You can make a difference with Dr. Rachel Korman, dentist

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 have an insightful conversation with Dr. Rachel Korman. 

Discover the joy of dentistry with new graduate and current pediatric resident, Dr. Rachel Korman.  She speaks about her passion for finding ways to make dental care accessible, inclusive and welcoming and the purposeful way she has included that in the launch of her career.

Epsiode Guide:
0:00 - Welcome & Host Introductions
0:24 - Welcome Dr. Rachel Korman
2:00 - Dr. Rachel Korman's education on sensory sensitivities
5:15 - Dr. Korman talks about the barriers to oral care
6:17 - Strategies Dr. Korman learned from school, and the education gaps.
10:49 - The biggest sensory challenges at the dentist
13:52 - Breaking down the tasks
15:07 - Dr. Rachel Korman discusses the Oral Health Total Health event
17:48 - Dr. Rachel Korman's thoughts on teaching oral health care to children
21:09 - Laura's advice to parents
24:52 - Accommodations for special needs patients
26:46 - Texture sensitivities
28:39 - The biggest barriers in oral health care
31:55 - Modernization of clinics and the affects of oral health care
34:00 - Utilizing technology
36:20 - Knee to Knee Exam
40:03 - Dr. Rachel Korman's vision for the rest of her career
43:14 - Thank you, Dr. Rachel Korman

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Transcript

Chelsea Bloom: [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, Chelsea Bloom. In today's episode, you will also hear the voices of co-host Stephanie London. My fellow occupational therapy student and friend, as well as sensory friendly solutions founder and CEO Christel Seeberger. Today, we will be speaking to Dr. Rachel Korman, a recent graduate from the McGill University Faculty of Dentistry, who is currently enrolled in a pediatric general practice residency in Halifax, Nova Scotia. Dr. Korman has had a lot of experience working with children, with special needs, and has expressed interest in continuing to gain more knowledge on how to treat this population. We are very excited to speak with her today and learn more about her education and experiences. Welcome, Dr. Korman. Thank you for joining us today. Would you like to introduce yourself to our listeners?

Rachel Korman: [00:00:53] Thank you. And hi, everybody. My name's Rachel Korman. And yeah, recently I graduated from McGill University Faculty of Dentistry, and now I'm in Halifax. And as Chelsea explained, it's a mouthful. But a pediatric general practice residency. It's a one year program where I'm working out of a children's hospital and seeing kids with all types of medical conditions. But a big emphasis on children with autism, ADHD. And it's been a very steep learning curve in the first few months. But I'm really enjoying it and looking forward to doing a lot more of this in my career. So thank you for having me here today and for letting me talk to you guys about it.

Stephanie London: [00:01:38] Thank you, Dr Rachel Korman, for that lovely introduction, as well as taking the time to come speak with us today on this important topic. I guess we'll start off now that you've introduced yourself to our listeners, just to ask you, based on our topic, sensory friendly dentistry, have you had the chance to explore or learn about dentistry for people with autism?

Rachel Korman: [00:02:00] Yeah, actually, during my undergraduate or my dental degree at McGill, we learn about pediatric dentistry and the techniques and behavior management skills that you need to acquire when treating children and almost a step up when you're seeing patients with special needs. And so you get a sense of the different techniques that you should be using, what you should be aware of, because, as you know, the second that you walk into a dental office, it's like sensory overload, kind of, there is bright lights, there are shiny tools, there's loud noises. There’s a lot of things that you've never seen before. And so I guess we try to prepare ourselves in dental school and we try to get as much training as we can. A video actually that really helps me kind of put myself in the mindset was the program director at my hospital actually showed it to me. It's by the national, I think Autism Society of the U.K. and they have a video and it shows you from the perspective, I think they interviewed a bunch of people with autism and it shows you, them walking through a mall and what they experience. And so all of these bright, flashy things that you see around you and someone who's just walking around like, you know, everything's normal, but for them, it's like so many things are going on. And so to think about just walking through the mall is such an overwhelming experience. Walking through a dental clinic must be so much more. So we try to prepare ourselves as much as we can in dental school and trying to understand what the experience is like as much as you possibly can and just being aware of that. And until you actually see patients and treat patients who have difficult, sorry, different medical conditions or who have autism, you can't really prepare yourself until you actually see the patients. So I guess for providers who haven't yet had people in their chair, it could be a little bit overwhelming because you're not sure what to expect.

Chelsea Bloom: [00:04:18] Yeah, I really like the example you just gave about walking through a mall and being exposed to all these different stimuli and how it can be a very overwhelming experience, especially for those with sensory challenges. Although many people think that there's five senses, including taste, touch, smell, sound and vision. There's actually three more, including vestibular, which involves balance,proprioception, which involves movement and then interoception, which involves being in tune with your body. One that can be particularly challenging for individuals with autism. So there is so much involved when walking through that mall. And all of these senses and stimuli are also involved when going to the dentist, getting treatments done and even getting in and out of that chair. So I thought that that was a great example. That really is sensory stimuli and how it affects people. I know you just briefly mentioned learning about how to treat patients with special needs, but I just wanted to know, throughout your dentistry, school education, did you ever think that there was a barrier for people with sensory challenges in receiving proper oral care?

Rachel Korman: [00:05:16] I think while I was in dental school, I kind of imagined that. Well, dentists must know how to treat these patients, so someone must be doing it right. But then now that I'm out in the world, I guess as a dentist and I can actually, especially working in the hospital system, you can really see the barriers. And based on the number of referrals that the hospitals get, both in Montreal and here in Halifax, it's an overwhelming number. I don't think I fully understood how much of a barrier it was, but it shouldn't be a barrier if we're properly trained and that we can prepare the patients for their experience at the dentist's office and just be sure that you have the proper resources established.

Stephanie London: [00:06:05] Yeah. And so I really like that you bring up the idea of awareness and experience and training, because that is very true, is that you can’t expect dentists or dental specialists to go in and treat this population without the experience, without the training, without the awareness. So I guess, I question, I kind of want to bring it back to education just because you're a new graduate besides the video that you were talking about earlier. What other strategies where you taught in school or rather what strategies or types of information do you find are lacking in the education system, in dentistry school currently?

Rachel Korman: [00:06:44] Ok. So during our lectures and so the clinics that we have with children. So I would refer to children first and then afterwards would say like to go a step up, I guess, to people with special needs. So we're taught tell, show, do or T.S.D. Those are the fundamentals of pediatric dentistry or the treatment of a patient with special needs. So tell them what you're going to do. Show them what you're going to do. And then hopefully you get to do it. But it's building on that. And each time telling them, showing them and then hopefully doing. And every single appointment that you have, hopefully you're going to get one step further. So those are the, that's the core of what we learn. And so I apply that every single day. And it's all, it almost turns into like this routine, like a dance routine. And, you know, every kid's different and they each have a different reaction to what you're going to be showing them. But that's really like the basis of what we learn in dental school. And then we develop each professor kind of has their own techniques that they'll share. My graduating year was a bit unique in that we were going through Covid. Right. So typically over the summer, we would have a clinic that's dedicated to seeing patients with special needs and people who would be able to access care otherwise.

Rachel Korman: [00:08:16] Unfortunately, that was canceled. And you hear that sentence so often. But I think that. Now that I'm in the residency that I'm in, I've had so much experience on so much it's been a couple of months, but a lot more than I would have had ever in dental school. And I think that it's just important for dental students and people seeking that type of education just to have that clinical experience, because I feel like I was missing that. And I can understand how someone graduating from dental school without having that experience now is very overwhelmed or feels unprepared to be seeing patients. And I guess that now that I've had that, I can see how that could be lacking in it. Schools don't have an emphasis on treatment of patients or just doing an exam or showing them like an introductory how, like a desensitising appointment is what we call it. So you don't actually do anything during that appointment, but you just welcome them into the dental clinic, show them what everything is, hopefully take one step at a time. And so I think that it's important that schools or the education system does that to make sure that we're prepared for it at the least.

Chelsea Bloom: [00:09:40] Thank you for sharing that answer. I thought it was very cool how you touched on a lot of like suggestions also about the tell show do. It's something that we've talked about before, too, and we think it's like a great method, especially to get individuals more comfortable with the process. So like it takes away that mystery and like that unknown. I also thought it was an important thing that you mentioned how like they're all different and they all have different sensitivities, which is something that a lot of people overlook. I think sometimes when it comes to people with special needs, but everyone is individual, they all have their different sensitivities. So it's important to like look at what can we do in general for people with special needs, but like also be able to adapt. Like, OK, this patient needs, is more sensitive to this, like what am I going to do? And all of that. So it touches on that client centered topic. But I kind of wanted to get into what you think would maybe be the biggest sensory challenges at the dentist. So obviously, like not all of them, because I'm sure there's a lot. But we talked about like each one is different, the different sensitivities. So just if you could think of a few.

Rachel Korman: [00:11:02] Oh, yeah, yeah, definitely. Where to begin? I guess when you first have a kid come into the room, some of them don't even want to set foot near the chair and getting them comfortable, getting them into a position where you can at least look into their mouth is step one. Step two is I guess we use a lot of light because I need to see into a dark hole. Right. So we have bright lights in the room. We have a bright light that's directly shown at their face. And, you know, we do what we can. We give glasses. We tell them that we're going to be using a bright light. We always say it's like the sun for a lot of kids trying to prepare them as much as we can. You know, if the bright lights, the overhead light is too much, we sometimes use a flashlight. So that's smaller but more restricted. Let's see, that's one of them. A lot of the time, what we'll do is we'll talk to the parents beforehand and we'll ask them specifically, what is a trigger? What is that one thing that if they're OK, some kids are very OK with light. Some kids are very OK with sounds. Other kids walk in with headphones on and you're almost happy that they brought them because you know that that's going to be helpful. Or just having a parent who's telling you because the parent knows the kid the best. Right. So if they say, I know that this is going to be bad, you try to work your best way around it and your exam might be a little bit compromised, but at the very least, you brought them to the dental office, you know, OK, you try to do the best exam that you can and see, OK, do they need to be seen for a follow up appointment or do they need to be seen perhaps under general anesthesia? But at least you answered that question of what is my next step? Yeah.

Stephanie London: [00:13:02] Yeah. And I really like the idea that you bring up kind of talking to the parents and the idea of like knowing what the triggers are. And it kind of brings up our first guest. We had Maureen Bennie, and she kind of brought up this approach called the low arousal approach. So it's kind of knowing the sensitivities that the children have and alerting professionals to be aware of the sensitivities and these triggers beforehand so that way they can be best prepared and avoid these sensitivities and this excessive stimuli from occurring for these people. So I definitely like all of the examples, like using the flashlight. And just before when you talked about the desensitization appointment, I like the word that you pinned on it, because we were always talking about having the kids come in in advance and counting their teeth, like kind of a graded approach. But I like desensitization appointment. I really like that word. I’ll use it from now on.

Rachel Korman: [00:13:52] Sometimes you don't even get to counting the teeth. I'll show them. I'll count my fingers and then I'll count their fingers and then I'll say, OK, now it's time to count your teeth. Little do they know that I'm actually doing a complete exam during that time and I'm counting the teeth. But they you know, sometimes you don't even get to that point. But at least the point of the desensitisation appointment is they get to see I'm using an explorer, which looks like a very sharpened skip. That's the one that the pick or it's called an explorer. So, yeah, at least they're familiar with what that is.

Stephanie London: [00:14:28] Yeah. And I like that you bring that up just because it kind of reminds me of like an occupational therapy term, like a task analysis. So you're really taking an activity, taking a task and breaking it down as much as possible. And we spoke about starting with counting your teeth, but you're breaking it down even more, counting fingers like it's just really great the strategies that you're giving us here. Another thing that I wanted to bring up, kind of, we didn't mention it in your introduction, but you sent it into us when you gave us a bit more about yourself. You attended an oral health total health sharing smiles day. That's another bit of a mouthful. But could you tell us a bit more about this event and like the types of instructions and strategies you gave during this day?

Rachel Korman: [00:15:15] Yeah, of course. So I think this was an initiative, oral health, total health, that was started by dental students. Couple of years ago, maybe five plus years ago, and it's been an annual event and a lot of dental schools, I think mainly in Canada. But I could be wrong. And so what we do is we'll go to a community center for people with special needs and we'll have activities all day or mainly in the morning time. And they'll be dancing, music, coloring just to have fun and build a relationship. But then afterwards, we'll have lunch and then we'll once everyone is settled, we'll start, we’ll bring out these big models of teeth and like show how flossing works or we’ll bring out like demonstrated toothbrushes. And we'll show we have these things called dentoforms, which is like a model of the mouth or like those chatter like those things that you would wind up in and would like chatter kind of. It looks like that. And that's what we would teach brushing techniques with. So we would ask them to hold the toothbrush, show them the proper direction, and show them the proper technique to brush their teeth. And these are mainly for adults, but those are always really fun events because, you know, you get to have fun with them in the morning and they get to know you and then afterwards you teach them dentistry. But a big part of going to the dentist is learning about prevention and learning about how to live a healthy lifestyle, whether that's through well, it's through your diet and through your oral hygiene. So those are two very big emphasises in the Assuring Smiles day. So, yeah, it's a lot of fun also.

Chelsea Bloom: [00:16:58] Yeah, it sounds like a great initiative. So thank you for sharing that. You touched on something about like getting to know the patients, which is also super important, especially like if it's a child with special needs to like build that rapport with them and like eventually like get to know them till they start to trust you more with like your treatments throughout. So I thought that was like a cool thing that like that's like the primary focus. Like at the beginning of the day, you touched a bit on the prevention. So I wanted to link it a bit to when you would work with the Friendship Circle and you did those videos about different recipes that are like low sugar and low cariogenic. Kind of wanted to have your view on the importance of teaching this prevention for dentistry, because it's obviously a big role in like we know if you have proper oral health care early on, like it’ll prevent complications. And more painful procedures.

Rachel Korman: [00:17:55] Certainly. Yeah, that's. Yeah, you hit that right on the head. So actually, first we typically start our appointments off by, you know, building a rapport with the patient that goes through trial and error, seeing what a kid responds to and hopefully building some form of bond. The next thing is we'll take actually quite a bit of time talking to if there's a parent there. The parent or the legal guardian or support person who's there. And also hopefully have a discussion that involves the patient and just talk about what are you doing now? What are your snacks during the day? What do you drink most of the time? Are you drinking juice, which is sugar in a bottle, even though it's like orange juice? That's good for you. There's just as much sugar as there is in a can of Coke. You do get vitamins. So there are different benefits. But yeah, we'll talk about juice. We'll talk about gummies or dried fruits or all of the things that people think are good for you, like granola bars. Welch’s I don't want to call out a brand in particular, but, you know, fruit gummies that people are like, well, these have tons of vitamins. These are a good snack and are easy to throw into a lunch box. But those are the things that if you like sugar sitting on your teeth for so long all throughout the day, that's what's going to lead to cavities. And when people don't know that, that's something that could be corrected so easily.

Rachel Korman: [00:19:24] Just giving someone that piece of information and that can make a world of a difference in someone's oral health. So taking the time at the beginning of the appointment to do that. So that's kind of what led me to I guess it was during Covid when people weren't able to go to the dentist, weren't able to have those checkups, weren't able to have these conversations. That's when my friends and I actually we first started doing a project with the Friendship Circle, Montreal. We were supposed to go in person, but then Covid. So we ended up doing an online series. And I love baking and I love cooking. And, you know, eating healthy is also very important to me and you know keeping a healthy smile. So all of those things came together and I started somewhat of a video series on their Facebook page, and it was like a weekly event. And every week I tried to come up with a different recipe that was low in sugar and low cariogenic means cariogenic means like cavity causing so low sugar equals low cariogenic. So that was the goal of that. And just get people excited about baking, eating and just understanding. And then I would always go into like at the end of it, like make sure that you're brushing your teeth for two minutes just to give people that reminder, because if you aren't going to the dentist, it's every six months. For some people, that didn't happen.

Stephanie London: [00:20:54] Yes, definitely, I definitely see the importance of diet in terms of prevention and education for parents on that front. I also had a question, so on top of diet, what are some other strategies or things that you could touch upon to educate parents in terms of oral health care in the home environment?

Rachel Korman: [00:21:16] Yeah, that's definitely really important. The one thing that we try our best to do and alert the general public of is we want kids to be seeing a dentist when the first tooth comes in or a bit later. So if you don't know, you get your first tooth around six months old. And sometimes what can be even more helpful is if a woman while she's pregnant goes to the dentist and the dentist can actually start to give her some tips about what to expect when you have a baby, because a new mom is going through so much. And the last thing on her mind is going to be to take them to the dentist. Unless they're teething, then they might be more inclined to. But the second that you have a tooth in your mouth. That means you can get a cavity. So actually, Severe early childhood caries is one of the most rampant diseases that there is and almost one of the most common diseases that there is. And that just means that little kids who just have tons of cavities and that's caused by, you know, not brushing properly or not brushing at all, not brushing with a fluoridated toothpaste, not having access to water that is fluoridated and just the habits that you gain when you're little. And I guess. So number one is go see a dentist. If you have teeth, you should be seeing the dentist. Even if you don't have teeth later in life. You should be. Everyone should be seeing the dentist, but. Another thing is, I guess, making sure that you have a toothbrush, toothpaste, making sure that it is fluoridated, if it should be.

Rachel Korman: [00:23:00] The guidelines suggest that a child above three years old can be using fluoridated toothpaste in some places if the water isn't fluoridated, we say even younger. But typically a smear of fluoridated toothpaste and then afterwards the size of a pea. And I guess some people are a little bit worried about swallowing fluoride. But if you keep to those like this smear of toothpaste, which is like a very small amount and just the size of a grain of rice, those are the equivalent of each other. And then a step up from that. So once you're above three years old, you can be using a pea sized, but just as long as you can spit. That makes sense. So just making sure that people have access to that information, and so it's just making sure they're brushing for two minutes. Another thing is making sure that a parent is brushing. And this goes for all kids. We say that, well, at least I learned you should be brushing your teeth on your own or you can be an independent brusher by the time that you write in cursive. But apparently people aren't learning how to write cursive anymore. So now we say until you can tie your shoelaces by yourself. But you really just don't have that manual dexterity. And if you don't have the concept of what two minutes really is. I have news for most people. Kids are brushing their teeth for like 10 seconds and then spitting the toothpaste and then just going to do something else. So supervision is of the utmost importance.

Chelsea Bloom: [00:24:38] Those are some really good at home oral health care tips, and we haven't really had a conversation about that yet. So that was like a really good insight that you shared with us. I wanted to go back a bit to like working in a clinic now. Is there anything in particular, like any accommodations that you guys will do for people with special needs, like different toothpaste options if they don't like the taste or the texture? So like things like that.

Rachel Korman: [00:25:08] Yeah. So some of the different recommendations that we've given are some kids need a higher quantity of fluoride. So once this is based on more of a dentist recommendation that there are products like president where? Well, that's what I think by Colgate, but it's 5000 parts per million. So it's a higher amount of fluoride. So first, we recommend that. I'm not sure, there aren't that many flavor choices with that, though, because it's such a it's a very specific product, I'd say. But then if a parent would tell me, you know, flavors are a big problem for us. On Amazon, actually, there's, you know, different toothpastes that I've recommended before. I think it's Oranurse. You can Google that and look it up on Amazon. So I'll tell parents that there are these products available. They might be a bit more expensive, unfortunately. But, you know, we try our best to find solutions like that. Some kids also don't like the feeling of like toothpaste frothing. So when you get like a lot built up in your mouth, some kids really don't like that. So sometimes what we say is do your best and do a dry brush. So don't wet the toothbrush with water. So that's not really that necessary. You still have the fluoride that's on your teeth. So just a dry brush or even one step further. Sometimes we say to use a washcloth, but that really doesn't get your teeth as clean as you can. But you compromise some things so that you can get a clean mouth as much as you can. Yeah.

Chelsea Bloom: [00:26:44] And in terms of the polish, at the end of a dental cleaning, some patients may be more sensitive to the texture and find that it's too gritty or they don't enjoy the feeling on their teeth or even the sound associated with the tool. Is there an alternative that you guys can do instead for people sensitive to this?

Rachel Korman: [00:27:01] For grownups who or people above a certain age start to form calculus. So that's the stuff that you really need to get off during a cleaning. So that's removed by a scaler, which is one of the instruments that we use, or an ultrasonic scaler. And that one vibrates. And it actually helps the dentist remove calculus. The calculus is what needs to be removed during a cleaning. Plaque is build up that you get every 12 to 24 hours or actually much sooner. If you look specifically at the textbooks. But that could be removed by a toothbrush and kids, except for some cases. For the most part, kids don't form calculus. So prophy or the polish isn't actually necessary for a cleaning with kids. You just need to make sure that there's no buildup of calculus because that's what can't be removed by a toothbrush and that's what's necessary. Polish is more just for like that extra minty fresh feel or just to clean very, very closely by a dentist.

Stephanie London: [00:28:03] No, it's definitely interesting that you bring that up, because I know in our last podcast with a dental hygienist, Laura Swinburne, she kind of told us that sometimes instead of using the polish, she'll just go ahead and use like just regular toothpaste. And that's like a great alternative. So it's nice to see like different strategies. And like you mention the studies and that it might not even be necessary. So we're always learning and seeing new strategies and tips to make dental care more sensory friendly. I had a question because, again, bringing it back to the last podcast, Laura kind of identified that x rays are a really big barrier in dental care. And I just wanted to ask you, like, what are some of the challenges that you've seen. What are the solutions that you've come up with, and do you see this as being one of the biggest barriers in dental care?

Rachel Korman: [00:28:52] It's definitely you know, I don't like getting x rays taken because it hurts the floor of your mouth. You know, it's not a comfortable thing to be doing. Kids don't like it. And someone who has trouble with sensory, the sensation like it's a very big thing actually for people with autism just have oral aversions. They don't like things being put in their mouths. And it's extremely uncomfortable to have x rays taken. So I can almost begin to understand how that would be so uncomfortable. But that being said, x rays are 100 percent necessary when you're doing a dental exam. More so when you're older, because when you're younger, if you've spaces between your teeth, you can see the surfaces. But once your teeth touch each other, that's an indication to take an x ray, because the number of times where I've looked at teeth and I've been like, oh, I don't see any cavities, then you take a couple of x rays and you can see them all over the place. They aren’t as big, but still they're there. And it's important to know that they're there because you need to follow and make sure that that patient is improving their oral hygiene. So it can definitely be a challenge to get that done. So some techniques that we use are coaching a kid through it, explaining what is going to happen. I always say this is like I'm not going to sugarcoat it. This isn't going to be comfortable. This is going to and I tell them exactly like the mirror on your tongue.

Rachel Korman: [00:30:21] It's going to it's not going to feel good. Don't say hurt because we avoid negative words. But I say it's not going to be comfy. But I'm going to run as fast as I can outside and I'm going to click the button. It'll be over as fast as we can. And depending on if someone is verbal or not or what their personal what their situation is and what they can handle, maybe I’ll get success with that. But a lot of the times that’s not the case. So. We also have other modalities, we have external X-rays that we can do where it's called pan bite wings, and so there's the machine that can go around your head to take a different type of X-ray, although not a lot of dental offices have this. So I guess that that is a barrier because sometimes you just need to bite down on something and stay still and we can get a pretty good picture. But it's an expensive device to own, and I don't think a lot of dentists have that. So I can really see how that could be a barrier. And then for more complex cases, hopefully I'll get a peek in the mouth and I'll see that there's something that needs to be addressed. And then we'll plan for general anesthesia so that the case can be completed. And during that, we would take x rays. But definitely there's a huge barrier. And it's very it's a difficult situation. But we do what we can.

Chelsea Bloom: [00:31:43] Do you find that with the advancement of technology and creation of more modern clinics, that dental appointments, particularly for individuals who have sensory sensitivities, can become easier? So I know there's some dental clinics now that have started using more handheld devices to look at and scan the mouth. Do you think new devices like this can help make these appointments easier?

Rachel Korman: [00:32:04] There's an impression that you normally would take an impression like, let's say, make a retainer or to make bleaching trays for some people if they can really do that. But in kids, it's mostly for or to make records or a model. So that would be like a scanner that you would use. I actually haven't used one yet, but I can definitely see how using a scanner is much less invasive and much more comfortable than taking an impression with alginate, which is that goopy material that kind of just forms around your teeth and then hardens. And for the tip, for a typical patient, it would cause a gag reflex. So for someone with special needs, it might be even it is a lot more difficult and sometimes can't even be done. So in that case, an internal scanner is much better. It's also a great learning tool so that you can show the patient this is what we're doing and just give them an idea of what's going to be happening, but otherwise. So in terms of that, technology for internal scanners is definitely helpful. Internal cameras, also all these different devices that have been created really help. And yeah, x rays, I guess, have gotten a bit easier, although with pediatric and patients with special needs, we use actually like more film plates than we use the digital sensors, because digital sensors, you can get a better picture, but they could be a bit bulky. But you use what you can and you figure that out. But I can see how different, you know, advancements in technology can definitely be helpful. Yeah.

Stephanie London: [00:33:49] Yeah. So apart from all these like different forms of X-rays and impressions that you kind of spoke about and how, like the digital technology has helped the advancement of this, what other ways has technology helped in the dentistry environment like in terms of communication? Maybe you digitalized patient charts and stuff like in what other ways have you utilized technology?

Rachel Korman: [00:34:15] I guess a big help is just being able to send a picture. So if let's say we have a lot of patients who recently, a lot of facial cellulitis, so that's when you have an infection that is spread to the cheek and it can actually be very dangerous in some cases, and it would be necessary to prescribe antibiotics in most cases. For some patients and some parents, adding a surprise dental visit can make the day go crazy just because it's sometimes preparing to go to the dentist takes a couple of weeks for a parent to give their child or to someone with special needs to just, OK, I'm going to the dentist. This is what's going to happen. And a lot of parents will prepare them and say they're going to look in your mouth, they're going to count your teeth. And if all of a sudden you're in an emergency situation and surprise, we're going to the dentist, that's not going to be helpful for some people. So a lot of the times what we'll say is send us a picture, tell us what they're looking like, and they'll send that by email or some offices have systems that you can send a confidential file. And so we'll be able to diagnose off of like an iPhone picture. And that saves everyone a trip to the dentist. But again, these are only in cases where it's your patient and you've seen them before. You can't just and anybody off the street, kind of. But I think that's a way that definitely helps. But. In terms of like other ways for treatment, pediatric dentistry is pretty bare bones of dentistry. There is maybe other specialties that are a bit more have a lot more like technology advancements that make it very easier to see patients. But we do a lot of the basic stuff.

Chelsea Bloom: [00:36:12] If you had any, like, tips or advice for other new graduates, like soon starting a practice or other dentists or pediatric dentists that are going to work with people with special needs on how to, like, accommodate that in their practice[1] ?

Rachel Korman: [00:36:31] So there's this thing called the knee-to-knee exam, and I'm sure that they use it in a lot of different styles of, you know, in medicine and health care professionals. And so what the knee-to-knee exam is, is you'll have a parent, I would have a parent facing me. The child would then be facing the parent. This can get a little bit confusing. And the parent will then tilt the child's head back into my lap. And this is used for anywhere from babies up until much older patients who just won't sit in a chair. And sometimes this is a very uncomfortable position for a lot of patients. And it's the kind of thing that desensitization is not going to be helpful for. And you get a lot of resistance from the patient, but sometimes you can't compromise. Getting a diagnosis or making sure that they're healthy, because if they're in pain or if there's something that's potentially causing them a lot of pain, you need to find what it is. So. There's kicking, they're screaming, there's crying, it's very loud, it's not a pleasant experience for the patient, for the parent, but it's a necessary exam to be able to do. And I think that it's a really good tool for all dentists to do.

Rachel Korman: [00:37:55] And I think unless you've had the experience in school or through some sort of a residency or program afterwards or have actually seen someone do it, it can be very intimidating and. I had done it with, I guess, smaller children, but now that through my residency, I've been doing it with people who are as big as me. And it requires a bit of muscle and. It's not fun, but it's necessary, and I think that it's important that dentists get comfortable doing it, because if not, it's just it's a barrier. It's limiting where people with special needs can be seen. So this is more for the child, but still, it's some. It's one of those basic skills that everyone learns in dental school. That's part of our pediatric lectures. But it's something that I think dentists should venture out to doing a bit more and getting comfortable with, especially at the beginning of your career. So you just keep that skill and keep building on that and serve and serve your community better and serve the population and serve those patients with special needs or children who just are afraid of the dentist, which is totally normal, totally expected. And although this exam doesn't help improve their relationship with the dentist, sometimes it's necessary.

Christel Seeberger: [00:39:27] Thank you for that. I just a really important insight right there are there are a lot of difficulties, right, that you've shared, but also a lot of solutions out there, too. I wanted to just tie it up a little bit. And it does tie into what you just shared and your wishes for the dental community. I'd really like to know when you imagine your practice in the future once you've completed your residency. I really want to hear what your vision for dentistry is. Does it include sensory friendly aspects? But paint us a picture for the experience that you want to create for your patients.

Rachel Korman: [00:40:21] Yeah, so what a question I really need to look into the future now, I guess. But, you know, seeing that I'm going through this residency and I'm really enjoying it, and there's something very rewarding about being able to serve this population and being able to be the one who can do that, knee-to-knee exam, or be the person who can coax a kid into taking an x ray. You get such a good feeling afterwards, and especially when you can get through to a parent and really explain something to them and make sure that they understand. So I definitely see myself going down this path and going further into pediatric dentistry. And I'm seeing patients who have special needs and just catering to that. And when it comes to the entire patient population, just making myself as accommodating as possible, my practice, my assistants, my receptionist, just everyone being able to be as knowledgeable as possible and accommodate to people's needs. And you know what? I might take what you were saying about having parents fill out a form or I don't know, maybe it'll be on an iPad and It’ll be like really high tech and stuff and use all that extra technology, but having a way to let them communicate to me, like what are the notes? What are the things that will help me? Is there a TV show that I should be referencing, you know, having a TV on the ceiling that will help the kid having headphones available, having flights that can be dimmed in the use of a flashlight, or just being able to be aware of what my patient needs and hopefully being able to deliver to the best of my abilities what they can.

Rachel Korman: [00:42:10] So I've always envisioned just like. It's cool. TV is on the ceiling and like bright colors and just enough for it to be like a happy, welcoming environment. And I'm not sure about what technologies will be in place, because who knows how quickly everything evolves so quickly, and especially dentistry's going through huge changes. So I don't know about technology wise, but I'd like to have like an up to date practice and just being able to have my patients comfortable. And if that's a modified chair or extra pillows, blankets or something that can help them get through their appointment as easy as possible, and just use everything that I can to hope that people aren't afraid of me.

Christel Seeberger: [00:43:01] Thank you, Dr. Rachel Korman, for painting a wonderful picture of the future where dentistry makes all the difference to people. That was beautiful.

Stephanie London: [00:43:13] Thank you to Dr. Rachel Korman, a dentist currently doing her pediatric general practice residency for sharing her insight and expertise about sensory friendly dental care for children with special needs. Dr. Korman shared an extensive amount of rich information with us today. But what came to light during this discussion, unique to the others we've had, was the idea of the dentist’s role in prevention and how diet and proper oral health care in the home can help decrease the amount of strenuous and lengthy procedures needed during a dental visit. Another highlight was our discussion about using technology to communicate with dental teams as a means to avoid a surprise visit to the dentist. Dr. Korman, along with dental hygienist Laura Swinburne, another guest in the series, paint us a picture of what a sensory friendly dental environment should look like. Another guest, Dr. Halford, a periodontist, also discusses the importance of a consultation and being able to explain to clients what you will be doing before you do it. Similarly, to Dr. Korman's description of a desensitisation appointment or the concept tell, show, do. So thanks again to Dr. Rachel Korman. 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. So stay tuned for more rich conversations and have a sensory friendly day. You can find more information about creating a sensory friendly dental practice on our website, sensoryfriendly.net.

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