Care and compassion overcome challenges with Dr. Peter Halford, periodontist

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 oral health expertise of Dr. Peter Halford.

Listen to Dr. Peter Halford, periodontist as he shares insights gleaned from his practice.  You will feel informed and excited to practice dentistry in a way that makes the most challenging interventions a positive experience for patients by creating a family-like atmosphere.

Episode Guide:
0:00 - Welcome & Host Introductions
0:28 - Welcome Dr. Peter Halford
1:26 - Dr. Halford thinks about Barriers to Oral Healthcare
2:08 - Dr. Halford provides his experiences with patients that have sensory-sensitivities
5:50 - Accommodating appointments for the patients
6:30 - Making the patient feel comfortable
7:20 - Pictograms & explaining procedures
10:16 - Dr. Halford talks about a patient experience to sensitivity to a dental implant
11:47 - Modernization of Periodontics
13:27 - Dr. Peter Halford reflects on what he knows now as an experienced dentist
15:05 - Dr. Halford's Philosophy as a Dentist
16:10 - Tools Dr. Halford uses to make patients comfortable
16:40 - Treating older adults and the challenges that arise
18:34 - Strategies for treating older adults
20:30 - Understanding the patient and where they are coming from
21:50 - Dr. Halford talks about utilizing technology
22:53 - The challenges of X-Rays.
24:12 -  Dr. Peter Halford talks about the importance of taking your time
24:52 - Thank you, Dr. Peter Halford!

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Transcript

Stephanie London : [00:00:00] 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 Dr. Peter Halford, an experienced periodontist and father of four children who is currently practicing with his brother, who is an endodontist doctor. Halford is a member of many associations, some of which include the Royal College of Dentists of Canada and the New Brunswick Dental Association. We are very excited to speak with Dr Halford and learn about sensory friendliness and a specialized field of dentistry. Welcome, Dr Halford. Thank you so much for joining us today. Would you like to introduce yourself to our listeners?

Dr Peter Halford: [00:01:00] So my name's Peter Halford. I think you did a good job introducing me already. I'm a dentist who specialize in periodontist. Periodontics is one of the specialties within dentistry, and it's specialized in the treatment of gum disease and gum grafting and problems with the bone, the surrounding tissues of your teeth.

Chelsea Bloom: [00:01:22] So to start off our conversation today, I wanted to know if you ever thought of dentistry for people with special needs as being like a barrier, so like a barrier to oral health care?

Dr Peter Halford: [00:01:36] Definitely. I guess. Initially, maybe in dental school, you might like physically like physical challenges, like someone not able to brush their teeth or perform adequate oral hygiene, like it's hard to floss even if you do have good dexterity. So that'll be like the first one that's the most obvious one that kind of jumps out at you. Then there's always some mental health issues, too. Maybe if someone's so depressed, they can't get into bed and they haven't brush their teeth in a month or whatever like that. So there's just things like that.

Stephanie London : [00:02:07] So within your practice or at your clinic, have you ever experienced some people having challenges? And what types of strategies have you used to kind of make them more comfortable in the environment?

Dr Peter Halford: [00:02:19] So the biggest one, I think, for me would be the noises. A lot of people don't like the noises, all those noises, or when you're in your mouth and they're your ears are so close. So a big one would be people don't like the noises and lot a fair number of people might bring like a headsets or something like that.

Chelsea Bloom: [00:02:38] In some of our other conversations, we've discussed how people with sensory challenges, especially people with autism, may be more sensitive to the taste and texture of toothpaste or even fluoride. Is there anything you do or you could suggest doing for patients with these sensory challenges?

Dr Peter Halford: [00:02:55] I personally never run across that. There's a million different types of toothpaste and toothbrushes, and I guess my recommendation would be to try lots and see how you. Just try them all out.

Stephanie London : [00:03:11] So what are some experiences like? I, I kind of did some research about periodontist and some things that I found where you would do a root cleaning or a scaling. Are those some of the things that you do?

Dr Peter Halford: [00:03:25] Yeah. So that would be like the main the main thing I do every day would be kind of if you'd gone to the hygienist to get your teeth cleaned. Some people that would have gum disease or gum problems, they'd get like a very thorough cleaning where you're actually scraping the roots because they have deep pockets around their teeth. A lot of people don't like it. They're frozen, obviously. But even just the the pressure and the and the sensation and the noise, because we along with that, the scraping that we do, I don't know if you ever had a hygienist use an ultrasonic machine where they they vibrate the tartar off your teeth. Yeah. But like that would be a noise that a lot of people don't like or can't tolerate.

Stephanie London : [00:04:08] And that's where people will kind of bring in their their headphones to kind of cancel that noise. Yeah. OK. Besides the noise that we talked about, is there any other senses that like patients of yours have, like expressed or have you've noticed have been difficult? I don't know. Sometimes, like the lights of the room, things like that.

Dr Peter Halford: [00:04:28] Yeah, the bright light would be another one. So the the lighter on the like on your chair that you use to light up inside the mouth. Then also I wear like a headlamp. So that could be a bright light that someone might bother someone. But we've got sunglasses that we get people to to wear sometimes.

Stephanie London : [00:04:50] Are there any like so going back to the procedures that you do? Are they typically lengthy procedures and would the patients typically be under for the duration of the procedure? How would that work?

Dr Peter Halford: [00:05:02] So my longest procedure would be an hour or so, like I want to go because that's how long the freezing lasts. I personally don't. When you mean go under, you mean like some type of sedation? Yes. So very rarely do I do any sedation once in a while. I guess that could be another strategy if someone is nervous or whatever. But I might do it like an oral sedative once a month. But it's usually just the local anesthetic.

Stephanie London : [00:05:31] Ok. And so would you ever if a patient can't handle the duration of the procedure, would you ever think of doing kind of half procedures and then having them come back in for the rest of it? Or is that a possibility with those types of things?

Dr Peter Halford: [00:05:45] Yeah, for sure. Like some procedures, you can't stop halfway through. But there's a lady not too long ago. And so if I was doing group planning on a new patient, I would usually freeze the top rate in the bottom right and then work on them for an hour. She didn't think she could do that, so I did. We did over four appointments instead of two appointments. So I just did the top right, top left and right. So I'm pretty easy going. Whatever the patients think they can tolerate, I just do it.

Chelsea Bloom: [00:06:16] So you're touching on the idea of clients tenderness, where you work with the patient to make them as comfortable as possible. You just mentioned something about modifying a typical root planing appointment and having to break it down into multiple appointment to better accommodate the patient. So I was wondering, are there any other procedures or tools that may be more difficult to work with for some patients?

Dr Peter Halford: [00:06:39] I guess most stuff that I do like is it's easy for me and a lot of people are nervous and I try to simplify things and explain things very simply to them. And 99 percent of the time, once we're done, the procedure is shorter than what I told them. And it's not as bad as what they're expecting, obviously. So I try and do that, I guess.

Stephanie London : [00:07:04] Ok. So in terms of like on top of like splitting it up into different time sections, how would you describe like your patient interaction and like what types of things would you do to make the patient feel more comfortable? Like what would you say to them? What kind of strategies would you talk to them?

Dr Peter Halford: [00:07:23] So I've got some like not pictures, but,whats the word, just like not photographs either. But just like

Stephanie London : [00:07:31] Pictograms, I guess,

Dr Peter Halford: [00:07:33] With pictograms to kind of explain them what the problem is. Show them what we're going to do. I tell them not to look on YouTube, but I usually do a pretty good for everybody, too. I tend to do a console, so I take that time to just explain to them what's going to happen and go through all that. I guess that's the big part of informed consent to you need to explain to people what you're going to do and how it's going to go.

Chelsea Bloom: [00:08:00] The idea of showing what you're going to do and explaining it before doing it has been a common suggestion from other guest as well. We've also touched on the idea of using a graded approach to help new patients become more comfortable and familiar with the dentist or upcoming procedures. So sometimes before a child first goes to the dentist, they'll come in for a tour of the office, or their first appointment may consist of just counting their teeth. So in your field, are there any steps of things you can do to slowly introduce a patients to yourself, your staff in your clinic, and help prepare them for procedures and treatments that you'll be doing?

Dr Peter Halford: [00:08:37] Well, I guess it's kind of lucky for me because I work on a referral basis. So everybody's been to the dentist and they're familiar with the dentist and what the dentist does. For the most part, sometimes when they come see me, they don't know what I'm going to do. And the referring dentist doesn't always do a great job explaining things. But like I said, I always do a consult first, and very, very rarely do I do treatment at the same time unless someone's in pain or something like that. So I would be just taking the time and explaining who I am, what I do, and why they're to see me. And then we usually do the exam and I usually get the mirror out and I show them like, this is the problem and this is what we're going to do to fix it. And this is why we need to fix it.

Stephanie London : [00:09:23] Ok, I know that's interesting because I know with our last guests that we had Dr. Rachel Korman, she was kind of talking to us. I guess your consultation is similar to what she does. She calls it a desensitisation treatment. So basically, like patients would come in and she would basically tell them what's going to happen at the next appointment and like kind of get them more familiar with the field. So I guess kind of what you're saying is you would do a similar thing. You'd show them what the problem is, kind of tell them what you're going to do. And then the follow up appointment would be when you actually perform the procedure. Right. OK. So do you also work with the placement of like dental implants as well? OK. Do you ever have patients who experience some like high sensitivity to like the dental implants and what kind of things would you suggest for them?

Dr Peter Halford: [00:10:12] That would be like very rare. There is one patient I can think of that has like generalized facial pain. And it kind of started out the she had a root canal done and then she still had pain and then she had the root canal redone. Then she had the tooth. Then she had an implant placed. And she still has facial pain kind of in that area. And she's a younger patient as well. So I don't know if it was an undiagnosed neuralgia or what. But any like sensitivity with dental implants would be very uncommon all. They should have no sensation at all.

Chelsea Bloom: [00:10:58] We talked a bit in previous conversations of the idea of like the advancement of technology and modernization, making dental clinics or different types of clinics more efficient, but also more like accommodating to some patients. So we talked about like X-ray machines and also like instead of like doing the exact molds like you could do, like a scanner. So that's good help for people who have like sensitivity to like the taste or texture of like mold. I was wondering if like that in your field they could periodontist could you see it as making like those sensitive issues easier or minimizing them?

Dr Peter Halford: [00:11:47] Yeah, the internal scanners, instead of taking the the goopy molds would be a big one for me. People really like that better in terms of other things, like the scaling. It's kind of like periodontist. I think it's a little bit old school. So the scraping of the roots and all that kind of stuff, that hasn't changed.

Stephanie London : [00:12:14] And what about in terms of the the tools that you use? Like, have you kind of upgraded those over time? Or like are there any, like, alternative tools you could use if someone's not having a good experience with one? It's two like scrapie to sharp.

Dr Peter Halford: [00:12:28] Everybody's frozen. So they're not going to feel anything. But the tools are kind of what they are. And they've evolved to like like periodontics kind of was started in the 50s or 60s. So the tools are kind of what they are and they do. Maybe materials may get better over time, but it's the same the same types of things to scrape your gums and all that kind of stuff.

Christel Seeberger: [00:12:55] Now it's me just you talking about that change over time. That leads me just to a little, a little question. OK, so the tools or the technique is maybe the same or the the treatment that your intervention is kind of the same. The tools are kind of the same. But just, you know, given the length of your practice, I'd really like to know, sort of reflecting back, what do you what you kind of wish a younger doctor, Peter Halford, knew or what you wish maybe other dentists would know about treating patients who might have a sensitivity to noise or to light or sort of before even before and after the freezing to the sensation in their mouth. You talked about generalized anxiety. Right. What are what are your reflections on what you know now versus what you knew that?

Dr Peter Halford: [00:13:51] I've always been like fairly easy going in general. So, yeah, it takes a lot to get me upset if someone's not having a good experience at the dentist. And sometimes you I don't know if you blame yourself because it happens so rarely that, you know, like once a year and you see a thousand people a year. So it's less than one percent that someone doesn't have a good or leaves unhappy or something like that. So. I don't know if there's one thing I would pick that would I tell myself to to watch out for, because I tend to have pretty good days and in general.

Christel Seeberger: [00:14:33] Yeah. So you picked a good match of the profession, right, with your with your personality. I'll go back to you on your website. You sort of you know, you very much describe your practice as a as a family practice and really making people feel comfortable. And I think you're your natural personality. Right. And just very, very even keel. Right. About something that is is stressful for might be very stressful for your patients. But what it just in in in your practice in general or your philosophy, is there anything. I'd like to hear a little bit more about that.

Dr Peter Halford: [00:15:11] So I guess I'm very like personal. They don't have to go through two or three layers of people to get to me. If someone phones the office and wants to talk to me nine times out of ten, I'll speak to them myself and explain to them a procedure or or what to expect before or after. Same thing with the console. It's like they're not seeing three or four people before they get to see me. They see the receptionist and then they see me like right away. So I guess that would be one thing.

Christel Seeberger: [00:15:42] Yeah, that's one very important thing. Right. So it sounds like you're you're just you're very accessible.

Dr Peter Halford: [00:15:49] Yeah. It's got to be you

Christel Seeberger: [00:15:50] Get to your patients and to explaining the procedures and what's going to happen. Is there anything you've you know, we talked a little bit about you gave some examples of clients bringing in headphones or sunglasses. Is there anything you've been able to to change with the tools you use or how you use them that makes people more comfortable?

Dr Peter Halford: [00:16:14] Maybe a family member once in a while might come. Sometimes medication helps. Yeah, well, yeah, that'd be the the would be the headphones or the glasses would be the kind of the two bigger ones.

Christel Seeberger: [00:16:29] So just sort of thinking about the other end of the spectrum of age and some of the challenges that come with aging and any difficulties with hearing or with vision. Right. That come along with that. Is there anything that that you kind of have to change with older adults, with seniors, maybe even with seniors who have some cognitive decline? Right. Already?

Dr Peter Halford: [00:16:58] Yeah. So one would be dexterity, which I talked about already. So we think about different strategies so they can actually brush their teeth effectively. Mobility would be a big one to just and just being able to get out of their house and up to our office and all that kind of stuff. Well, some people like. There's people I see from that would come from St. Stephen. And then, you know, they hit 75 and they say, I can't do this anymore. Instead of coming every three months, I'm going to come once a year and see my regular dentist. And that's probably fine. And here I find a lot of older people, if they have hearing AIDS, say don't wear them. And then you're trying to explain something to them and they don't have there. So once again, the pictograms and all that kind of stuff for them, for the most part, to show people as well, because there's less interest.

Christel Seeberger: [00:17:55] Yeah. Well, regardless of age, a little a picture helps worth a thousand words sometimes. And you talked a little bit about mobility. I'd actually love to hear any background in occupational therapy coming out here. But any particular strategies to share about those difficulties with, you know, arthritic hands. Right. And dexterity and maybe even vision being able to see, you know, clearly in in your own mouth. So this is, you know, a little bit more specific to the recommendations you give patients. But I think that's valuable for everyone on the on the team to hear.

Dr Peter Halford: [00:18:34] So a big one, if you having dexterity issues would be electronic toothbrushes help a lot. Yeah. Let me you can just kind of use those and they do all the work for you. And they they've got timers on them now and they can tell you when to move around your mouth and all that kind of stuff. And most of them, you can't brush too hard because if you push too hard, they turn off as well. There's and there's if you go to shoppers, there's tons of little aids. You can buy a little brushes or pointing brushes or flusters and all that kind of stuff. And there's I remember in school that people put in a tennis ball on a on a toothbrush so they could someone could could hold it. But I think I look at electronic toothbrushes are like fairly cheap now, and they do quite a good job and

Christel Seeberger: [00:19:21] Talks a little bit about accessibility and just people's ability to move. Right. And any difficulties, any challenges, any solutions about just getting in and out of the chair. Right. And feeling comfortable and not has not ever come up for you.

Dr Peter Halford: [00:19:37] Yeah, well, one of the big ones is people are laying back and then you set them up and then all the blood rushes from their head. I guess just taking their time. The chairs go up and down so we can get them as close to the ground or a little bit off the ground if they need to be. And had just happened lots of room because we have so many tools and all the cabinets and stuff, too. So having room for their walkers or whatever to to get in there so they can get in the chair.

Chelsea Bloom: [00:20:04] What we've talked a bit of before about like the idea of creating a good like team in the clinic you work and how that could improve, like make or break a patient's experience. So I was wondering like, what are some of the key characteristics or qualities you think of that team that could like make a better all over experience? Like we've talked about trust before as a big one, like between even like between is the assistant, the dentist periodontist and like the patient and the parents, too. That may be like you have other ideas of other important qualities.

Dr Peter Halford: [00:20:43] Patients would be a big one as well. For me, just if someone's nervous, there's probably a reason they're nervous and you can't just tell them to be quiet and do your work. You have to kind of understand why they're nervous and all that. I always tell people that I'm coming from a strange place, too, because my father was a dentist. And so my experience at the dentist was going in on Sunday afternoons to get my teeth checked. And I never had a feeling in my life. And then I went to dental school, and people are petrified of me just because I walk in the room. Right. And I think, why would you ever be scared of a dentist? And it's I've always had a good experience of dentists and same thing. A lot of young dentists, their only experience would be going to get braces or something like that. At the very most maybe getting their wisdom teeth. And then all of a sudden they're in dental school and they're doing extractions or doing fillings or root canals on people that are petrified just because they're who they are. So patients would be a big one for me.

Stephanie London : [00:21:46] And so bringing it back, what are some ways that you would utilize technology in your clinic? So, for example, patient charting or alert's to let you know that the client is ready?

Dr Peter Halford: [00:21:59] We have a small office. We just have four chairs. We do have a fair amount of technology. But usually the patient might be left alone for. Ten seconds. And I can I can hear when the patients come in from my office, so I've got it timed down like pretty, but by the time my assistant says I'm going to go get the doctor, I'm usually there. So it's fairly minimal if anybody is left alone. And we try not to leave anybody alone anyway, if someone's had some freezing ends, you have to keep an eye on them just in case there you never know what could happen. And I guess technology to the one nice thing, because we have digital X-rays on a big computer screen. And so that's something we can show people as well, what's going on to explain to them why we're doing what we're doing and what needs to be done

Stephanie London : [00:22:51] For like x rays. Have you found that that was like a challenge? Challenging procedure to do

Dr Peter Halford: [00:23:00] Is definitely something that can be challenging for the person taking X-rays and the person having x rays done. For me, if I'm seeing someone for generalized gum disease or periodontal disease, I could recommend taking 20 of those little x rays. So it can definitely be. We've all had x rays done. So it's it can be an unpleasant experience, I guess. Would be. But same thing, just trying to explain to people why you're doing it, and we've got little tricks to like, if you tell someone if they're put up while they're taking the x ray, they're going to concentrate on lifting a foot up instead of. Think about the X-ray in the mouth.

Stephanie London : [00:23:46] Yeah, so that that's a really good technique and all of the things that you you've explained in in the big world of periodontist. It's definitely cool to learn all of these tips and tricks that you've given us. I'm sure there's much more that we can learn from you. But just one final question to wrap it up. I just want to hear from you. What is one piece of advice that you would give to future periodontist or periodontist out there who are working on their sensory friendly dentistry practice?

Dr Peter Halford: [00:24:21] I think the biggest thing, just to take your time and get to know someone before you're going to. Do anything to them or and this is after me because I always say people are people. So you just have to meet them where they are and trying to get through the procedures, which can be unpleasant for someone without any sensory issues. So. Yeah. So just meet people where they are and take your time and. Go from there.

Chelsea Bloom: [00:24:52] Thank you to Dr. Peter Halford, a periodontist, for speaking with us today about the importance of being a personable and trustworthy dental specialist when providing services to clients. Dr. Halford highlights the benefits of a consultation appointment in order to provide clients with the information necessary to feel comfortable and prepared for procedures. He also discussed with us the strategy of breaking up appointments to be able to cater to each individual's needs. Dr Halford's discussion links our talk with Laura Swinburne, a dental hygienist who talks about the importance of consent before you perform a procedure on a patient. 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 more 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.