It’s not easy to find children – or adults, for that matter – who enjoy going to the dentist. That’s not a knock against the kind and highly-trained dentists who serve our communities, but merely a reflection of the reality that most of us don’t like someone poking around our mouth, and stretching our lips and gums with instruments we don’t recognize.
It can be unsettling. Now imagine it for a child who has sensory issues. What was unsettling becomes chaotic.
The team at the Children’s Health Dental Clinic is out to change that.
The Children’s Dental Health Clinic (CDHC) is a non-profit pediatric dental clinic with a nearly 100-year history of providing specialized oral health care services, support and training, with an emphasis on low-income children and young adults ages 0-21 who live in greater Long Beach and southern Los Angeles County. The CDHC team also supports the unique needs of neurodiverse children, as well as children who have medical complexities like asthma or cancer.
So as we begin National Children’s Dental Health Month, we decided to check in with the CDHC team for their thoughts, especially since they serve 5,500 patients and families each year at their main clinic in Long Beach and in Miller Children’s & Women’s Hospital, both on the MemorialCare Long Beach Medical Center campus; through their school-based, satellite clinic in Avalon on Catalina Island; and through early intervention, education and outreach in the community.
How many people are on the CDHC team?
We consider ourselves very lucky, because our team is made up of more than 50 dedicated dentists, dental hygienists, dental assistants, anesthesiologists and administrators who are passionate about providing quality, compassionate and comprehensive oral health care to our community. A majority of them have been part of our team for at least 10 years, and for many, it’s more.
We are also an accredited training facility for multiple dental specialties, providing hands-on training to student interns in local dental hygiene and dental assisting programs, as well as through a Clinical Residency program for pediatric dentists and oral surgeons in partnership with USC’s Herman Ostrow School of Dentistry and MemorialCare Long Beach Medical Center. After spending time in the different placement settings during their first year, four of the pediatric dental residents then join our Multi-Specialty Pediatric Dental Treatment team during their second year. This gives them hands-on experience with the complex treatment needs of children with disabilities and medical complexities both in our clinic and in Miller Children’s Hospital, where they’re on-call for the emergency room and serve on the hospital’s integrated hematology, oncology and cleft palate/cranio-facial teams.
What type of services to you provide?
We have three programs – Multi-Specialty Pediatric Dental Treatment, Orthodontics and Early Intervention – and both our programs and facilities are designed support the unique needs of children who are physically, mentally or developmentally disabled and/or medically compromised.
Through our Multi-Specialty Pediatric Dental Treatment Program, we provide children and young adults with preventative, restorative and specialized treatments, including all levels of sedation. These services include general and pediatric dentistry, endodontics and periodontics, oral surgery, treatment with intravenous (IV) sedation, and treatment under general anesthesia in the operating rooms at Miller Children’s Hospital.
Through our Orthodontics Program, we offer comprehensive orthodontic treatment, including braces and Invisalign. We also treat patients with everything from routine to complex cases, such as children with cranio-facial/cleft palate development challenges.
Our Early Intervention Program is specially designed to provide fun and engaging ways for children ages 0-5 and their parents/caregivers to work together to prevent cavities, learn about healthy habits, and reduce a child’s fear of the dentist. These individualized, 30-minute sessions take place in a classroom-like setting every three-to-six-months, depending on the results of the child’s Oral Health Risk Assessment. We begin each session by letting the child play while we talk to the parents/caregivers about their day-to-day lives and how it has an impact on oral health. We also provide personalized guidance and give them an opportunity to set two or three self-management goals, following up on future visits. After that, we introduce the child to dental care tools, and they practice using them to clean a stuffed alligator’s teeth or their own teeth in a mirror. Finally, while standing, sitting on their parent’s lap or sitting on their own, the child’s teeth are examined, cleaned and a treatment is applied. At the end of the visit, they are given a new oral health kit to take home, along with a toy or sticker.
What can parents do to prepare their neurodiverse child for a visit to the dentist?
We asked our Dental Director and Pediatric Residency Team to provide these tips, and they suggested the following:
- Before the appointment, show your child photos and videos of positive experiences in a dental office, including kids having dental exams and treatment.
- Encourage your child with positive talk about the dentist and dental office.
- Use pretend play to simulate a visit to the dental office at home, helping them become more desensitized to what they will experience. Start by having them lay down and then:
- Touch their cheeks and around their mouth.
- Have them practice opening and closing their mouth.
- Look into their mouth with a flashlight and count their teeth.
- Ask them to open their mouth wide and use a toothbrush to brush their teeth.
- Choose a time of day when your child is well-rested.
- Try to keep routines as normal as possible the day of the dental appointment.
What accommodations do you have or do you make to a neurodiverse child to keep them comfortable?
We asked our Dental Director and Pediatric Residency Team to help with this question too. Here’s what they said:
- We ask the parents to help us facilitate a familiar environment by bringing in their own toothpaste and/or a favorite toy.
- We suggest scheduling early morning appointments, and we try to minimize how much time they spend in the waiting room to help ease anxiety.
- We have single-patient rooms that we can specify using for their appointment, which offer limited stimulation to help patients who need a quieter environment away from others.
- We consider using flavorless fluoride and prophy paste (cleaning/polishing paste), if needed.
- We suggest using nitrous oxide (aka laughing gas) or IV sedation for their treatment.
- We also schedule out longer appointment times for exams and treatments, so we can take the time to talk to them and walk them through each step.
You can learn more about how we take the time to care for our patients based on their individual needs and why we suggest using of nitrous oxide in a story we shared before the holidays. This story features Luis, who had extreme anxiety due to a previous dental experience, and it’s a great example of how we build trust with our young patients.
What should parents do to ensure good oral-care habits are established at an early age?
We asked Elizabeth Valdivia, RDH-AP – who works with families through our Early Intervention Program – to provide these tips. Here’s what she said:
- Brushing as a family is very important, and for small children, don’t just limit it to the bathroom. It can be done anywhere they’re comfortable, such as in a high-chair or stroller or while they’re playing.
- Sing a song to them as they brush their teeth, and start incorporating it as part of their bedtime routine. You can find a links to helpful tools like the Brush, Book, Bed Sing-Along on our website.
- For neurodiverse children, it’s especially helpful to establish a habit and make brushing their teeth part of a structured routine.
- When looking at children’s toothpaste, make sure it has fluoride. You only need a little bit, the size of a grain of rice or half of their pinky nail, which is safe to swallow if they don’t spit it out or rinse their mouth.
- You can also dip a toothbrush in children’s mouthwash when they’re learning to brush. As they get in the habit of brushing, they’ll also get used to having a clean mouth. Same with using floss on their teeth early – it helps them to get used to the feeling, even if it’s not done perfectly.
- And of course, begin taking them to the dentist at an early age – as early as six-months-old – so they can get acquainted with the dental staff and facility. This is especially helpful if you find something like our Early Intervention Program with an environment where they can relax and play!
Anything else our community should know about your clinic?
Let’s talk a little bit about how we are able to do this work. While a majority of our patients are on Medi-Cal, we also accept some PPO insurance and offer sliding-scale fees based on income. Please call our office at (562) 933-3141 if you’d like to discuss insurance details. You can also find more information for patients and families on our website.
Unfortunately, we’ve found that because of the complexity of treatment and low reimbursement rates, few dentists in our area treat children with disabilities or medical complexities. Patients are continuously referred to us for our Multi-Specialty and Early Intervention programs, and about 40% of our patients have one or more of these special health care needs.
We are proud to help our community overcome various barriers to oral health care, but we can’t do it without the support of our community. The reality is that we only receive about 55% of the true cost of our services through insurance reimbursements, and as a 501(c)(3) non-profit organization, we are able to make up the difference thanks to support from corporations, foundations and generous individuals throughout the community.
