1 00:00:00,040 --> 00:00:02,440 Again next time, so during the first visit. 2 00:00:02,440 --> 00:00:05,800 Sometimes doing less allow us to do more in the future. 3 00:00:06,440 --> 00:00:07,960 Do less. And less. 4 00:00:08,520 --> 00:00:12,920 Yeah, perhaps sometimes parents can take a small step back and 5 00:00:12,920 --> 00:00:15,520 allow the dentist to build the connection with the child 6 00:00:15,960 --> 00:00:19,480 because one calm voice is less overwhelming than that. 7 00:00:19,480 --> 00:00:21,320 And be present. So when. 8 00:00:22,080 --> 00:00:23,080 Yeah. So. 9 00:00:24,000 --> 00:00:25,400 Yeah, so. So I think. 10 00:00:34,200 --> 00:00:36,680 This podcast shares personal stories and professional 11 00:00:36,680 --> 00:00:39,280 insights, but it's not a substitute for medical advice or 12 00:00:39,280 --> 00:00:41,600 therapy. If you're looking for support, 13 00:00:41,600 --> 00:00:44,480 do speak to someone qualified and trained in child development 14 00:00:44,480 --> 00:00:47,520 or special needs care. You'll find the full disclaimer 15 00:00:47,520 --> 00:00:49,040 on the screen and in the show note. 16 00:00:50,320 --> 00:00:53,240 Welcome back to Adapting Together podcast, which is a 17 00:00:53,240 --> 00:00:57,800 podcast created to empower, inspire and support family and 18 00:00:57,800 --> 00:01:02,160 caregivers who has individual or children on the spectrum. 19 00:01:02,360 --> 00:01:06,960 Now, if you can think back flashback in time, do you 20 00:01:06,960 --> 00:01:10,000 remember the first time you've been to a dental clinic? 21 00:01:11,320 --> 00:01:15,080 I can remember well because for me it was the in the primary 22 00:01:15,080 --> 00:01:18,400 school setting and I feel very scared. 23 00:01:18,880 --> 00:01:21,960 A lot of things I don't know what to expect and I just know 24 00:01:21,960 --> 00:01:26,560 that I've been told to sit there, open my mouth and it's 25 00:01:26,560 --> 00:01:29,640 not a good feeling. And when it comes to children 26 00:01:29,640 --> 00:01:33,560 who are on the spectrum, I guess it's fair to say that it 27 00:01:33,560 --> 00:01:36,280 represents a different layer of challenges. 28 00:01:36,600 --> 00:01:40,640 For example, there's already a sensory overload problems and 29 00:01:40,640 --> 00:01:44,960 also been told to sit still and also follow rigid instruction 30 00:01:44,960 --> 00:01:48,800 like open the mouth and maintain the posture that can invite a 31 00:01:48,800 --> 00:01:54,360 lot of other behavioural issue or maybe other maybe belt down 32 00:01:54,400 --> 00:01:57,400 or many, many things that we want to. 33 00:01:58,280 --> 00:02:02,080 We wish it wouldn't take place. So which is why today we bring 34 00:02:02,080 --> 00:02:06,760 the podcast to into a dentist clinic and we are pleased and 35 00:02:06,760 --> 00:02:12,280 blessed to have Doctor Elen go. Doctor Elen go, Welcome to the 36 00:02:12,600 --> 00:02:15,600 podcast and we appreciate you studying time aside for us. 37 00:02:16,400 --> 00:02:18,040 Thank you so much for having me today. 38 00:02:18,400 --> 00:02:20,040 Yeah. Thank you so much for joining us 39 00:02:20,040 --> 00:02:22,880 as well. Maybe to begin with, could you 40 00:02:23,000 --> 00:02:29,120 kindly have you to share with us your background and what is it 41 00:02:29,240 --> 00:02:33,760 that drove you to dedicate your life work to work with children 42 00:02:33,760 --> 00:02:34,560 on the spectrum? Sure. 43 00:02:35,720 --> 00:02:38,320 All right, again, thank you for having me. 44 00:02:38,320 --> 00:02:41,600 I am Doctor Elingo. I'm currently based in 45 00:02:41,600 --> 00:02:45,040 Patalingjaya. I am a general dentist and a 46 00:02:45,120 --> 00:02:48,440 certified clinical hypnotherapist with over 10 47 00:02:48,440 --> 00:02:52,960 years of working experience. So over the years of working, I 48 00:02:52,960 --> 00:02:56,120 found myself naturally drawn to working with children, 49 00:02:56,400 --> 00:02:59,760 especially those who need a little bit more time and a 50 00:02:59,760 --> 00:03:04,280 little bit more support and mostly children on the spectrum. 51 00:03:04,800 --> 00:03:08,520 And I had the opportunity and I was really blessed. 52 00:03:08,520 --> 00:03:12,400 I was working in early on in my career, I was working in the 53 00:03:12,560 --> 00:03:16,600 pediatric dental department in the KKM hospital, mostly based 54 00:03:16,600 --> 00:03:21,640 in Mallaca and Jokoba group. So during that exposure, I was 55 00:03:21,640 --> 00:03:24,360 working with children avoid a variety of children with 56 00:03:24,360 --> 00:03:27,000 different needs, especially children on the spectrum. 57 00:03:27,520 --> 00:03:30,600 And that is where I realized something. 58 00:03:30,920 --> 00:03:34,760 What people usually label as difficult behaviour during 59 00:03:34,760 --> 00:03:39,160 dental visit is often just children trying to cope with 60 00:03:39,160 --> 00:03:44,200 very, very difficult environment that can be very overwhelming 61 00:03:44,200 --> 00:03:48,920 for them. So now a huge part of my job is 62 00:03:48,920 --> 00:03:54,480 mainly focused on creating the safe space in the dental clinic. 63 00:03:55,080 --> 00:03:58,560 Of course we have to treat the teeth not, but the main goal is 64 00:03:58,560 --> 00:04:01,640 helping them to feel safe 1st and that's going to be what we 65 00:04:01,640 --> 00:04:07,040 will talk about a lot today. And now I found myself doing a 66 00:04:07,040 --> 00:04:11,800 lot by slowing things down, building trust and meeting them 67 00:04:11,800 --> 00:04:15,560 at where they are. And the first goal is always to 68 00:04:15,560 --> 00:04:18,200 make them feel safe, to support the needs. 69 00:04:18,360 --> 00:04:20,320 And then we talk about dental treatment. 70 00:04:20,600 --> 00:04:22,920 So that's basically what I am doing right now. 71 00:04:25,400 --> 00:04:29,840 So just curious when when a child first come into your 72 00:04:29,840 --> 00:04:33,160 clinic, you want your, your first objective is to build 73 00:04:33,160 --> 00:04:36,760 rapport and help them to feel safe around this setting, right? 74 00:04:37,000 --> 00:04:42,080 So during this duration, right, Will the parents be together 75 00:04:42,080 --> 00:04:46,400 with them? Yes, I always encourage parents 76 00:04:46,400 --> 00:04:50,280 to be there and I don't think dental treatment and dental 77 00:04:50,280 --> 00:04:53,800 visit is one man's job. It's a teamwork. 78 00:04:54,280 --> 00:04:58,080 Just share it first, like what kind of behaviour challenges or 79 00:04:58,080 --> 00:05:02,160 common challenges a kids will go through as soon as they step 80 00:05:02,200 --> 00:05:07,920 into this room. So one of the, I would say among 81 00:05:07,920 --> 00:05:12,880 the common difficulties is when they first see me with my 82 00:05:13,520 --> 00:05:16,440 surgical care and maybe sometimes with my face, with the 83 00:05:16,560 --> 00:05:19,720 eyes. Yes, that is already a huge 84 00:05:19,720 --> 00:05:22,440 challenge. It's an unfamiliar face, but I 85 00:05:22,440 --> 00:05:25,640 would say the most difficult thing is not the dental 86 00:05:25,640 --> 00:05:28,960 treatment, but it's everything around the dental treatment. 87 00:05:29,160 --> 00:05:33,280 It could be the lights from the chair, the noise from the 88 00:05:33,440 --> 00:05:37,560 instruments, or having unfamiliar faces, the nurses and 89 00:05:37,560 --> 00:05:39,600 the team. And Can you imagine having 90 00:05:39,600 --> 00:05:43,640 someone so close to you into your face and wanting to put an 91 00:05:43,640 --> 00:05:46,800 instrument into your same zone, which is the oral cavity? 92 00:05:47,040 --> 00:05:50,880 That could be very overwhelming and very challenging. 93 00:05:51,320 --> 00:05:56,040 And then I think another huge difficulty that not just 94 00:05:56,040 --> 00:06:02,480 children, but adults itself is a huge sense of control. 95 00:06:02,560 --> 00:06:05,720 The, the loss of sense of control that that loss of sense 96 00:06:05,720 --> 00:06:08,560 of control, not knowing what will happen, the probably the 97 00:06:08,560 --> 00:06:10,800 dentist will just say, OK, open your mouth now. 98 00:06:11,000 --> 00:06:12,520 Then. Then I'll be wondering, oh, what 99 00:06:12,520 --> 00:06:14,720 is she going to do? Is she going to judge about the 100 00:06:14,720 --> 00:06:17,760 veggie that is stuck or, or is she going to drill straight? 101 00:06:17,840 --> 00:06:21,400 So not having to know what is going to happen, not being able 102 00:06:21,400 --> 00:06:24,800 to predict what's going to happen next is the most 103 00:06:24,800 --> 00:06:27,360 difficult thing that I think my patient. 104 00:06:27,360 --> 00:06:30,480 Thinks I'll be thinking like open for how long Also don't 105 00:06:30,480 --> 00:06:31,080 know. Correct. 106 00:06:31,200 --> 00:06:34,840 So not knowing what would happen next, the sense of control, it's 107 00:06:34,840 --> 00:06:37,760 something that is very, very challenging to so many of us. 108 00:06:38,240 --> 00:06:42,680 So I guess you are the most patient patient person when you 109 00:06:43,360 --> 00:06:49,880 facing your patient. I think people grow over time 110 00:06:50,200 --> 00:06:54,240 and just like I mentioned, I'm also a clinical hypnotherapist 111 00:06:54,280 --> 00:06:59,480 and that itself has helped me to be a very calm person and a very 112 00:06:59,480 --> 00:07:02,560 patient person. So I can only say that I'm 113 00:07:02,560 --> 00:07:06,120 learning to to understand what the child or my patient is 114 00:07:06,120 --> 00:07:08,440 trying to tell me on a daily basis. 115 00:07:08,720 --> 00:07:10,720 Everyone is trying their best every day. 116 00:07:10,720 --> 00:07:14,600 We are learning, correct? Correct patient and not coming 117 00:07:14,640 --> 00:07:17,680 every day like like us, you know, they come to us every day. 118 00:07:17,680 --> 00:07:21,400 We can get to know them day-to-day, right? 119 00:07:21,440 --> 00:07:22,480 But for. Few months. 120 00:07:22,840 --> 00:07:26,240 Yeah, the few months you even yearly see you one time. 121 00:07:26,280 --> 00:07:30,120 So yeah, it's a bit challenging. Definitely. 122 00:07:30,280 --> 00:07:32,720 But it's on the both side. Like it's not just challenging 123 00:07:32,720 --> 00:07:34,120 to me, but it's. The same. 124 00:07:34,160 --> 00:07:36,000 For the it's neutral. Yes, it's mutual. 125 00:07:36,960 --> 00:07:40,240 Just maybe this is a bit out of scope, but I'm just curious. 126 00:07:40,360 --> 00:07:44,760 Yes, did you learn the hypnotherapy knowledge because 127 00:07:44,840 --> 00:07:48,240 it's a part of requirement to help you do better with the 128 00:07:48,240 --> 00:07:52,360 patient or? What really made me decide to to 129 00:07:52,360 --> 00:08:00,120 do the hypnotherapy was when I was managing adult autistic 130 00:08:00,120 --> 00:08:04,720 patients who are capable of expressing their thoughts and 131 00:08:05,280 --> 00:08:07,200 their mind and what they want to say. 132 00:08:07,640 --> 00:08:11,400 But I in younger children where emergency treatment may be 133 00:08:11,400 --> 00:08:16,360 needed, we may think about options like maybe to to use gas 134 00:08:16,360 --> 00:08:20,360 addition or to sometimes parents comforting them, restraint or 135 00:08:20,360 --> 00:08:22,520 physical restraint. That would be the last result. 136 00:08:22,520 --> 00:08:28,160 But I was thinking, what about adult autistic that is capable 137 00:08:28,160 --> 00:08:35,679 of expressing what they want? And should we force them or 138 00:08:35,840 --> 00:08:38,880 should we create the inner motivation to help them to 139 00:08:38,919 --> 00:08:43,120 understand and to cope? Yeah, mainly trying to support 140 00:08:43,120 --> 00:08:47,400 their need like so hypnotherapy is where we build the inner 141 00:08:47,400 --> 00:08:49,800 resources for our clients and our patients. 142 00:08:49,800 --> 00:08:52,800 So that is where I thought I want to give it a try. 143 00:08:52,960 --> 00:08:54,640 So that's why I venture into that. 144 00:08:55,560 --> 00:08:59,120 Wow, I always like talking to people who acquire new skill 145 00:08:59,120 --> 00:09:02,200 because they realized it helped them with their existing. 146 00:09:02,320 --> 00:09:06,440 I think I, I have to give credit to one of my autistic patient 147 00:09:06,440 --> 00:09:10,760 who told me that I really wanted to try, but I'm so anxious and 148 00:09:10,760 --> 00:09:13,760 so nervous. Can you make me feel more 149 00:09:13,760 --> 00:09:16,200 relaxed? So that's where the hypnotherapy 150 00:09:16,400 --> 00:09:18,880 techniques come in because they have a lot of relaxation 151 00:09:18,880 --> 00:09:21,120 protocol. So I think that that really 152 00:09:21,120 --> 00:09:25,480 helps the that that group of patients who really want to try, 153 00:09:25,560 --> 00:09:29,520 but still very anxious, yeah. Yeah, until today I was still 154 00:09:29,520 --> 00:09:33,000 anxious, although I really, Yeah, like being a dentist. 155 00:09:33,080 --> 00:09:34,400 I'm. So very anxious. 156 00:09:35,280 --> 00:09:39,280 Yeah, I think, yeah. The next question I will have in 157 00:09:39,280 --> 00:09:43,800 mind is actually what can the parents do right before at home 158 00:09:43,800 --> 00:09:46,760 or before seeing you, You know, how does it look like, like say 159 00:09:46,760 --> 00:09:51,040 for example, we have a client that you know refer to wanted to 160 00:09:51,080 --> 00:09:52,840 see you. So anything that you want the 161 00:09:52,840 --> 00:09:56,560 parents to prepare them, you know or how before they come in 162 00:09:56,560 --> 00:10:00,480 so that to reduce a little bit in terms of the challenging 163 00:10:00,840 --> 00:10:03,200 behavior and expectation. Yeah, OK. 164 00:10:04,360 --> 00:10:07,880 Simplest thing can go a big way can go, can make a big 165 00:10:07,880 --> 00:10:10,880 difference. So I think first of course is 166 00:10:10,880 --> 00:10:15,440 the mental preparation. But talking and explaining, 167 00:10:15,640 --> 00:10:18,320 letting the child know ahead first that they will be 168 00:10:18,320 --> 00:10:20,400 attending a dental visit would be good. 169 00:10:20,480 --> 00:10:23,160 Nobody likes surprises. I don't like surprises as well. 170 00:10:23,400 --> 00:10:27,880 So mental preparation to tell the child that they will be 171 00:10:27,880 --> 00:10:30,920 going to the dentist would be a good way to start. 172 00:10:31,400 --> 00:10:38,480 And then we can also tell the child that we are just going to 173 00:10:38,480 --> 00:10:40,200 the dental clinic to get things checked. 174 00:10:40,280 --> 00:10:43,840 So some, some parents may sometimes say, like, I don't 175 00:10:43,840 --> 00:10:46,760 know that my parents of my my parents generation, don't tell 176 00:10:46,760 --> 00:10:49,560 me if you don't brush your teeth, I will take you to the 177 00:10:49,560 --> 00:10:52,680 dentist to take out the teeth. So I don't encourage this kind 178 00:10:52,680 --> 00:10:54,000 of fear. Fear. 179 00:10:55,560 --> 00:10:59,680 Mongering statements but very neutral and very gentle 180 00:10:59,680 --> 00:11:02,880 languages like we will get your teeth checked. 181 00:11:02,880 --> 00:11:07,160 It's OK if you don't like it, we just have a look and just go 182 00:11:07,160 --> 00:11:09,200 explore. That will be fine as well. 183 00:11:09,440 --> 00:11:13,080 Yeah, I like to emphasize that point because we don't actually, 184 00:11:13,080 --> 00:11:16,440 I always don't encourage the parents only get the child sent 185 00:11:16,440 --> 00:11:20,200 to dentist when they have a decay or when they have a 186 00:11:20,200 --> 00:11:22,880 problem. I always encourage the parents 187 00:11:22,880 --> 00:11:26,640 send when they are even as early as three years old or you know, 188 00:11:26,960 --> 00:11:32,040 to, to just go there and have fun, you know, have fun to be on 189 00:11:32,040 --> 00:11:36,520 a dentist chair and feel that it's relaxing and it's it's fun 190 00:11:36,520 --> 00:11:38,320 before the real things come. I. 191 00:11:38,440 --> 00:11:42,280 Think if you have very young children at home, it's good to 192 00:11:42,280 --> 00:11:46,800 start them young because you do not want to be bringing the 193 00:11:46,800 --> 00:11:49,720 child to the dentist at a very last minute where treatment is 194 00:11:49,720 --> 00:11:52,960 needed and expect everything to be done magically because the 195 00:11:52,960 --> 00:11:55,080 child is in shock, having a new environment. 196 00:11:55,400 --> 00:11:59,360 And then at the same time we also again, the language is very 197 00:11:59,360 --> 00:12:01,600 important. When you prepare your child, you 198 00:12:01,600 --> 00:12:05,240 can always reassure them that we will just have a look. 199 00:12:06,120 --> 00:12:08,040 Sometimes we tend to say oh love, love. 200 00:12:08,160 --> 00:12:10,760 We tend to say don't be scared, it's not going to hurt. 201 00:12:11,040 --> 00:12:15,160 But that itself gives the idea of the fear is coming, It's 202 00:12:15,160 --> 00:12:16,800 building. Up, yes. 203 00:12:17,440 --> 00:12:19,720 Correct. And another thing is to lower 204 00:12:19,720 --> 00:12:21,800 the expectations you are bringing your child to the 205 00:12:21,800 --> 00:12:26,960 dental visit to let them try something new that will be 206 00:12:26,960 --> 00:12:31,480 beneficial for them in long run. But we are not fixing everything 207 00:12:31,480 --> 00:12:34,960 at one goal. So later I will share about how 208 00:12:35,480 --> 00:12:39,000 simple tricks to to prepare the child a little bit more in terms 209 00:12:39,000 --> 00:12:43,640 of other ways. Do you recommend any tools like 210 00:12:43,640 --> 00:12:48,840 social story, you know, or role play or watch certain videos to 211 00:12:48,840 --> 00:12:50,600 prepare our kids? Yeah. 212 00:12:51,120 --> 00:12:54,000 Yes, definitely. In fact I collaborated with a 213 00:12:54,000 --> 00:12:57,760 friend to draw like a social story where I did my patients 214 00:12:57,760 --> 00:13:00,960 face inside. So I think social stories, role 215 00:13:00,960 --> 00:13:06,240 play and simple videos gives the child a preview of how the 216 00:13:06,240 --> 00:13:10,080 experience would be but in a Safeway and in the predicted 217 00:13:10,440 --> 00:13:13,480 manner. So you can do simple role play 218 00:13:13,480 --> 00:13:17,680 at home by counting how many teeth you have and checking each 219 00:13:17,680 --> 00:13:20,680 other's teeth. And sometimes just a simple 220 00:13:20,840 --> 00:13:23,680 toothbrushing session together could be a great start. 221 00:13:24,040 --> 00:13:28,640 And at the same time, I also think that giving the child 222 00:13:28,640 --> 00:13:32,680 small choices during the role play would make a big difference 223 00:13:32,680 --> 00:13:34,800 because that gives them a sense of control. 224 00:13:35,040 --> 00:13:36,920 So you can ask your child, do you want to start with a 225 00:13:36,920 --> 00:13:39,520 toothbrush or do you want to start with a mirror? 226 00:13:39,800 --> 00:13:43,840 So that is where the child feels that oh, I have to say I am also 227 00:13:43,880 --> 00:13:46,960 in control so they don't feel that they are trapped in doing 228 00:13:46,960 --> 00:13:48,720 this. So the role play experience 229 00:13:48,720 --> 00:13:52,560 becomes something more positive and more encouraging. 230 00:13:52,560 --> 00:13:54,200 I. Like the? 231 00:13:54,720 --> 00:13:56,000 Idea more like. Yes. 232 00:13:56,200 --> 00:14:01,080 And also if the speech therapies or the occupational therapies 233 00:14:01,080 --> 00:14:03,840 are involved, right, or their strategies are also very good. 234 00:14:03,840 --> 00:14:06,360 So sometimes we work closely together to create social 235 00:14:06,360 --> 00:14:08,320 stories that are beneficial for the child. 236 00:14:08,320 --> 00:14:11,160 Yeah. Even before I think in in our 237 00:14:11,160 --> 00:14:13,720 centre, we usually role play, yeah. 238 00:14:13,720 --> 00:14:16,920 We also show them video, you know, because some of the 239 00:14:16,920 --> 00:14:19,960 parents are quite anxious. They will just let us know few 240 00:14:19,960 --> 00:14:22,520 months in that once that hey, my child going to see these 241 00:14:22,600 --> 00:14:24,320 dentist. You know, sometimes we even 242 00:14:25,480 --> 00:14:28,560 previously before you, I think now you're have your own social 243 00:14:28,560 --> 00:14:30,640 story. Previously when the dentist has 244 00:14:30,640 --> 00:14:34,080 no social story, then we have to create our own social story. 245 00:14:34,080 --> 00:14:36,920 We need the dentist picture, you know, we need the clinic 246 00:14:36,920 --> 00:14:38,840 picture, the chair and all this thing. 247 00:14:38,840 --> 00:14:40,520 Yeah. And I think another thing to add 248 00:14:40,600 --> 00:14:45,560 on is children who communicate with communication tools, AAC, 249 00:14:45,960 --> 00:14:49,200 it will be very helpful to have that tool along when you're 250 00:14:49,200 --> 00:14:51,960 walking through The, Walking them through the procedure or 251 00:14:51,960 --> 00:14:56,080 the visit and also letting them to express how they feel about 252 00:14:56,080 --> 00:14:58,320 the visit. And during the dental visit 253 00:14:58,320 --> 00:15:00,840 itself, I always encourage parents to bring along the 254 00:15:00,840 --> 00:15:04,640 communication tool so that I, it's not a one way communication 255 00:15:04,640 --> 00:15:07,280 and we don't have to guess what the child is trying to tell us. 256 00:15:07,440 --> 00:15:09,640 Yeah, so. You are very familiar with AAC 257 00:15:10,000 --> 00:15:14,320 like pro local, yes? I have the app and if they don't 258 00:15:14,320 --> 00:15:17,360 bring it but they're familiar with it, I will allow them to 259 00:15:17,400 --> 00:15:20,720 use yeah. So passionate thought. 260 00:15:20,920 --> 00:15:23,800 About every kind of possibility. And. 261 00:15:23,880 --> 00:15:30,800 Yes, because I feel not having a voice is something that we 262 00:15:30,800 --> 00:15:32,920 should be able to help with. Support. 263 00:15:33,000 --> 00:15:35,120 Yeah. Support, yeah. 264 00:15:35,800 --> 00:15:38,880 So if, say, the parents come here, the intention is to get 265 00:15:38,880 --> 00:15:42,400 the teeth checked. So how what usually happened 266 00:15:42,400 --> 00:15:45,120 during the first visit? Can you maybe bring us through? 267 00:15:45,120 --> 00:15:48,560 You know, Yeah. OK, my first visit may be 268 00:15:48,560 --> 00:15:53,200 something very different and unexpected, but it's usually 269 00:15:53,200 --> 00:15:56,880 very gentle and meeting the child at where he or she is. 270 00:15:57,280 --> 00:16:03,280 So I don't usually start by telling them to go straight to 271 00:16:03,280 --> 00:16:05,960 the chat. So most of the time I would let 272 00:16:05,960 --> 00:16:08,240 them. After saying hi, of course I 273 00:16:08,240 --> 00:16:09,560 will let them explore the room first. 274 00:16:10,160 --> 00:16:14,960 So I have many, many times where we were sitting on a sofa or 275 00:16:14,960 --> 00:16:18,600 just sitting on the floor here to just do examination and even 276 00:16:18,600 --> 00:16:21,520 standing up. So it's not a standard routine 277 00:16:22,240 --> 00:16:25,240 examination where I need the child to lie down on the chair, 278 00:16:25,440 --> 00:16:28,320 but it could be anywhere that the child is comfortable with. 279 00:16:28,720 --> 00:16:33,960 So it's to me it's not like any regular dental check up where we 280 00:16:33,960 --> 00:16:36,280 expect the child to sit on the chair immediately. 281 00:16:36,520 --> 00:16:42,040 So we have done many check UPS on at the play area and on the 282 00:16:42,560 --> 00:16:46,800 in on the sofas as well. And recently I had one that I 283 00:16:46,800 --> 00:16:50,120 did by the staircase. So, so it's not the conventional 284 00:16:50,120 --> 00:16:54,400 way and sometimes I don't wear my mask because I feel if the 285 00:16:54,400 --> 00:16:57,560 child is really, really fearful and I can sense it already, I 286 00:16:57,560 --> 00:16:59,880 don't think I should add on to the fear. 287 00:17:01,280 --> 00:17:04,280 So basically the whole you need it's. 288 00:17:04,560 --> 00:17:06,640 Your surgery. Yes, whenever the child is 289 00:17:06,640 --> 00:17:09,119 comfortable, I'm OK. Yeah. 290 00:17:09,119 --> 00:17:11,880 So then they will do the checking, yes, yeah. 291 00:17:12,200 --> 00:17:16,160 Then after that, any other thing that they will do on the first 292 00:17:16,240 --> 00:17:17,880 visit. Sometimes we do some 293 00:17:17,880 --> 00:17:22,119 desensitization, oral massages to help them feel comfortable. 294 00:17:22,520 --> 00:17:27,960 And I would also if the child is able to cope and if, if we 295 00:17:27,960 --> 00:17:31,400 follow the child's pace, if they are OK to accept more new things 296 00:17:31,520 --> 00:17:34,640 that day, then we will introduce one instrument at a time, 297 00:17:35,200 --> 00:17:37,320 depending on what kind of treatment that they need. 298 00:17:37,720 --> 00:17:40,040 Yeah. Look at the parents support the 299 00:17:40,040 --> 00:17:43,360 child during this session without increasing the children 300 00:17:43,360 --> 00:17:44,280 anxiety. I don't know. 301 00:17:44,400 --> 00:17:46,720 But for me, I feel like sometimes parents might not be 302 00:17:46,720 --> 00:17:49,840 the one who can calm them. I feel like sometimes parents 303 00:17:49,880 --> 00:17:54,320 will add anxiety to the kids because they themselves panic. 304 00:17:54,400 --> 00:17:58,160 You know, the kids also panic. Well, how do you see this this 305 00:17:58,160 --> 00:18:00,960 thing actually like when parents come in with the child? 306 00:18:00,960 --> 00:18:04,520 Yeah. I think parents, the simplest 307 00:18:04,520 --> 00:18:07,600 thing is to stay calm and be present. 308 00:18:07,960 --> 00:18:09,720 So when they come. Yeah, yeah. 309 00:18:11,800 --> 00:18:16,720 So, so I think children are very, very sensitive. 310 00:18:16,880 --> 00:18:19,240 So. So if the parent is anxious or 311 00:18:19,240 --> 00:18:22,720 the surrounding is anxious, they can really pick it up very, very 312 00:18:22,720 --> 00:18:25,040 fast. And that could build a lot of 313 00:18:25,040 --> 00:18:28,400 pressure in them. So when when parents are here 314 00:18:28,400 --> 00:18:30,720 with the kid. So I always tell them to 315 00:18:30,880 --> 00:18:35,680 acknowledge their feelings, give them space and also allow short 316 00:18:35,680 --> 00:18:39,480 breaks. And sometimes out of love, we 317 00:18:39,480 --> 00:18:44,720 tend to tell or encourage or persuade the child to cooperate 318 00:18:44,800 --> 00:18:46,680 like you must do this today. So. 319 00:18:47,000 --> 00:18:47,600 Extremely. Yeah. 320 00:18:48,080 --> 00:18:51,000 So. So I think we should lower the 321 00:18:51,000 --> 00:18:54,720 expectations and we first build a very safe and comfortable 322 00:18:54,720 --> 00:18:58,560 environment for the child to to come back again next time. 323 00:18:58,800 --> 00:19:02,160 So during the first visit, sometimes doing less allow us to 324 00:19:02,160 --> 00:19:05,600 do more in the future. Do less and. 325 00:19:05,640 --> 00:19:08,000 Less is small. Yeah, and we can have more. 326 00:19:08,000 --> 00:19:12,680 And perhaps sometimes parents can take a small step back and 327 00:19:12,680 --> 00:19:15,280 allow the dentist to build the connection with the child 328 00:19:15,720 --> 00:19:19,280 because one convoys is less overwhelming than many. 329 00:19:20,240 --> 00:19:24,160 So so parents, stay inside the room, but try to be away as far 330 00:19:24,160 --> 00:19:26,800 as possible. I always encourage parents to be 331 00:19:26,800 --> 00:19:30,880 in the room because in such a way the parents would feel that 332 00:19:30,880 --> 00:19:32,960 the child sorry, the child would feel much supported. 333 00:19:33,280 --> 00:19:37,920 So there were a lot of my patients who love to be hugged 334 00:19:37,920 --> 00:19:41,960 by the father or the mother on the chat and that hug gives them 335 00:19:42,240 --> 00:19:47,080 a good sense of comfort. So, but calmness is the most 336 00:19:47,080 --> 00:19:50,480 important thing I would say, and acknowledging how the child 337 00:19:50,480 --> 00:19:54,160 feels, meeting them at where they are following their pace is 338 00:19:54,200 --> 00:19:57,880 very, very crucial. After talking to doctor for a 339 00:19:57,880 --> 00:20:00,200 while, I can feel the calmness. Thank you. 340 00:20:00,280 --> 00:20:06,440 I'm actually very. Nervous, very anxious, but yeah. 341 00:20:06,920 --> 00:20:08,840 Good thing you have a hypnotherapy skill. 342 00:20:09,600 --> 00:20:12,560 Right all right so she is so calm and I can see that the 343 00:20:12,560 --> 00:20:16,040 parents also like you say like doctor is here parents have to 344 00:20:16,040 --> 00:20:17,760 stay calm. I think that's very important 345 00:20:17,760 --> 00:20:21,640 because I think a lot of times the child feel anxious or 346 00:20:21,640 --> 00:20:25,320 nervous is because how the people around you know how they 347 00:20:25,320 --> 00:20:28,640 feel, You know, like you say, don't, don't be scared, don't be 348 00:20:28,640 --> 00:20:30,080 scared. Actually, that is the most scary 349 00:20:30,080 --> 00:20:32,960 they will. Be thinking like, oh, what is 350 00:20:32,960 --> 00:20:35,560 coming next? That that that you have to tell 351 00:20:35,560 --> 00:20:36,000 me. Don't. 352 00:20:36,200 --> 00:20:36,840 Don't be. Scared. 353 00:20:37,400 --> 00:20:41,480 Giving a teaser or preview of the next thing will be scary, so 354 00:20:41,520 --> 00:20:43,400 don't be scared. Right, correct. 355 00:20:43,400 --> 00:20:45,280 So. So our choice of words are very 356 00:20:45,280 --> 00:20:47,680 important. So doctor in in the quest of 357 00:20:47,680 --> 00:20:51,640 trying to build the rapport and calm the children right would 358 00:20:52,200 --> 00:20:54,960 like having like a reward as a reinforcer. 359 00:20:54,960 --> 00:20:58,600 Will it be something that is good to practice? 360 00:20:58,960 --> 00:21:03,920 OK, I think what we can include to practice the strategies 361 00:21:03,920 --> 00:21:06,920 includes giving the child a sense of control first. 362 00:21:07,160 --> 00:21:11,920 So on my chair or during the treatment I always give them, we 363 00:21:11,920 --> 00:21:13,480 always walk through stopping queues first. 364 00:21:13,520 --> 00:21:16,720 Like I will tell them, raise your hand or give me a nudge if 365 00:21:16,720 --> 00:21:20,240 you feel uncomfortable. They, they know that they are 366 00:21:20,240 --> 00:21:23,880 not trapped in that situation and they can respond on how they 367 00:21:23,880 --> 00:21:26,000 feel. So if let's say I'm not 368 00:21:26,000 --> 00:21:28,800 comfortable with the dentist doing this, I will raise my hand 369 00:21:29,000 --> 00:21:32,400 and I will stop the dentist. So that's one thing to be 370 00:21:32,400 --> 00:21:35,200 considered. And then I think breaks are very 371 00:21:35,200 --> 00:21:41,160 important because sometimes pausing, sitting up, gargling 372 00:21:41,160 --> 00:21:44,080 water or just stepping out of the room to regulate how you 373 00:21:44,080 --> 00:21:46,880 feel and your emotions are equally important. 374 00:21:47,240 --> 00:21:50,600 And then As for rewards, right? I always see it as a form of 375 00:21:50,800 --> 00:21:53,920 encouragement rather than something to push the child 376 00:21:53,920 --> 00:21:56,640 through. So I believe on inner 377 00:21:56,640 --> 00:21:59,520 motivation. And when it's a form of 378 00:21:59,520 --> 00:22:03,920 encouragement, it motivates the child to to go further and to be 379 00:22:03,920 --> 00:22:07,360 willing to try more things instead of just going through 380 00:22:07,360 --> 00:22:10,280 the dental treatment. In that way it builds a lot of 381 00:22:10,520 --> 00:22:14,240 negative experience. OK. 382 00:22:14,320 --> 00:22:18,680 How do you adapt your approach when treating children with ASD? 383 00:22:18,840 --> 00:22:22,000 Yeah. It has always been the same. 384 00:22:22,640 --> 00:22:25,400 It's always very child LED and very flexible. 385 00:22:25,800 --> 00:22:30,800 I don't expect anyone to fit into a standard routine dental 386 00:22:30,800 --> 00:22:32,920 practice. So like I mentioned, sometimes I 387 00:22:32,920 --> 00:22:36,160 remove my mask, sometimes we do treatments on the chair if we 388 00:22:36,160 --> 00:22:39,560 are able to, and sometimes we do treatment on the stool or even 389 00:22:39,560 --> 00:22:42,440 on the floor. So it's more or less like, 390 00:22:42,880 --> 00:22:46,160 again, meeting the child where they are and where they feel 391 00:22:46,160 --> 00:22:50,960 comfortable. So in short, I don't expect to 392 00:22:50,960 --> 00:22:55,400 adapt the child into dentistry, but it's more of like adapting 393 00:22:55,400 --> 00:22:56,520 dentistry into the child. Try. 394 00:22:57,000 --> 00:23:02,040 To adapt yourself to that. So for example, just now we are 395 00:23:02,040 --> 00:23:06,000 talking majority at the first visit, you know, and also we 396 00:23:06,000 --> 00:23:08,520 encourage parents to come in when the child is actually 397 00:23:08,520 --> 00:23:13,400 pretty OK, you know, just to do some normal preventive, you 398 00:23:13,400 --> 00:23:15,920 know, and all these things. How about when the kids really 399 00:23:15,920 --> 00:23:20,520 came with, you know, decay, some situation where you really need 400 00:23:20,520 --> 00:23:25,240 to do some feeling or pulling up the tooth, you know, or things 401 00:23:25,240 --> 00:23:29,440 like that for some procedure. So how it looks like? 402 00:23:29,600 --> 00:23:32,480 Yeah. OK, first we need to address how 403 00:23:32,480 --> 00:23:37,440 severe the symptoms is and how how severe the care, how urgent 404 00:23:37,440 --> 00:23:41,080 the care is needed. And if if urgent care is needed 405 00:23:41,080 --> 00:23:44,360 and the child is not being able to cope, it's too overwhelming 406 00:23:44,360 --> 00:23:47,600 for them, then we will suggest a specialist referral where you 407 00:23:47,600 --> 00:23:51,920 can consider gas sedation or a general anesthesia to manage 408 00:23:52,000 --> 00:23:55,920 your decay and your current symptoms at one goal and the 409 00:23:55,920 --> 00:23:58,160 child's comfort of its best lasso. 410 00:23:58,160 --> 00:24:00,480 Meaning the child is very comfortable because I don't see 411 00:24:00,480 --> 00:24:05,800 the the point of forcing the child to endure the treatment, 412 00:24:05,840 --> 00:24:08,080 the drilling and all the extraction. 413 00:24:08,080 --> 00:24:12,800 So we do what is needed and referrals to pediatric 414 00:24:12,800 --> 00:24:16,120 specialist for management under general anaesthesia would be 415 00:24:16,520 --> 00:24:20,240 much helpful. And of course, if the problem is 416 00:24:20,280 --> 00:24:25,120 minor, we would start by a few visits of desensitization, 417 00:24:25,400 --> 00:24:30,200 getting the child to be used to the treatment and whatnot, and 418 00:24:30,520 --> 00:24:32,200 and then slowly we build from there. 419 00:24:32,480 --> 00:24:34,640 And when the child is ready, then we will address the 420 00:24:34,640 --> 00:24:36,960 symptom. Yeah. 421 00:24:36,960 --> 00:24:39,400 How? Often do you think the parents 422 00:24:39,400 --> 00:24:41,640 should bring the child to dentist OK? 423 00:24:42,960 --> 00:24:45,040 Yeah. So a regular dental appointment 424 00:24:45,040 --> 00:24:50,120 should be 6 monthly, but children with needs and that 425 00:24:50,320 --> 00:24:52,960 that we need to support, right. Sometimes we would prefer a more 426 00:24:52,960 --> 00:24:56,120 regular appointment for desensitization, for 427 00:24:56,560 --> 00:24:59,040 familiarization. So it would be ranging from a 428 00:24:59,040 --> 00:25:01,560 two to three monthly appointment visits, OK. 429 00:25:02,040 --> 00:25:07,000 OK, Yeah. So for parents that's around PJ, 430 00:25:07,080 --> 00:25:11,680 you are quite lucky we have dentist like doctor Elaine, you 431 00:25:11,680 --> 00:25:14,360 know that's so patient. I know that it's not easy like 432 00:25:14,360 --> 00:25:18,320 for example, parents that's listening to gifts podcast might 433 00:25:18,320 --> 00:25:22,480 be from anywhere, anywhere, you know, So maybe you can give some 434 00:25:22,480 --> 00:25:25,680 tips to the parents, you know, when they're looking for a 435 00:25:26,040 --> 00:25:28,120 dentist. What are the, you know, 436 00:25:28,160 --> 00:25:31,720 something that they need to consider? 437 00:25:31,800 --> 00:25:33,520 Or look out. For look out for yeah. 438 00:25:34,960 --> 00:25:39,800 I think the the most crucial thing is being patient and calm 439 00:25:40,120 --> 00:25:44,520 and willing to work as a team. So your dentist should be 440 00:25:44,560 --> 00:25:48,840 flexible and has an open minded to to work as a team because we 441 00:25:48,840 --> 00:25:51,880 don't work alone, sometimes we work together. 442 00:25:51,880 --> 00:25:56,000 So parents start by brushing teeth at home 1st and and we 443 00:25:56,160 --> 00:26:00,000 also work with therapies to help to regulate the child a little 444 00:26:00,000 --> 00:26:03,120 bit more the coping strategies and the routines. 445 00:26:03,440 --> 00:26:08,440 At the same time, the dentist should also slow down, avoid 446 00:26:08,440 --> 00:26:11,440 rushing things because rush appointments can be too 447 00:26:11,440 --> 00:26:13,960 overwhelming for the child and also for the parent. 448 00:26:14,400 --> 00:26:17,680 And parents can observe the interactions with of the 449 00:26:17,680 --> 00:26:21,440 dentist, with the child, whether the dentist is explaining things 450 00:26:21,640 --> 00:26:27,040 slowly, whether the dentist is also respecting the child's 451 00:26:27,040 --> 00:26:31,040 boundaries and giving the child enough time to cope. 452 00:26:32,200 --> 00:26:35,040 I think there's no one-size-fits-all, but it's very 453 00:26:35,040 --> 00:26:37,960 important to find the right person because you're not 454 00:26:38,040 --> 00:26:40,680 finding someone to just treat your child's teeth, you're 455 00:26:40,680 --> 00:26:43,200 finding someone for your child to feel safe with. 456 00:26:43,960 --> 00:26:46,080 Yeah, and it's not a touch and cool thing you. 457 00:26:46,200 --> 00:26:48,080 Just come one. Yeah, it's a long term thing 458 00:26:48,080 --> 00:26:51,400 because during the first visit of most of my patients, I always 459 00:26:51,400 --> 00:26:55,600 tell them our end goal is for the child to feel comfortable on 460 00:26:55,600 --> 00:26:59,280 the chair for her, his or her regular 6 monthly appointment 461 00:26:59,400 --> 00:27:01,760 till they are adult next time, yeah. 462 00:27:02,320 --> 00:27:05,160 Just a doctor mentioned about brushing teeth. 463 00:27:05,200 --> 00:27:08,440 So maybe we also can take this opportunity to ask from a doctor 464 00:27:08,680 --> 00:27:12,760 advice, you know, say the children below 5 years old or 465 00:27:12,760 --> 00:27:17,560 six years old, you know, we are how some of the parents say, oh, 466 00:27:17,560 --> 00:27:19,520 my child still cannot brush their own teeth. 467 00:27:19,520 --> 00:27:22,120 You know that I always advise the parents, although, yeah, 468 00:27:22,120 --> 00:27:26,080 they still cannot, but doesn't mean that you can let stop stop 469 00:27:26,080 --> 00:27:30,520 doing it, you know, So maybe you can give some advice to the the 470 00:27:30,520 --> 00:27:33,520 parents here. You know that what is the right 471 00:27:33,640 --> 00:27:35,920 amount of time? You know how to take care of 472 00:27:35,920 --> 00:27:38,000 their teeth at how many times a day? 473 00:27:38,280 --> 00:27:40,680 Yeah, I think it's very crucial to start young. 474 00:27:41,120 --> 00:27:44,200 So our first dental appointment usually start as young as one 475 00:27:44,200 --> 00:27:46,440 year old. So when when the child is still 476 00:27:46,440 --> 00:27:49,560 at a pre cooperative age, usually we try our best to clean 477 00:27:49,560 --> 00:27:52,200 and brush. So when it's already a routine, 478 00:27:52,360 --> 00:27:57,080 the kid would definitely comply and take it in a positive manner 479 00:27:57,080 --> 00:27:59,120 that oh, brushing teeth is not something that I dread. 480 00:27:59,360 --> 00:28:01,400 So starting off young is very important. 481 00:28:01,400 --> 00:28:04,280 And of course brushing twice a day in the morning and before 482 00:28:04,280 --> 00:28:06,480 sleep. After brushing at night, before 483 00:28:06,480 --> 00:28:09,680 sleep, there's no more any other food and drinks other than plain 484 00:28:09,680 --> 00:28:13,120 water. Also, to schedule your first 485 00:28:13,120 --> 00:28:16,160 dental visit as young as one year old or when the first tooth 486 00:28:16,160 --> 00:28:18,440 erupts so that the child gets familiarized. 487 00:28:18,760 --> 00:28:21,800 With. The dental visit, so don't start 488 00:28:21,800 --> 00:28:24,640 too late. And consistency matters. 489 00:28:24,640 --> 00:28:29,520 So even if your child refused at a very early stage, I hope that 490 00:28:29,520 --> 00:28:32,200 parents persevere. Toothbrush for the patients. 491 00:28:32,400 --> 00:28:38,520 I I like the advice where after second brushing, meaning before 492 00:28:38,520 --> 00:28:44,480 sleep, the child shouldn't take any other food except water. 493 00:28:44,480 --> 00:28:47,360 But a lot of time, Asian parents, we will still give them 494 00:28:47,360 --> 00:28:51,040 the last bottle of milk. They have to. 495 00:28:51,040 --> 00:28:55,200 Then you have to put in a little bit of extra work to gently wipe 496 00:28:55,200 --> 00:28:56,680 and clean off the teeth surfaces. 497 00:28:56,720 --> 00:28:59,360 You know the layer of milk will be stuck onto the teeth causing 498 00:28:59,360 --> 00:29:01,400 tooth decay later on. Yeah. 499 00:29:02,160 --> 00:29:07,160 But can can I ask if you have any like memorable or 500 00:29:07,200 --> 00:29:12,000 interesting story or visits from one of your child? 501 00:29:13,160 --> 00:29:17,640 I have a number. Recently I I was in the 502 00:29:17,640 --> 00:29:23,520 emergency department because I was beaten by a child and it was 503 00:29:23,520 --> 00:29:27,800 a lot of bleeding and whatnot. But what I gained was the child 504 00:29:27,800 --> 00:29:31,920 was very overwhelmed and I failed to capture that. 505 00:29:32,280 --> 00:29:35,400 So I thought my patient was OK to continue. 506 00:29:35,720 --> 00:29:39,880 So when I was helping him to clean his teeth, I was placing 507 00:29:39,880 --> 00:29:45,760 my finger to support his jaw. So he beat me and he didn't know 508 00:29:45,760 --> 00:29:48,560 how to let go. So I thought that was quite 509 00:29:48,560 --> 00:29:52,480 memorable for me and and I gained a lot from that 510 00:29:52,480 --> 00:29:55,920 experience. I should definitely be more 511 00:29:55,920 --> 00:29:59,760 sensitive to how they feel, especially certain certain small 512 00:29:59,760 --> 00:30:05,200 hints like telling me no. So I should know to to be more 513 00:30:05,200 --> 00:30:07,320 sensitive. I think to to be able to gauge 514 00:30:07,320 --> 00:30:10,000 because they do not know how to respond when they are too 515 00:30:10,000 --> 00:30:11,720 overwhelmed, when it's too much for them. 516 00:30:12,280 --> 00:30:18,040 And I also had another child that took us almost a year to be 517 00:30:18,040 --> 00:30:21,880 able to sit comfortably on the chair and to allow examination. 518 00:30:22,240 --> 00:30:26,040 And I really admire the parents dedication and patience in 519 00:30:26,040 --> 00:30:29,920 bringing the child monthly for us to try small different 520 00:30:29,920 --> 00:30:34,800 exposure during the monthly visit to be for the child to be 521 00:30:34,800 --> 00:30:39,240 where he is AT and when he is able to cope with the dental 522 00:30:39,240 --> 00:30:39,800 treatment. Right. 523 00:30:39,800 --> 00:30:42,200 I would say is it wasn't false at all. 524 00:30:42,200 --> 00:30:45,240 It was his readiness and it's all the hard work of the parents 525 00:30:45,240 --> 00:30:50,680 bringing him. So that was like expose exposure 526 00:30:50,680 --> 00:30:55,000 therapy, trying the things that you don't feel pleasurable bit 527 00:30:55,000 --> 00:30:56,720 by bit. Yeah, +1. 528 00:30:57,120 --> 00:31:00,080 And I just want to add on that you did not fail to capture the 529 00:31:00,200 --> 00:31:04,520 patient's nervousness that time during for the accident you went 530 00:31:04,520 --> 00:31:06,760 through. It's probably just another way 531 00:31:06,760 --> 00:31:09,200 for you to find out that next time you can have a different 532 00:31:09,200 --> 00:31:11,920 way of doing things. Yeah, that's also one way of 533 00:31:11,920 --> 00:31:15,520 looking at things. But it has really made me think 534 00:31:15,520 --> 00:31:21,680 a lot like on how I do things and whether that's why I feel 535 00:31:21,760 --> 00:31:24,160 earlier on when we're talking about giving the child a voice, 536 00:31:24,400 --> 00:31:28,360 it's very important to to give the child her voice, his or her 537 00:31:28,360 --> 00:31:32,960 voice to be able to tell us what to do and what not to do. 538 00:31:34,520 --> 00:31:37,320 So I might sound a bit insensitive and lack of empathy 539 00:31:37,320 --> 00:31:39,760 to say this, but I think it happened for a good reason. 540 00:31:41,400 --> 00:31:44,160 OK, because we also notice that our kids a lot of time, they 541 00:31:44,160 --> 00:31:47,320 just cannot gaggle, right? Yeah, they have problem with 542 00:31:47,440 --> 00:31:49,920 gaggling and then even speed up the water. 543 00:31:49,920 --> 00:31:53,840 Many and many, many of our kids actually, after they brushed it, 544 00:31:54,120 --> 00:32:01,480 drink, drink everything, go into it, you know, So is it OK or you 545 00:32:01,480 --> 00:32:04,360 know, what will be, or some of the parents say I don't even 546 00:32:04,360 --> 00:32:07,280 need, I didn't even use toothpaste, you know, because my 547 00:32:07,280 --> 00:32:09,960 kid has been eating toothpaste. And yeah. 548 00:32:09,960 --> 00:32:12,120 So maybe you can share a little bit about that. 549 00:32:12,400 --> 00:32:16,360 If we use the right amount of toothpaste, the right amount of 550 00:32:16,360 --> 00:32:21,200 fluoridated toothpaste, not being able to spit out or gaggle 551 00:32:21,200 --> 00:32:23,960 is completely fine. So for children one to three 552 00:32:23,960 --> 00:32:27,840 years old, we usually advise a teen smear and three years old 553 00:32:27,840 --> 00:32:30,560 and above is like a green pea size and we advise fluoridated 554 00:32:30,560 --> 00:32:33,200 toothpaste. So the fluoride helps to prevent 555 00:32:33,200 --> 00:32:34,880 decay. But parents are always very 556 00:32:34,880 --> 00:32:36,480 concerned. My child don't know how to 557 00:32:36,480 --> 00:32:38,120 gaggle wall, don't know how to spit wall. 558 00:32:38,360 --> 00:32:41,600 If they are using the right dosage, it's completely safe and 559 00:32:41,720 --> 00:32:44,880 it's OK. Every child has their own 560 00:32:44,880 --> 00:32:48,840 milestone, so it's a natural reflex to just drink the water, 561 00:32:48,840 --> 00:32:51,760 not being able to gargle. But they will eventually be 562 00:32:51,760 --> 00:32:53,960 there and get there. They will get there eventually, 563 00:32:53,960 --> 00:32:57,160 so it's completely OK. Yeah, instead of not giving 564 00:32:57,160 --> 00:33:00,400 toothpaste at all, you will still advise to give at least 565 00:33:00,520 --> 00:33:04,400 with certain amount, Yeah, so that in a safe amount so that 566 00:33:04,400 --> 00:33:08,360 even then they swallow it and it's fine, but while waiting for 567 00:33:08,360 --> 00:33:11,280 the gargle and the spitting skill to develop. 568 00:33:12,320 --> 00:33:17,600 Yeah, we hear quite a lot of effort that you put in to you 569 00:33:17,600 --> 00:33:21,000 know, build a relationship and provide a safe space for the 570 00:33:21,000 --> 00:33:23,800 child. I'm not sure whether it happened 571 00:33:23,800 --> 00:33:27,520 before, but let's say, oh, like the one that you described just 572 00:33:27,520 --> 00:33:29,880 now when the child actually the patient beat you, right. 573 00:33:30,200 --> 00:33:33,560 So I suppose that treatment was ended abruptly. 574 00:33:33,840 --> 00:33:37,920 So because you needed to go to emergency department, so for 575 00:33:37,920 --> 00:33:42,440 treatment that could not completed in the clinic, is 576 00:33:42,440 --> 00:33:45,640 there anything that the parents can do after or just come back 577 00:33:45,640 --> 00:33:50,000 again? I think tolerance is not built 578 00:33:50,000 --> 00:33:54,280 over a single visit. And for that incident that I 579 00:33:54,280 --> 00:33:56,000 mentioned, it was the first visit. 580 00:33:56,120 --> 00:34:00,160 So we we still wrap things up nicely. 581 00:34:00,160 --> 00:34:03,040 But if, let's say, in the event that we do not complete any 582 00:34:03,040 --> 00:34:06,080 dental treatment or we couldn't complete the dental treatment, 583 00:34:06,360 --> 00:34:11,199 we shouldn't see it as a failure or unsuccessful visit because 584 00:34:12,960 --> 00:34:15,639 the process is still a form of progress. 585 00:34:16,080 --> 00:34:19,120 And I always encourage parents to celebrate small wins. 586 00:34:20,560 --> 00:34:24,320 It cannot be quantified whether it's small or big, it's still a 587 00:34:24,320 --> 00:34:26,840 win. If the child allows examination, 588 00:34:26,840 --> 00:34:30,719 to me, it's a big win already. If the child allows cleaning on 589 00:34:30,719 --> 00:34:34,440 that day or even just sitting on the chair comfortably is really 590 00:34:34,440 --> 00:34:37,560 a win already. So it shouldn't be seen as a 591 00:34:37,560 --> 00:34:42,239 failure or a mistake, but we should definitely calibrate it 592 00:34:42,239 --> 00:34:46,000 as a form of progress. We learned something from it for 593 00:34:46,000 --> 00:34:48,800 sure. Just said how, where, how, how 594 00:34:48,800 --> 00:34:52,440 we look at things. Correct the child. 595 00:34:52,440 --> 00:34:59,800 After he beat me, he gave me a hug and he actually said thank 596 00:34:59,800 --> 00:35:04,160 you and he left. So he was just overwhelmed and I 597 00:35:04,160 --> 00:35:06,640 don't see that as a failure because we didn't complete it. 598 00:35:06,680 --> 00:35:09,800 I still managed to clean and he was just too overwhelmed. 599 00:35:09,800 --> 00:35:13,800 So I see that as a big win and. Probably it was his only way he 600 00:35:13,800 --> 00:35:16,600 could team up, you know, to, to escape. 601 00:35:16,600 --> 00:35:19,600 But he's also aware. Yeah, but he, he, he's still 602 00:35:19,600 --> 00:35:21,840 allowed after that. And he he said thank you and he 603 00:35:21,840 --> 00:35:26,080 gave me a hug that that. As a parent to a child on the 604 00:35:26,080 --> 00:35:30,440 spectrum, there are places that before we bring him go, we will 605 00:35:30,440 --> 00:35:35,320 feel very, very anxious. Cutting hair, visiting a dentist 606 00:35:35,320 --> 00:35:38,720 is one of those two things that is high on the anxiety list. 607 00:35:39,680 --> 00:35:42,360 I always ask the parent what about haircut? 608 00:35:42,560 --> 00:35:46,080 When, when when the child is new to me, I always ask what about 609 00:35:46,080 --> 00:35:50,240 haircut. So I just want to say for every 610 00:35:50,240 --> 00:35:53,480 new visit with my patient, I'm equally anxious because every 611 00:35:53,480 --> 00:35:54,560 child is different. Yes. 612 00:35:54,680 --> 00:35:55,960 Yeah, you. Don't know what? 613 00:35:56,320 --> 00:35:59,160 To expect yes, I'm equally anxious, but you're not alone. 614 00:35:59,920 --> 00:36:04,320 We are here to work as a team and you're not here to figure 615 00:36:04,320 --> 00:36:09,120 everything out on your own. And I think it's good to have a 616 00:36:09,160 --> 00:36:12,200 change of mindset where you think that I'm bringing my child 617 00:36:12,200 --> 00:36:15,600 to meet somebody to take care of their oral hygiene and for their 618 00:36:15,600 --> 00:36:19,240 dental health to begin with. Not to complete everything at 619 00:36:19,240 --> 00:36:23,000 the first visit, do. You think that is a like a 620 00:36:23,080 --> 00:36:26,840 perceptual issue culturally like in here? 621 00:36:26,840 --> 00:36:29,040 Like it's still early, it's still so young. 622 00:36:29,200 --> 00:36:31,920 Don't need love. Yes, yes, I do. 623 00:36:31,920 --> 00:36:36,920 Because I always get patients coming in at 8 or nine with 624 00:36:37,080 --> 00:36:41,200 problems like retain baby teeth. So then, then the parents would 625 00:36:41,200 --> 00:36:44,720 want me to extract the baby tooth there and then because the 626 00:36:44,720 --> 00:36:48,560 adult tooth is growing, but the child is 8 or 9 and this is his 627 00:36:48,560 --> 00:36:53,000 or her first dental experience. Because we may think that oh, 628 00:36:53,240 --> 00:36:56,320 nothing, ma, no pain, ma, no need to bring so early, la why I 629 00:36:56,320 --> 00:36:59,480 need to bring so early? But I think good early exposure 630 00:36:59,760 --> 00:37:04,200 and familiarization is very important because dental care 631 00:37:04,200 --> 00:37:06,320 and dental health is a lifelong thing. 632 00:37:08,080 --> 00:37:13,520 We all need a regular checkup for early carries detection and 633 00:37:13,520 --> 00:37:16,200 also for routine scaling every six months. 634 00:37:17,360 --> 00:37:19,880 It's good to start. With how I read someone told me 635 00:37:19,880 --> 00:37:22,840 this 20 years ago that I'll take care of my oral hygiene better 636 00:37:25,440 --> 00:37:26,520 but it's never too late. It's. 637 00:37:26,520 --> 00:37:27,640 Never too late. Yeah, it's. 638 00:37:28,640 --> 00:37:29,800 Never. Too late myself. 639 00:37:32,360 --> 00:37:37,200 So I think with that, we have really have a lot of tips and 640 00:37:37,880 --> 00:37:41,120 also advice and guidance from Doctor Elenco. 641 00:37:41,520 --> 00:37:45,600 And hopefully I'm not not to say hopefully. 642 00:37:45,600 --> 00:37:50,480 I mean, if few years ago I listened to a podcast like this, 643 00:37:50,920 --> 00:37:54,880 I would have a lot of idea on how to prepare my son to his for 644 00:37:54,880 --> 00:37:58,600 his first dental visit. And probably I'll be less 645 00:37:58,600 --> 00:38:02,760 anxious as as well. And I, we hope that this episode 646 00:38:02,760 --> 00:38:08,960 gives you parents and caregiver, a good insights or a view like, 647 00:38:09,000 --> 00:38:11,040 you know, what to expect and what can I do? 648 00:38:11,280 --> 00:38:13,680 And apparently, from what doctors share with us, you will 649 00:38:13,680 --> 00:38:16,600 know that there's a lot of things that we can prepare for 650 00:38:16,600 --> 00:38:19,720 our children so that their visit will be more pleasant. 651 00:38:20,000 --> 00:38:22,760 And we will also be happier that we bring them here. 652 00:38:23,040 --> 00:38:24,000 Right. Yeah. 653 00:38:24,320 --> 00:38:26,720 And with that, I want to thank you again, Doctor, for your 654 00:38:26,720 --> 00:38:28,960 sharing. Thank you, thank you. 655 00:38:29,040 --> 00:38:31,160 It's. Really a delight to see people 656 00:38:31,160 --> 00:38:35,640 who want to share, you know, the knowledge that took you many, 657 00:38:35,640 --> 00:38:37,920 many years of hard work and figuring out. 658 00:38:38,200 --> 00:38:42,440 And I would just want to express our gratitude to you as well. 659 00:38:42,640 --> 00:38:45,040 So thank you very much. And if you find this episode 660 00:38:45,040 --> 00:38:48,960 useful again, you can share with people your friends, your your 661 00:38:48,960 --> 00:38:52,640 other children's friend or students friend, especially 662 00:38:52,640 --> 00:38:56,120 those who have children on the spectrum who have special needs. 663 00:38:56,600 --> 00:39:00,280 Talking about a topic that is surely going to erupt a lot of 664 00:39:00,280 --> 00:39:05,000 emotion and anxiety feeling to visit them this for the first 665 00:39:05,000 --> 00:39:06,400 time. Thank you very much. 666 00:39:06,400 --> 00:39:06,840 Bye, bye. Thank. 667 00:39:07,480 --> 00:39:08,000 You bye.