The mere sight of a dentist’s chair can unnerve even the most jaded adult. For kids, it can be even more harrowing. Music delivered through headphones can help drown out the drilling sounds, and colorful, creative office interiors can add a friendly glow. Videos, prizes, treats, gum—all have been employed by dentists to ease the angst of that six-month obligation that sets American smiles apart from much of the rest of the world.
“The whole idea of somebody unfamiliar touching your mouth or poking at your teeth is not something anyone finds easy to accept,” says Dr. Rose Wadenya, a dentist with Eagle Crest Pediatric Dentistry in Havertown. “The mouth is a very sensitive area— very different than touching your skin. And when it’s painful, it magnifies the whole problem.”
Born in Kenya, Wadenya has written 16 children’s books relating to dental care and reducing anxiety. She has a tendency to hum while she works—a habit she wasn’t aware of until someone brought it up. “Parents would smile and tell me that I make their kids so comfortable, humming or telling a story,” she says.
As young patients started asking her to retell the stories, she decided to document them. “Considering that kids are bullied because of their buck teeth or double teeth, I decided to address those stories, as well—to empower them,” says Wadenya.
Those aged 3-21 with special needs represent 7 million patients (or potential patients). According to the American Dental Association, that’s anyone who, due to “physical, medical, developmental or cognitive conditions,” requires “special consideration when receiving dental treatment.” Standard dental procedures can be a challenge for patients with autism, Alzheimer’s disease, Down syndrome, spinal cord injuries and other conditions.
To qualify to care for a special-needs patient, pediatric dentists receive an additional two to three years of specialized training. “A licensed pediatric dentist with board certification means that you’ve also done a residency in a children’s hospital,” says Chestnut Hill’s Dr. Jill Garrido, who heads Brandywine Pediatric Dentistry. “Most pediatric dentists would be comfortable with special needs, even if it isn’t specifically listed on their website.”
The complex needs that require additional attention are as varied as the patients themselves—everything from wheelchairs to brushing fears. “Having teeth brushed feels tingly, which is scary,” says Garrido, adding that even toothpaste flavors like bubblegum or strawberry can scare more sensitive children. “Dental lights are super-stimulating.”
Consulting parents on those triggers— and how to soothe the child afterward—is crucial. “We take extra time with parents to gain the trust of the child,” says Wadenya. “If it means doing a cleaning over three visits, so be it. Over time, they become more comfortable with me and the staff.”
For Wadenya, the most challenging part is when a nonverbal youngster is discovered to have an abscess or needs an extraction. Infections are particularly troublesome. “When a special-needs child has a toothache, isn’t eating well and just seems kind of sad, you can’t simply get x-rays at the office,” says Garrido. “If anesthesia is needed, the care must happen in a pediatric hospital.”
Yet, despite the wealth of hospitals in our region, the greatest challenge is finding a facility to provide the care. Recent nursing shortages have only compounded the problem. Though she’s worked with the Nemours surgical center at Bryn Mawr Hospital for 10 years, Wadenya hasn’t had access since the pandemic. “Some offices have surgical centers, but they’re overwhelmed with the demand,” she says.
Finding available operating rooms for dental care has become a national issue. In February, the ADA issued a plea for a change in Medicare billing to make access to hospitals more streamlined for dentists. Often, patients only wind up there when the problem becomes acute.
“[It can result] in a child with abscess winding up with cellulitis because they couldn’t get access to hospital for [regular] dental care,” Garrido says.
Garrido has found taking care of kids with special needs especially rewarding, whether she’s assessing how medical concerns affect dental health or searching out options for care. “I hope to continue getting better at sharing that information,” she says.