Positive dentistry from childhood to adulthood with Maureen Bennie

In this episode of the Sensory Friendly Dentistry  Audio Conference join Sensory Friendly Solutions Founder Christel Seeberger, and guest hosts Stephanie London and Chelsea Bloom, occupational therapy students, as they take a deep dive into the extensive expertise of Maureen Bennie, parent and autism advocate.

Build a toolbox of strategies for your practice.  Listen to Maureen, Bennie, Autism Awareness Centre Founder, and parent to 2 autistic adults, as she shares her extensive knowledge. Understand the barriers experienced by autistic persons to dental care and learn how to overcome them, in a positive, proactive way.

Episode Guide:
0:00 - Welcome & Host Introductions
0:29 - Introducing Maureen Bennie
0:58 - Autism Awareness Center
2:58 - Making the dentist environment predictable
4:00 - Oral Motor Friendliness
6:30 - Choosing the right dentist environment
7:16 - Utilizing consistency & routine
12:00 - Dentist Sensitivities
15:02 - Advice to dental offices looking to become more sensory-friendly
19:15 - Anesthetic at the dentist
22:58 - Barriers to sensory-friendly dental offices
25:34 - Pre-appointment questionnaires
27:23 - Each patient is different
30:05 - COVID-19 and the impact on the dentist experience
34:19 - Separation Anxiety
37:05 - Open communication with patients
40:35 - COVID-19 Setbacks
42:51 - Low arousal approach
47:32 - Take home messages for dental practice and parents
52:30 - Thank you, Maureen Bennie!

Sign up for the Sensory Friendly Solutions newsletter to receive sensory-friendly tips and strategies delivered straight to your inbox.

Connect with us on any of our social platforms:
Facebook
Instagram
LinkedIn
Twitter
YouTube

Transcript

Stephanie London: [00:00:01] Welcome to the sensory friendly dentistry audio conference brought to you by sensory friendly solutions, where we have important conversations about creating a sensory friendly dentist experience and environment. I'm your host, Stephanie London and in today's episode, you will also hear the voices of co-host Chelsea Bloom, my fellow occupational therapy student and friend, as well as sensory friendly solutions founder and CEO Christel Seeberger. Our guest in this episode is Maureen Bennie, founder of the Autism Awareness Center. The center was created to address what Maureen saw as a gap in support, information, resources and advocacy for those people with autism spectrum disorders and their families. Maureen is also a mother of two young adults with autism. Welcome, Maureen. Thank you for joining us today.

Maureen Bennie: [00:00:51] Thank you for having me.

Stephanie London: [00:00:53] Would you like to introduce yourself to our listeners?

Maureen Bennie: [00:00:56] Sure. So as you were saying, I am the co-founder and director of Autism Awareness Center and I am based in Calgary, Alberta, but I really work internationally. I've had the company for eighteen years, and we do a number of things. My main focus has been conferences and in-person training on something called the low arousal approach, which is small group training to managing behaviors of concern. I also have a book store which has almost 900 titles on autism and related disabilities, and I do a lot of consulting in the book and resource world. I have a blog. I write twice a month for that. I also do webinars, was doing them twice a month and probably moving to once a month in the fall. They're always a lot of work fun, but, you know, a lot of work. And I also speak for things like what I'm doing today. And then just a variety of other answering emails from all over the world every day on different questions pertaining to autism and struggles that both parents and professionals have. So that's sort of my life in a nutshell. I have two children on the spectrum. I have Mark who is 24 now, Julia, who is 22. They're both at home with me full time. And then we have some we do what's called Family Managed Services. So I have staff in here throughout the day. And we try to tailor a very individualized program for them to meet their needs and their interests and their goals as they are going along here in adulthood.

Stephanie London: [00:02:31] Thank you, Maureen, for that wonderful introduction. So you're very knowledgeable on this topic for sure. We're very excited to chat with you today. And I wanted to start it off. I know you've been on the Sensory Friendly Solutions podcast in season one, and you had mentioned that going to the dentist can be a real trauma experience for your children. And I was wondering if you could maybe explore that a bit further and tell us what makes it that way.

Maureen Bennie: [00:02:58] I think there's two things that come into play, not just the sensory and the sensory piece would be really the biggest piece, but also that environmental piece so what I mean by environment is how do you make an environment predictable and very user friendly. So, for example, for us, what we had to do is I had to go down to that dental office first, take all photos of the place, and then put together a whole booklet on what was going to happen. And the dentist that we were working with and we're still with today. He was very willing to just do things like, for example, have them come in and just sit in the chair for a few minutes and then leave. And that's all we did. Then the next visit, he would just count their teeth. So that was this concept of having the mouth open and that someone is, you know, going to have a finger in there. And what is that like? And then we were also trying to do some of those oral motor sensory things at home as well. So wetting a washcloth and running it around the teeth, buying something called a NUK, which has like the baby toothbrush. It doesn't have actual bristles on it. It's got little raised rubber ends on it and running that around. So that's where it has to start. You have to start with this whole getting used to what are these sensory sensations.

Maureen Bennie: [00:04:24] And I think a lot of problems that we struggle with in dentistry as well is that our kids are not always the best brushers. They don't understand how much force and gradation to use the pressure. And it's also a really complex, fine motor skill where you have to be able to rotate a brush around. You have to get, you know, at the back part of the teeth on both sides of the teeth, on top of molars around the front. And a lot of those areas will have different sensitivities as well. Like some people are more sensitive on the front teeth, some people are more sensitive on the back, and then if you can't do a lot of those basic dental care, things like flossing, you are going to have, you know, inflamed gums. You're going to have pieces of food stuck in between the teeth. So there's a lot of layers to this. So I always say, you know, to parents, you really have to address both that environmental side, making that as predictable as possible and walking them through the process. And that may have to be done in small steps. And then also looking at how do we build oral motor friendliness? How do we work up to this? Because many people just booked that appointment and go in it. And I did that mistake, too. And I will tell you that I was so horrified by why I took my son to the children's hospital when he was two.

Maureen Bennie: [00:05:48] And the dentist just told me to pin Mark's head in between my knees. And she went at it. And I had never seen anything like that in my life. My son ended up passing out when I took him to go back to the car. Yeah. And was not really coming to for a little bit. There was just an absolute full shut down. And so after that experience, I thought, OK, I have to really do something differently. And it took me a while to find the right dentist who is willing to do this as well, because, you know, time is money. But he was willing to say, sure, bring the kids and we'll just have them sit in the chair and then they'll go. And it was also looking for that right office environment as well. So as in a pediatric dentistry office, I mean, he had a big train going around. And my son really loves Thomas the tank engine and still does. And he'd always give the kids little prizes when it was over. So, again, if you're starting with younger children, you may want to look if you can, if you have the option, that's not always the option. In a smaller town, in a rural setting, you may only have that one dentist, but sometimes it may be worth making a little drive somewhere else if you can find someone who really specializes in the pediatric population.

Stephanie London: [00:07:04] Yeah, exactly. No, it's definitely important to have a dentist who's prepared and ready for these differences and needs of the population, especially the pediatric population. And you kind of started to allude to these things of the importance of kind of routine and consistency, which you also mentioned in your last podcast with us. So do you think that parents can utilize these factors of consistency and routine to promote a better dental experience for children?

Maureen Bennie: [00:07:33] Absolutely, and I think you also have to break down the steps of that experience, and you can do that again by either using videos or you can also use visual supports. And there's lots of websites that even have like what are the breakdowns of those steps? In fact, on my website, I wrote in my question and answer section, you know, how do you make a dentist visit successful? And I've got some links in there to different apps, to different visual supports. So they're really readily available. And I think this has been such a great thing now as in the 21st century, that we've got this technology that can instantaneously and very simply produce these, you know, these kinds of tools, because even when we started, you know, we didn't have those kind of cell phones with cameras yet. You know, Google wasn't up and running. And now we have such ready access to these materials. And in fact, almost every dental office will have an excellent website as well. And there may be photos on there and there may also be information on their particular procedures. So I also think it's helpful too if parents can go first, maybe just set up a meet and greet interview and get to know that dentist or how, you know, how does the office work? You know, another thing, too, is really reducing wait times, because I know not every dentist can avoid that.

Maureen Bennie: [00:09:05] Sometimes they have a dental emergency come in. But, you know, the longer that that person has to sit waiting for that appointment, the higher the chance you're going to have anxiety building, which could again then, you know, lead to some kind of a stressful reaction if the person is just sitting there and waiting and waiting and waiting and nothing is happening. So I always say to parents to make sure you bring some little activities with you in case you do have that wait time, that's unpredictable as well. But you want to keep it as predictable as possible, as routine based as possible. And I mean, here my kids are at 22 and 24 and their dentist is still doing those exact routines that he set up when they were, you know, three and four years old. And it works.

Stephanie London: [00:09:49] Yeah. No, I definitely think that's important because the dentist is not something that you do every day. So it's important that when you do go to the dentist, that the dentist kind of maintains that routine for children in order to so that way they know what to expect, kind of.

Maureen Bennie: [00:10:08] I think more frequent appointments can help as well, particularly if you have children that aren't really moving that brush around well, that aren't, you know, getting the pressure. You can have real tartar buildup, of course, and and and then impacted food and a lot of plaque. And the longer that's left, the more, you know, digging that has to happen. And I mean, we had that whole example just we didn't have a dental appointment at all during the whole pandemic. So my kids were over a year and oh, boy, that was a tough one even as far as we've gone. And they know the dentist office and everything, because there just was so much buildup to remove in that time period. So if you have a dentist, too, that's willing to say, you know, I'll meet you every three months instead of every six months, that can cut down on the length of that appointment on, you know, how much picking and scraping that they have. And none of us like that. I mean, none of us like that. I'll tell you that when I go, you know, they always take my blood pressure and every time it's really high and then I'll go to a drugstore, you know, and take it myself and it's fine. And I know it's just because I can't stand all that digging and flossing and cold water spray. And so, you know, I think everybody has their issues at the dentist for sure, diagnosed or not. Right.

Chelsea Bloom: [00:11:34] So I actually had a question then about your talking a bit before about how certain I guess certain people have different sensitivities. Like right now you're just talking for you, the scraping and the water for your kids when they were going to the dentist. Which of those eight senses did you find like affected them the most? Like, I know there's touch, smell, taste, vision, hearing, movement, balance and the newer one interception. So which one do you find was the most affecting them with their experience?

Maureen Bennie: [00:12:10] I would say for my daughter, it's an interesting combination because she's very auditory defensive. So I know that she didn't like, you know, when they're doing the water. And I mean, thank God neither of my children have ever had a cavity, but that, you know, there's that high it's kind of got a high pitched sound. Some of that or the polishing for the floor. It has a high pitched sound. And I think for her, too, it was the touch, just having somebody in her mouth, like making any kind of pressure, scraping. Mark did a lot better. And he's got a different sensory profile than Julia. But his personality is one of being a people pleaser. And he's almost willing to override any kind of discomfort. He has to be that people pleaser. And he had a real connection, a real relationship with our dentist. That and he looks forward to seeing him. But there's also this added bonus of seeing the trains. He brings particular Thomas the trains tank engines with him to sort of be connecting with these trains that are going around. So if he had sensory issues, honestly, he doesn't really let them be known.

Maureen Bennie: [00:13:34] And because he's willing to be such a people pleaser, he will pretty much agree to do almost anything. He's completely relaxed. He's trying to chit chat in between. And I mean, he's very verbal, but his speech is not always intelligible or you can't always understand what it is he's trying to say. But he does like to talk a lot. So he’s been rather good. But I will say when they were little, I didn't even risk the big cleaning. Both would go under general anesthetic. And because that is a big deal, you don't really want to be putting children under general anesthetic for these kinds of procedures. So, I mean, we started there, but it was really a big motivator for me to figure out another way, because I really didn't want this to become the normal procedure for doing a teeth cleaning, you know, every three to six months. That's just too much general anesthetic. So it took a little bit of time. But again, you know, we were working on that at home with the running the washcloth around and the little NUK. Yeah.

Chelsea Bloom: [00:14:49] So like the routine and building that relationship with your dentist really changed your children's experience with the dentist, like from the first time to now.

Maureen Bennie: [00:15:00] Absolutely.

Chelsea Bloom: [00:15:01] So what is like for dentists who are trying to start a more sensory friendly practice? Like what kind of advice could you give that helped your children go from that point at the beginning till now, especially your son, who is very he's not as sensitive to it.

Maureen Bennie: [00:15:23] I think offering sensory tools as well can help, so if they have like a little basket, there are things like where you've got a stress ball, where you can hold something and squeeze it. So I mean, Julia needs that type of assistance. Noise canceling headphones can help if that child, excuse me, is really sensitive to hearing those different kinds of high pitched, whirring sound. So, I mean, that's a really easy solution. In fact, if I think about it, I think Julia does take her noise canceling headphones, not every time, but she often does. And again, I think that whole relationship that our dentist built with this, let's just start with having them sit in the chair and make it a very friendly approach, because it's like anything you need to build trust with somebody before they're going to make themselves somewhat vulnerable to you. And when you think about you're in a dentist's chair, you've got a very bright light in your face, your tilted back, which a lot of children don't like either, because that's very disorienting. You have that bright light in your face and you're sitting there with your mouth open. It's a really vulnerable position to be in. So I think, again, if you can build that trust and I talk about this, we talk about this a lot in the low arousal approach that I mentioned at the very beginning of this podcast, that when you have those really trusting relationships, then you tend to have a better experience with that person on the spectrum because they they trust you.

Maureen Bennie: [00:17:01] They don't mind being in that vulnerable position. So you that's what you really want to work towards, is getting to know the person and then also having those tools to alleviate any of the discomfort. You know, if you've got, say, a non-verbal child, can you have some of those little pick symbols there where they can hold up a stop? Because you know how the dentist is saying, just tell me when to stop. And our kids, they may not, especially if they're anxious, even if they're verbal, they may not be able to access that language in the moment. So have a little set of those pic symbols like stop, you know, wait. You know, I need time, whatever those can be to work. And you can get general ones. And again, you can find those on numerous websites like do to learn or they're all over the place and then have those kinds of tools accessible as well.

Maureen Bennie: [00:17:57] And I think that could even help for anyone who is highly anxious at the dentist. I mean, you can be using those little symbols for anyone or for, you know, young children, again, who may not have that instantaneous access to language to say how they're feeling, which connects us, again, to that interception piece. Because, you know, it's sometimes not until something really builds where that person will have that connection, like I'm really uncomfortable now. And then that's when you can have that more explosive behavior. So it's always giving those tools, giving that out. So maybe that person even needs to get out of the dentist chair every ten minutes and walk around and then come back. Right. Or maybe they need to wear the dark glasses to not have that light in their face. So both of my children wear very heavy, dark sunglasses when they're in that chair as well to dampen that light. So finding those tools that lessen the level of the sensory input, but as well, letting that person know you've got an out, you are in control. You can tell me when to stop. Here's the little signs. You're going to be holding them and. That helps.

Stephanie London: [00:19:11] I'm just curious, going back to when you were talking about how your children needed to be put under local anesthesia when they were going to the dentist. Do you think that had the dentist been employing some of these sensory friendly solutions, that that would have been necessary for your children?

Maureen Bennie: [00:19:30] You know, it's hard to say, but I think why that, for example, happened with Mark. I described that early first dental experience where I had his head pinned in between my knees. I mean, I was uncomfortable doing it. But at the time, like I was so new to the world of autism, I didn't really understand the sensory piece yet. And I think if you're if you have a child that has had some of these early traumatic experiences around dentistry, let's say, too, if they've had cavities really early or they've had to have a tooth pulled or they've even had like a dental injury where they've fallen down and chipped a tooth or any, you have to look at what is the history. So if there have been traumatic experiences around dental or traumatic experiences in general, you may have a hard time. So I, personally we had to play that by ear, but we had not had good experiences up until we found this particular pediatric dentist. So I think you just have to really look at each case individually. For example, my daughter is going to have to have her wisdom teeth out. And I know that's going to be a big deal. And we will probably have to look at a general anaesthetic option for that just due to the level of anxiety that she still has around going to the dentist and then she can't have her usual dentist do that procedure. So I think you have to look at that, too. Are you in a practice where they're rotating dentists? Are they going to be with a new person? There's just a lot of things.

Maureen Bennie: [00:21:15] So I think if if a dentist is willing to take this in much smaller steps and support along the way, you may not need to get to that anaesthetic part, but you may always have a child that feels very anxious and will not really cooperate in, you know, in that procedure. And it's interesting, because one of the first things I ask, too, when parents come to me and say “my child is chewing on the side of a wooden table” or “they're chewing on inanimate objects like a piece of metal or something”. And then the first question I always ask them, when was their last dental visit? And sometimes I hear, oh, five years ago. I'm like, OK, you've probably got some inflammation there, some sensitive gums. And if you're seeing any of those sort of unusual types of behavior or something starts like that, you may have a cavity there. You may have impacted food in the teeth that are really, you know, causing pressure on the teeth or in the gums. So you want to investigate that right away. And that's why I'm very adamant about if you can have those regular appointments, make them more frequent so that we don't get to a situation where you're like, oh, we've got four cavities here. We've got a big procedure coming up. Right? Yeah. And I know, I can be an avoider too, just like everybody else. I don't want to face it. But if you can, you know, keep those visits frequent and short.

Stephanie London: [00:22:52] Yeah, exactly. So the importance, again, of keeping a routine. And so your dentist now is sensory friendly and incorporates a lot of these things that you had mentioned. But what do you think are the biggest barriers for dentists who do not have a sensory friendly environment currently?

Maureen Bennie: [00:23:15] If well if they don't have a sensory friendly environment, then to me, they don't really understand the level of importance of this piece in dentistry, so that for me, if I walked into a dentist's office and I saw there were absolutely no accommodations happening, I would be pretty frightened, like scared. I would be scared because I would think this may be the dentist even thinking, well, this is a mind over matter thing or, you know, we're going to be able to get this in control. And again, it's about if you don't have that positive experience and it becomes a traumatic experience, then it's very hard to get that child, that person back into that dentist chair again. So I think dentists can make it easier on themselves by, you know, having that soft lighting, maybe having that gentle music, you know, providing the dark sunglasses. So having those sensory tools. And we're not talking about things that are really expensive to do. We're talking about very minor accommodations that can, you know, make or break the whole experience. And personally, if I was a dentist working on people all day long and people were, you know, freaking out and jumping out of the chair or, you know, really making it hard on me, I would want to examine that and say how can I do this better? And it can even be things like, you know, soft colors, like a soft green, a pale yellow, you know, nice pictures on the wall. Or it may also be not being too visually stimulating, you know, not having a lot of geometric shapes or that sort of thing. So. Everybody's different.

Stephanie London: [00:25:05] Yeah, exactly. You know, it's all about preventing these traumatic experiences from happening because then people will want to go back to the dentist.

Maureen Bennie: [00:25:14] Oh, absolutely. And prevention and, you know, laying the right groundwork first is far easier than having the bad experience and now having to backtrack and try to undo that. That is much harder to do.

Stephanie London: [00:25:31] Yeah, exactly. That's why I've also heard of some dentists who send out these pre appointment questionnaires. So basically before meeting a new client, they'll basically have a questionnaire or a little interview where they have to fill out kind of what their needs are, what they expect from the dentist. And then that kind of gives a dentist who may not be sensory friendly yet more of an idea on how to accommodate for each client.

Maureen Bennie: [00:25:55] I think and I think that's a great idea. And I mentioned that in this podcast, too, about that idea of meet and greet and really going through like what are the needs? Because here I am with two children with an identical diagnosis, and they couldn't be more different in their sensory needs. So even going to the same dentist, you know, we had to say to our dentist, like, you've got two completely different children here. And interestingly, too, with Julia, she's really been a person that has a very, very high pain tolerance normally and doesn't complain about anything. So like one time she had an ear infection. Most kids are screaming when they have an ear infection. I had no idea until it burst and all of this liquid was coming out of her ear. And I said, what is this? But she had pulled all of her hair out around her ears. So I didn't connect these two problems together. Right. So, yeah, it's far easier to set the right tone and tempo in the beginning, right from the start, than to have a bad experience. Like I never went back to the children's hospital dentistry program after that, because I, I don't even know if I would get Mark out of the car after that. Right. So we had to start again. And that's when that's when I started to really do the research and say, OK, this needs to be a lot different the second time around.

Chelsea Bloom: [00:27:21] And you just mentioned how, like your kids, although they have the same diagnosis or like completely different, and it's kind of like a concept that me and Stephanie have learned throughout our undergrad experience about how OTs look at the client like separate from the diagnosis. So although you could have certain things that help a certain population, you have to like to implement those things, but also like, I guess kind of take it with a grain of salt because everyone's going to be different. So just like you said, for like your two children, like the toys helped your son, but the noise canceling had to do for like helped your daughter. So do you find the dentist should maybe not like have a kit, but have something to cover all the different sensory problems?

Maureen Bennie: [00:28:18] Yes, I and I call it the toolbox. Build your toolbox so that you can pull the right tool. A car mechanic just doesn't have this one set of tools for one type of car. Right. They have to have a wide variety of tools because not every wrench is going to fit. I mean, I don't know anything about cars, but do you know what I mean? Like, if you have any kind of a practice, it's the same thing with what I do in Autism Awareness Center. The blogs I write are of a wide variety for different age groups. You know, is the person verbal? Have they had trauma? Like there's so many things that come into play. And the more tools that you have in your toolbox and are able to access very quickly, the more success that you will have. And we really are talking about very simple, inexpensive tools, something like a fidget for your digit, which is, you know, a little spring that you can put on your finger and just roll. That may be enough distraction for someone to not be focusing on their mouth the entire time. Right. And distraction techniques can often work really well. And like when Julia is very upset about something, if I start talking about certain cats that she loves on the Internet, like moru, or these different cats she follows, they all have their own YouTube channels now, famous cats. That can almost take her right out of herself and stop this hyper focusing on, you know, what the upset is at hand. And it doesn't work every single time. But, you know, having some distraction there or that's why, you know, maybe even squeezing that stress ball can take the distraction off of being in your mouth onto I'm squeezing something in my hands and I'm putting my energy there.

Stephanie London: [00:30:03] I actually wanted to talk a bit about how Covid has really impacted the dental experience for you and your children, because I know that now there's a lot more sensory things that have been introduced, sensory objects, because now people have to wear a mask, people have to apply hand sanitizer. And you mentioned your dental clinic is sensory friendly. How have they accommodated during these times?

Maureen Bennie: [00:30:30] Well, I have to tell you, because I told you I wasn't at the dentist for a year and I made the mistake. I should have called first to ask what the protocols were, and I didn't. And that was a big booboo on my part. So when I got there, they were like, you can't come back here. And I've always come back there with the kids. And they said they would only take one child at a time. And usually both are back there together, sitting side by side. So I had to leave with one and do something else. And I was scared because I have never left either one of them alone at the dentist. And I'm like, you phone me right away if you need. Like I didn't go very far or anything, but you know, you phone me if you need me to come back. But, you know, it was interesting. In some ways, I think they did better. Now, again, they're in their early 20s. But, you know, when Julia's got me sitting there, she's a lot more fussy. And apparently she was fine. Now, maybe she was fine because she was actually internalizing a lot of that and not being letting that out because she didn't feel she was safe to do so. She's maybe letting that out more when I'm sitting there and she's got a higher comfort level. So I didn't completely feel like, OK, it may have gone fine in the moment, but I'm not completely convinced she was very comfortable with all of that. But then they went a second time, just a couple last month, and it was much like there was no problem at all.

Maureen Bennie: [00:32:04] So, again, I think that was an element of surprise. So I would recommend to parents like keep, you know, phone ahead of time and say, like, what are your Covid protocols? Both of my children have known there is the expectation for masks. We did work with hand sanitizer right at the beginning of the pandemic. So we did have to work on those sensory issues. And interestingly, when Mark has a mask on, he feels he cannot speak. So it's like having a gag on. Yeah. Julia will wear a mask. She doesn't like it, but she's also quite quiet. But Mark actually thinks he cannot speak through this mask. So you get no communication, no response to anything. So most people think he's nonverbal when we're out, when he's wearing a mask, plus a mask takes away a huge amount of information that everyone uses to pull together for emotions. So it's added a level of difficulty for sure. And of course, then your hygienist, your dentist is also masked the entire time, which really alters their appearance. You're only just looking at eyes. And for both of my children, they find looking into eyes, eye contact is too intense for them. They don't like it. They tend to look away. So they're getting very little information because pre-Covid, they would look more in your mouth area to get their information about, you know, emotions. And they won't really look directly in eyes. So certainly phone ahead of time and ask what are those procedures? And I think don't think too that, oh, I had an appointment six months ago and it was like this and it'll be like this again.

Maureen Bennie: [00:33:56] This is changing all of the time. And I think as we also get new variants, as we learn new information, you know, that these protocols may be changing. And the other thing I just contributed to a book that's coming out soon called Life After Lockdown, and I wrote on the anxiety piece and seeing like how anxious my kids were being left there. There is really a huge spike right now in separation anxiety because our kids are not used to being left alone now. Right. Like many parents have been working from home, school has gone online. So they've really come into this cocoon-like existence. And certainly this has been true for my children. I mean, they're out of school, but they lost every single activity. And my daughter is literally sitting beside me here while I work like up to 10 hours a day. She can be right here beside me. So separation anxiety can start even in adulthood for the first time. And we are seeing this spike in separation anxiety where they think something's going to happen to the parent or the parent isn't coming back. You know, Mark, even going outside, keeps saying to me, he calls it Corvid. He's like Corvid is there. It's out there. And Covid is such a difficult thing to explain because it's that, you know, the boogeyman is in the air. What does it look like, we can't see it, we can't feel it, we only know if we come down sick that we have it.

Maureen Bennie: [00:35:37] So this is a very abstract concept as well. But I also have to keep assuring my children, we're keeping you safe and here's how we're doing it. And again, it's introducing it's back to this element of control. You have to make sure that that child feels, even if they're little, that they have a sense of control, that a mask is keeping them safe from Covid. They're not going to get Covid at the dentist's. And you explain all of these safety procedures and why they're there. And I think don't be hesitant because some people think, oh, if I give my child all this information, they’ll, you know, they'll ruminate on that and they'll make it much bigger. But it's like anything you have to take the mystery out of it, because once the mystery is out and the explanation is there, it's usually OK. So even when I'm leaving to do anything, even now, I always tell my children I'm going out to do this. I'm going to be back at this time. And, you know, they're in their 20s, but they would particularly, Julia, would have some anxiety about when is she coming back? And she is a little bit undone. Like the other day, I went for a hike and I was gone like eight hours. And I told her that I was going to be gone a long time. But there was still I could see that there was some spike in anxiety over that separation.

Stephanie London: [00:37:02] Yeah. You bring up the importance about open communication and being able to let everyone know what you're doing in advance and being the most prepared for these situations. And I think that also translates back into the dentistry environment just because it's important for dentists to be able to have that open communication with their clients, to be able to let them know what to expect. I know my dentist mentions the concept called Tell, Show, Do. So telling your client what you're going to do. Showing your client what you're going to do. And then finally doing that. So it's important before that you do something or carry out a procedure or start to clean a client's teeth. It's important to be able to communicate as much as you can to remove those unknown factors and to avoid all of this built up anxiety and to prevent these negative experiences from occurring.

Maureen Bennie: [00:37:56] Yeah, well, just taking the mystery out of it. Just get it predictable. Don't you know, if something is unknown, you're going to be far more anxious. What's going to happen to me? What's happening next? What is this piece of equipment that they're bringing out? And that's another thing, too, that a dentist could do, is show how equipment works. Right? Like they could give a little demonstration. They can let the child hold it so that little spray or, you know, just spray it into, okay, this is what this is. And again, you're taking that mystery out. You're making it taking something that is abstract because you can't see what somebody is doing in your mouth. Right. So it's about taking an abstract concept and making it concrete and to give you an example of that. So when my, this is like a little bit off topic, but it could be brought into dentistry, is that when my son is flying in an airplane, he actually holds a replica of the airplane for the entire flight in his hand. So if he's on a West jet flight, he has to hold the West jet plane. If he's on an aircraft.

Maureen Bennie: [00:38:58] I have every airline, by the way, that makes a model plane. And I think it's how he makes this. Like this is what I'm like inside this tube up in the air. And this is what it looks like from the outside, because, of course, when you're looking out the window, you only see a little bit of the wing or you only see a little bit of the front. You can't get this. What does this entire object look like? So even things like it may help some children to hold those, you know, those teeth dental molds in their hand. Or to have somebody there, you know, with a model of teeth and saying this is what we're doing now just to make that abstract experience that all you can have is the feeling part of it. But think about even if I were to blindfold you, you know, and stick your hand in cold water, the feeling of that is much more intense than if you have your eyes open. And you can see my hand is going into a bowl of ice water. So, again, making it concrete, taking the mystery out will really lower that anxiety.

Chelsea Bloom: [00:40:05] So kind of keeping them in the loop of what's going on and what's going to happen to help make them more comfortable, which I guess also could happen by creating this routine. And you suggested it in the beginning of our conversation that having more frequent appointments could help make the dentist a more comfortable, positive experience. And do you find that because of its bringing it back to Covid, but do you find that because of Covid and that like gap between going to the dentist and coming back? Not if it was like a setback. Do you think it influenced their experience because there was like a big break?

Maureen Bennie: [00:40:50] Yes, I would call it. I think you used a great word. I would call it a setback because we had far more tartar buildup. There had to be a lot more, you know, pressure put to pick all that off. In fact, they thought they were going to have to have more than one appointment. They didn't think they were going to be able to get all of this mess off in one fell swoop. Then, of course, they've got very sore gums after which they're not used to having when they go every three months. But I mean, the dentist was actually closed for a period of time. And then I had a certain level of fear over it as well, because Mark has also a higher level of immunocompromised from an injection monthly injection that he's on. So even though they were doing all of those protocols, I had some fear around it, too. So I think if there's been an interruption in dental appointments, absolutely, it can be a setback. And then also all of these new changes and protocols that have been introduced during Covid can be a setback, too, because now it's not what it was before. Right. It's now these people are fully masked. And there's not I don't know, there's hasn't been that many changes in my opinion. But like the big one for us was you're not allowed back here now. We can't have this many people back here. You know, Julia and her brother are very emotionally connected. They're like a real support for each other. So even that separation was a bit of a wrench for them.

Christel Seeberger: [00:42:25] Maureen, you've shared just like a phenomenal amount of tips and strategies, your brilliance, I think, for dental care, but also just very much tying that in to parents and patients. It's the team together, problem solving together. So just. Yeah, amazing, very concrete examples that I think everyone can use going forward. I'd like to circle back to something you mentioned at the very beginning. I think it was something that you're championing, which is the low arousal approach. I'd like to invite you. I really, that piqued my interest. I'd love to hear a little bit more about that. It's overlap with dentistry. If it does overlap and does it overlap with the sensory experience at all at dentistry? I'd really love to hear your thoughts on that.

Maureen Bennie: [00:43:20] It's very tied in because you really have to understand autistic neurology as well. And that this brain experiences the world differently. And I mean, we're starting to have more of these conversations on neurodiversity, which I think is fantastic. But we still have a tendency to isolate problematic behavior like outbursts or aggression. And we say, oh, my gosh, this child is just there being difficult and we're not really going beneath the water line to say, OK, what has built up to this outburst or this resistance or there's something more at play here. We're just seeing a symptom. So that's what I've liked about low arousal approach, because it is teaching people how to recognize when someone's arousal mechanisms are becoming engaged. And that can be very subtle for my daughter. She starts twirling a piece of hair. If I see the hair twirling, I'm like, uh oh, we're going to tip here in a certain amount of time. But she's not being vocal about it. She's not screaming. She's not being difficult. So people will overlook those kinds of subtle signs. So low arousal is really about understanding when are these mechanisms becoming engaged? And you have and also what is our role in it? So a lot of times when people are becoming upset, we tend to do what I call the laying on of hands.

Maureen Bennie: [00:44:52] So we might start to, you know, touch that person and say, calm down. And I'll tell you when someone's getting upset. Nowhere in the history of the world is touching person and telling them to calm down ever works. And it never works here. In fact, usually touching a person will send the arousal mechanism even higher. So you can start to really get escalation going. So it's again, it's this relationship piece. What is my role in escalating this situation and recognizing when it is escalating and how do we bring that person back down? So it comes back to this, you know, this being prepared that the sensory tool kit and using those things that really work and also not thinking of it is giving in, because I have so many people that say to me, well, aren't I giving in? You know, if they're getting and I'm like, no, no, you are heading off something that's going to escalate into a potentially traumatic experience. And a lot of autistic people do have this rumination piece where they have incredible memories and they ruminate on a bad experience that has happened to them.

Maureen Bennie: [00:46:03] And I'm seeing that with my daughter. Now, she is now going into incredible detail with me about negative experiences she had in junior high. And I'm like, Julia, this was over like eight, nine, 10 years ago. But it is so vivid with so much detail. It's really been a repressed memory that's now coming out. And she does ruminate and perseverate on that. So you really do have to understand that neurological piece and also that we have an active role, support role. And how are we going to play that role? Are we going to dig in and just say, oh, this person is manipulating me? And they're trying to get out of this situation. And as you escalate a situation, yes, that person will go into that, you know, fright flight mode and they will want to get out of there. And you never want to get to that stage, because that's traumatic both for the person who's in the room or supporting the dentist, as well as for the person. And then it just makes it all that much more difficult to come back round. So, yes, I think low arousal plays a very important role in all of this.

Christel Seeberger: [00:47:15] That's thank you so very much, Maureen, for explaining that. I think that really tied a lot together. Right. And in our conversation today. I'd like to get to know before we close off the conversation if you had just one take home message for dental practices and maybe one take home message of parents to either inspire or inform them in this journey towards, you know, good dental care, which is such a critical part of good overall health.

Maureen Bennie: [00:47:54] I would say for the dentist, it's the predictability and letting that person feel they have control over themselves and what they're feeling and that that is going to be respected. If that trust is not there, you're not going to have that successful appointment. For parents, it's about, again, trying to help with this oral motor piece, you know, helping them with brushing. For example, even today, my children still use the children's toothpaste. They could never graduate to that strong minty flavor. And we're trying right now because Mark doesn't put enough pressure when he's brushing to introduce mouthwash. But we've had to really explore that and not get like the ones with alcohol in really sting. They now make these ones without alcohol that say zero on them. And those are much more gentle. And so we're going to have to do like a gentle introduction to that. So, helping your children become a little less oral motor sensitive if possible. It's not always easy to get dental floss in there and whatnot. But even if you can do those gentle things like you're having a bath and you just for, you know, a few seconds, take that washcloth on your finger and run it around, just start to get used to having that feeling in your mouth, because it helps in the long run, because you never want to get to a point there where you're having to have teeth removed, cavities filled. And I'm very, very lucky, neither of my children have ever had a cavity, but I'm 55 and I've never had a cavity.

Maureen Bennie: [00:49:38] So I don't know if they. Yes. So I don't know if they've inherited that from me or whatnot, but, you know, it's about what is that good hygienic health and that hygienic health will help them to be successful in adulthood as well. Because when you start to think about, OK, I'm in a volunteer position or I'm in a job, you know, and you come with teeth that aren't flossed and for it's really off-putting. So you want to always think from a parental point of view about looking forward. Right. Like, what is this going to look like when they're 20, when they're 30, when they're 40, and you have to start building a lifetime of good habits when they're two and three years old, even though it can be very difficult in those early years. And you just want to give up. And this will never happen. And kids do mature over time as well. So it won't always be like that. And they also develop their own strategies and coping mechanisms as well. So Julia is a real pro at doing a lot of that relaxation breathing now when she's at the dentist. But it took us many years of rehearsing, relaxation breathing so that she could access it in those moments. So it's a long term process with a long term arc, but it's always about taking those baby steps along the way and keep at it and add, you know, more and more to that so that they can be successful on their own and start to access those tools themselves.

Maureen Bennie: [00:51:14] Like I'm proud of Julia now, where she's at a point when she has something stuck in her teeth, she goes and gets the dental floss on her own and gets it out. Right. But that took us time to get there. You know, Mark is willing to have somebody floss his teeth, but that took us time to get there. We're going to be in a slow process on introducing the mouthwash, because, of course, the thing I'm most scared about is that he's going to just drink it. Right. So how? Because the second he puts it in his mouth, I'm not going to have control about him spitting that out. So I have to admit, I'm going very slowly right now. I will do a lot of demonstration, with me doing it first and explaining and we'll have the visual supports. And then hopefully he can get into doing the mouthwash himself. But it will take time. I can't just hand him the mouthwash and think, oh, he'll watch me do it once. And that's done. So it's still even at this age, in their early 20s, there's still this step by step process to take the mystery out of it, to get it familiar. And again, going back to what Chelsea had said many times, to get it part of that routine, and once he's going to have that in his routine. He will never not do it. So, yeah, we're looking at a good future there, I hope.

Christel Seeberger: [00:52:31] Lovely. Maureen Bennie of the Autism Awareness Center. What an informative and inspiring conversation about just the team that's needed between parent, patient and dental practice. Yeah, I cannot thank you enough for just how much wisdom, insight, experience and recommendation you've shared with us today. Thank you.

Maureen Bennie: [00:52:59] Thank you for having me and for giving me the opportunity to share my own pitfalls and dilemmas along the way to really have the success that we have now.

Chelsea Bloom: [00:53:10] Thank you to Marine Bene, founder of the Autism Awareness Center, for sharing her insight into the barriers that people with autism face when going to the dentist, as well as her experience with being a mother of two young adults with autism, Maureen's expertise on the topic shined through as she provided us with valuable information, including tips and tricks on how to promote a better dental experience. For example, her explanation on how dental clinics can create a sensory toolbox for patients demonstrated how to provide individualized and client centered care. This personal approach links to our conversation with Cindy Green and Megan Gallant, where we discuss how every child requires different accommodations as they all have different needs and sensitivities. We are very lucky to have had the opportunity to discuss these difficult but necessary topics of conversation and hope that you, our listeners, are enjoying and learning a bit more about sensory difficulties in the dental environment, as well as strategies to be able to create a positive experience for those living with sensory challenges. Stay tuned for more rich conversations. Have a sensory friendly day! You can find more information about creating a sensory friendly dental practice on our website, sensoryfriendly.net