preparation ahead of time. Do the preparation, and once we get into that mold to try to help the individual, paradoxically we make our own lives easier and more rewarding, and if youre a doctor or a dentist it converts to better productivity in the office, a better bottom line, better patient satisfaction, better family satisfaction, and everybody’s happy. It’s win, win, win by using the golden rule of doctor Allen Wong.

AW

I dont know who said it but the phrase, “Seek to understand, and then be understood.” It makes a great sense to me, because if I can understand the best way to take care of you and we can understand what Im trying to do, we can both achieve the same success. I think the best teacher really is the patient. Listening to them and how they react to things, and saying, well I need to be able to see this, whats the best way we can do this? I think this open-dialogue communication. The paradigm of the doctor knowing everything and doing everything to someone really, you’ve got to throw the out the door. The paradigm really got to be, “Tell me how I can help you and this is what I need to do to know to help you.” We can both speak at the same commonality and do it in a very respectful manner, desensitize, and I think we’re all clear to win.

HR

That is, to me–that was the highlight of the whole talk. What you just said, and you said it so eloquently and so well, thats what its all about. And its fun. Its fun, you know? I dont know people having more fun than you and Steve Pearlman and Rick Rader and that whole crew. Youre just having fun, youre helping people every day and youre–and thats what I tell the kids over at the Boys and Girls Club and stuff, you know, dont believe society’s kind of big lie that things are mutually exclusive. You can have a good time, working hard, helping others, making a living, doing good for the society, and theyre not mutually exclusive. You can do all of those things, and youre certainly doing it and I want to thank you for all that you do, and are so dedicated. All of the students youre teaching, all of the patients youre treating, all of the colleagues youre helping. Dr. Allen Wong, you’re great. You’re a great one.

AW

Well I couldnt do it without people like yourself and my heroes lke steve and everyone else. Like you said, I dont think its a one person–its really interconnected with all of us, and I think were all here to make each other better and remind each other of our role in here.

HR

Well thank you very much. Now if people want to learn more about what youre doing, how do they go about doing that?

AW

Well, they can email me, if you want to get my email address I’m very fine with that, its awong@pacific.edu. You can also look up our website at the University of Pacific, www.Dental.Pacific.Edu and its under special care dentistry. Or special care.

HR

So if I google Dr. Allen Wong, A-L-L-E-N, correct? Allen Wong University of Pacific and Dental, I’m going to find you all over the place.

AW

I’d hope so.

HR

That’s good. That’s good. Okay, talk a little bit about the special special needs of the elderly special needs population?

AW

Well, you sort of identified a lot of things; they have more complications, they take more medications, their mouth is much drier, there are greater chances of gastric reflux. Often the care providers sometimes get really frutrated that they wont let them brush their teeth so they give up on brushing. So they have physical challenges, they have medical challenges, they have gastrointestinal challenges, they dont eat well, they end up biting their food and not chewing well because they dont have enough teeth and they swallow so they have GI problems as well. Theres a whole host of–its like a domino-effect. The systemic and then eventually the oral, and then eventually the tooth breaks or something needs to be treated and they wont sit in a dental chair; we have patients that have dementia now, you know, where we’re seeing patients with neurodevelopmental disabilities along with dementia, and people like Seth Teller have been on the forefront of trying to study this more to make recommandations. So it’s not getting easier for the population; they hit more challenges; thats why prevention is an even greater, greater necessity.

Allen, I know youve contributed greatly in the literature and publications into different books and things; could you mention, for our audience, some of the publications and some of the books you have chapters in and what that was about?

AW

Great. There are a lot of great authors out there, and I would be remissed if I didn’t mention Dr. Barry Walton, and hes client management for when it comes to scholarly activities. So ive been able to collaborate with him on many articles and different journals; both state journals as well as international journals and dental health. Ive written some chapters in text books for the periodontal treatment type entity, as well as a very good, comprehensive book with Dr. Steven Pearlman and Cameron Reposa on treating patients with developmental disabilities. Ive got another couple of chapters and articles in hospital dentistry books at the office, but this is my basic one.

HR

All right. Well, that’s going to bring us to the end of this edition of Exploring Different Brains. Im Dr. Hackie Reitman. Weve had the pleasure of speaking with Dr. Allen Wong, the professor and director of the Dugoni Dental School at the University of the Pacific, a proud member and leader in so many different organizations; one of which is the SCDA but hes also in the AADMD and is in about 20 other ones that I dont even know all of the initials. But Allen, keep up the great work. Youve dedicated your life to helping those of us with special needs and different brains and really you explained so much to all of our listeners and viewers here. We’ve been speaking here with Dr. Allen Wong, Allen, keep up the great work. I hope to see you soon, and thank you all for looking at Exploring Different Brains. Thanks.

AW

Thank you.

 

 

Author Image
Dr. Harold “Hackie” Reitman is the founder of DifferentBrains.com. He is an entrepreneur, philanthropist, children’s activist, retired orthopaedic surgeon, and a former professional heavyweight boxer. He who currently serves as the CEO of Fort Lauderdale, Fla.-based PCE Media, LLC, the multi-platform production company he founded in 2004. Dr. Reitman wrote, executive produced and co-directed the full-length independent film, “The Square Root of 2” (starring Darby Stanchfield of ABC’s “Scandal”), and is the author of the book “Aspertools: A Practical Guide for Understanding and Embracing Asperger’s, Autism Spectrum Disorders and Neurodiversity” from HCI Publishing. He also hosts the DifferentBrains.com interview show “Exploring Different Brains.”

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