Preparing for the Dentist with Dr. Steven Hogan

Preparing for the Dentist with Dr. Steven Hogan

In this episode we chat with pediatric dentist Dr. Steven Hogan about the unique challenges and treatment for a neurodiverse population, including children with sensory processing difficulties, anxiety, communication difficulties, and a wide range of medical diagnoses. Dr. Hogan discusses things parents can do to prepare children for the dentist, tips for at the dentist, strategies he personally uses in treatment, and advice for brushing at home. Dr. Hogan’s goal is to make the trip to the dentist a positive experience to support lifelong dental health. 

Dr. Hogan is a native Houstonian and part owner of Houston’s Pediatric Dentist. He attended University of Texas Austin and University of Texas Dental School at San Antonio. He completed a pediatric residency through the Texas A&M Baylor College of Dentistry where he trained at Children’s Medical Center and Texas Scottish Rite Hospital and received extensive training in sedation, special needs and medically compromised patients, and patients with dental trauma. Dr. Hogan is also a father of three who focuses on providing care in a positive manner. 

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Stephanie Landis (00:06):

Hello, and welcome to Unbabbled, a podcast that navigates the world of special education, communication delays, and learning differences. We are your host, Stephanie Landis and Meredith Krimmel, and we're certified speech language pathologist who spend our days at The Parish School in Houston, helping children find their voices and connect with the world around them.

Stephanie Landis (00:26):

In this episode, we chat with pediatric dentists, Dr. Steven Hogan about the unique challenges and treatment for a neurodiverse population, including children with sensory processing difficulties, anxiety, communication difficulties, and a wide range of medical diagnoses. Dr. Hogan is a native Houstonian and part owner of Houston's Pediatric Dentist. He attended University of Texas Dental School at San Antonio, completed a Pediatric residency through the Texas A&M Baylor College of Dentistry and received extensive training in sedation, special needs of medically compromised patients and patients with dental trauma. Dr. Hogan's goal is to make the trip to the dentist, a positive experience to support lifelong dental health. Throughout the episode, Dr. Hogan discusses things parents can do to prepare children for the dentist. Tips to use during dental visits and strategies he uses in treatments. He also gives his input on which toothpaste and toothbrush to use and advice for brushing at home. This episode is full of comforting and helpful advice.

Stephanie Landis (01:27):

Welcome in today's episode, we're speaking with Dr. Hogan of Houston's pediatric dentist, and we have been wanting to have a dentist on for a long time because parents are frequently asking us for recommendations because it can be difficult to take any child to a dentist. So we're extremely excited to talk to you today. Thank you for being here.

Dr. Hogan (01:48):

It's my pleasure. I'm happy to be here. Thank you for having me.

Stephanie Landis (01:51):

Yeah. So we had you specifically on, because you have background in treating, not just pediatrics, but children that have varying different special needs or sensory processing and things of that. What made you kind of pursue that as a specialty?

Dr. Hogan (02:11):

Great question. So when you're in dental school, when you're young in dental school, you kind of have to make a decision on what route of care you want to go. Do you want to just be a general dentist, which is great. Do you want to pick one of the specialties? And a lot of my mentors and people who were guiding me in school kind of nudged me in the direction of pediatric dentistry because they thought that my skillset fit that better, which I'm really grateful that they did. And so in order to be a pediatric dentist, after your four years of dental school, you have to do two more years of a pediatric residency program. And the residency program that I got to, that I got into, which is at Baylor college of dentistry in Dallas, and mostly through children's hospital in Dallas is the residency program in the country who sees the highest population of special needs patients and proportion to what your overall training is and all different, special needs from medical healthcare needs to communication differences to learning differences. And so I've got a really large expansive exposure during training to to working with those types of patients and truly just fell in love with it. And in private practice that has grown vastly, just not just myself, but my staff, it's just our favorite population of patients to help and treat. And it's really rewarding and, and the patients are super sweet. And so that's kind of how it's done.

Stephanie Landis (03:40):

So as far as even just the office set up, are there certain things that make your office different in thinking about how it's set up and the structure of it from say a typical pediatric program?

Dr. Hogan (03:54):

Yes. Great question. Yes, there is actually not, maybe not necessarily we did this on purpose, but it just kind of organically happened, and it's also helped us a lot during COVID too, but a lot of pediatric dental practices are very open in the sense that you can be in one chair and having kids having the kids' teeth being cleaned, and you can see multiple chairs around you. It's called like an open bay type setting in our office. We have hardly any open bay. It's almost all private room, which really helps in their big private rooms. And so if parents need to be in and feel more comfortable, they can a kid can feel free to kind of just be, be more private if there's more volume, if there's more challenges, if we need more assistance in the room who can help help you know, and manage and, and help and deal with special circumstances then we can. And you know, the parents just don't have to feel near as concerned with with being, having other people be around them. It's just more intimate

Stephanie Landis (04:55):

That, and the dental instruments can be really loud and those lights are very bright. I totally understand why they need to be right. They're looking into a dark hole. But that can be very sensory over-stimulating for a lot of kids that have sensory regulation difficulties. And if they are listening to what's going on with them and all the kids around and everything that's happening, it's hard to block that out. And you, I think I can see the benefit of having just one room with a big open space. So not only is it more private, but then it's, it's quieter and less overstimulating.

Dr. Hogan (05:32):

Absolutely. And that's the name of the game with working with any kids with any type of sensory issues is removing the outside environment and getting them to feel focused and comforted in their own individual environment and meeting them there. And that is definitely best well done in a private, private setting with, with them alone, with multiple staff members,

Meredith Krimmel (05:54):

I would see that this would benefit children with anxiety or even adults with anxiety. A lot of people who have anxiety about going to the dentist. So not having to hear the dental equipment in the room next to you can really start to alleviate that and speak. Like when you have a child who has anxiety about going to the dentist, do you have any tips that you, that you suggest to parents to get them ready for the visit it or any way that they could prepare so that would go a little smoother?

Dr. Hogan (06:21):

Yes. Have a lot. I, I think one thing that's helpful and we don't do this for every single patient, but we sure offer it is sometimes it's helpful just to take them up to the office before they actually do the visit. So just come walk through, come spend some time in the waiting room, come spend time just walking through and meeting everyone. And we're not doing anything today and they don't even necessarily know that, but just, Hey, we're just gonna come. We're gonna meet the doctor. And we're just gonna come by and say hi. So I think familiarity is extremely important too. I think buzzwords and staying away from them are really important. Yeah. You have no idea what a kid has heard or processed an understanding about what the dentist actually is. And like one of the biggest challenges we have is when we see a kid for the first time, and they've heard from a sibling, from a friend, from, even from a parent that the dentist is a bad place or someone who had pain, or it was uncomfortable. And so you already had preconceived notions setting up for it. So I, I think staying away from, you know, cavity, buzz, words, pain pressure loud and more focusing on like kindness of the dentist that they're gonna love you and be right there with you. And that, you know, mommy and daddy are their friends and you know, they're gonna love and support you those type of things. I also think there are multiple shows out there that, that kids can watch. Peppa pig has a good one. Curious George has a good one. Their episodes on like going to the dentist and like a, a, a fun friendly environment. But again, I just seeing the environment and having experience in the environment and seeing our walls that have ocean themed and toys everywhere and encouraging staff. I think that's really important.

Stephanie Landis (08:11):

My daughter has high anxiety. And so to prep for the dentist, we watch like Daniel tiger, all the shows got like three books out. I've played pretend and had them give checkups to their stuffed animals. And luckily our pediatric dentist was very kind and even gave their stuffed animal a like dental checkup before giving it to them. And that helps ease some of the anxiety. So those are some wonderful tips.

Meredith Krimmel (08:38):

Yeah. The curious George goes to dentist book is, is popular in my house.

Dr. Hogan (08:42):

Very good. And, and to your point about the animal that's extremely helpful. We have a big alligator in our office of stuff, alligator with a big old set of teeth with a large toothbrush. And the, the whole tell show do aspect of pediatric dentistry is magnified with any kid with sensory processing disorder, anxiety issues at all it really helps to tell show do, and using a stuffed animal as some sort, as a comfort creature for them is really helpful.

Stephanie Landis (09:12):

I like that it's very much similar with what we do of like, we call it frontloading kids. The tell show do like front loading that definitely speaking our language.

Meredith Krimmel (09:22):

And some of these recommendations apply. We, we used for other new experiences for children, you know, just, just like you, I mean, watching a video or going to a place, meeting the people before you have to do the work, those are all really great strategies to help children kind of know the expectations, take the, the worry and the unknown out of the equation.

Dr. Hogan (09:42):

Yes. Ma'am.

Meredith Krimmel (09:43):

What about some of our kiddos they struggle with even brushing their teeth at home. Do you have any ways that you can help families get over that battle every night and morning?

Dr. Hogan (09:52):

For sure. You know, I think there's mult, there's a couple of reasons why that will happen. If you have your kid with actually like a, a, a physical challenge to hold a toothbrush, the small handles can be really hard. So anything you can do to increase the handle width can be really can make it better because you don't have to use as much acute sensory motion to do it. So if you have a kid that just has a challenge physically to hold ways to increase that toothbrush size, or you can take a tennis ball and cut a hole right through the middle of it and put the toothbrush right in the middle of it. And the tennis ball is actually what, what holds. And it's also just like a comfort thing too. You can do the same thing with a pool noodle. You can take a pool noodle and put it over top the toothbrush handle so you have a bigger thing to hold onto. Also there are multiple different toothbrushes out there that anatomically can help. There's multiple three sided toothbrushes, and I'm not gonna go into the brand names, cuz there's a lot of them, but you can find multiple of them on Amazon or whatever, but those really help so you don't have to be so defined with your movements with a toothbrush and they can really help you get to a lot more places. And that can be, that can help. The other thing I think is just really involving them in the process and making it fun. So, you know, past the age of two, we recommend fluoride toothpaste for kids. And when you move to the fluoride toothpaste, they can be really spicy and really stringent for a kid, especially if they have sensory challenges. And so letting them brush first with a like really simple nons spicy toothpaste, that's even fluoride free and using their own toothbrush and having their own world involved in it. But then you follow up afterwards and do it the way that needs to be done, I think can be helpful. So just giving them autonomy in the process, I think is helpful.

Stephanie Landis (11:52):

That's great. You know, I didn't even think about how brushing and flossing is a fine motor, a fine motor movement as well. And if kids are already struggling with fine motor, then that's gonna be difficult too. What about electric toothbrushes? Do you find that's more helpful, less helpful if kids can tolerate them?

Dr. Hogan (12:15):

So electric toothbrushes are just in general, a wonderful product. Most of the time around somewhere between the ages of eight and 10, depending on the development of the kid, like how advanced they are dentally we recommend them universally. But I also find that kids with sensory challenges, electric toothbrushes, most of the time are, are not helpful. But I'm, it's all about the family themselves. So I don't push that because I tend to find more negative with that with the kids. But what I tell the parents is try it, buy a cheap one first, see how it does if the kid really likes it, then that's a wonderful thing. It's all about if they like it, you know, if it makes it easier and better, there's some percentage of population out there that like, well, that's the only thing they'll use or like really actually relaxes them. But I, I tend to find that it's the opposite for the most part.

Stephanie Landis (13:05):

Yeah. That's in my house. I have two sensory sensory seeking kids and my younger one, he only wants to brush with that. And my older daughter, she flipped and was like, no, wanted nothing to do with it. So we, we backed off and stopped.

Dr. Hogan (13:23):

Very good.

Meredith Krimmel (13:24):

Both of my kids are sensory seekers and they both love their electronic toothbrushes, but mostly they love them because of the characters on the handle, which can be a huge draw. When you're searching, we also took my children to pick their own toothbrushes to pick their own characters, to help with, like you were talking about the autonomy and taking ownership over it.

Dr. Hogan (13:46):

Yes Ma'am.

Meredith Krimmel (13:47):

But that spicy toothpaste thing that we, we, I see that in our family. And I, I mean, as an adult, I have my own preference in what toothpaste works. Have you found one that maybe is the flavoring is more tolerable by people who are sensitive to the, the spice or the flavor?

Dr. Hogan (14:06):

Yes. And there are a lot of 'em, but one I like to push initially is called Toms. It originally Toms is a company that originally marketed themselves as a fluoride free toothpaste, but several years ago, they came up with a, a strawberry based product that does have flouride in it, but it's not near as spicy and not near as big of a transition for kids. And so when when they're struggling with that transition, the Tom strawberry can be really helpful, but just make sure it does have flouride in it if you're past the age of two. So yeah, kids do really well with that one, I would say. And also just like something with a flavoring agent in it, you know, toothpaste are called kids toothpaste kind of, for two reasons. One, they either don't have fluoride, which we don't want or, you know, past the age two or they have a flavoring agent and they can help a lot, you know, like bubble gum, crest products, something like that would be great. But yeah, that Tom strawberry can be really helpful.

Stephanie Landis (14:59):

Do you have any advice for parents when they're seeking out a dentist like tips, things they can ask to see if this will be a good fit for their child?

Dr. Hogan (15:09):

Yeah. Yeah. That's a challenging one. Just because it's hard to know as a parent, like which residency programs, you know, they had more experience and sought more. Most of the time, if you go on a pediatric dentist website, they'll mention in the bio, if their residency program had a lot of activity with special healthcare needs children, but still that can be misleading. You know, people can write that and you still don't know, you know, the difference, honestly, I think probably one of the biggest resources are like Facebook groups with other parents, you know, for example, like Steel Magnolias, you know I, I get lots of new patients from those types of, of sites. And just hearing from experiences from other parents who have done it and like, okay, this didn't like, they knew exactly how to manage her or manage him. They made us feel comfortable. So I think that's helpful. I also think if you, if you call somewhere and they're really like excited to talk to you about, and they can, you can tell that they just feel comfortable answering your questions. And if you're asking specifics about how this child's going to be treated differently and they know that means they're probably answering that question a lot. So I, I, I think that that's helpful. But I think the peer conversations would, are probably the most, but because it's, it's hard to really know by like looking on a website or something. Does that make sense?

Stephanie Landis (16:37):

Yeah. Yeah. That's a, that's a lot of what we get often into is just through our school, moms and dads, talking to other moms and dads and being like, yeah, we had a great experience here with this person, try this person go there. So it makes a lot of sense.

Dr. Hogan (16:53):

That's what's so great about information, you know, not just with, I mean, most of my referrals are, are word of mouth from existing patients, which I'm grateful for. But but I, I think that means a lot.

Stephanie Landis (17:06):

What age do you start seeing kids?

Dr. Hogan (17:09):

So the average kid, we start seeing at two for the most part. Sometimes there are unique dental problems that present themselves before, two which we're there to help for, of course. And some parents want to come before that, because they have a specific question, but routinely, most of my new patient exams are around the two year old year. And, but it just kind depends on kids. Sometimes we don't see patients for the first time until their four or five. I would argue that that's too late just because there's lots of things that you can miss before then and things can get out of control on you. So, and then we see kids through college.

Stephanie Landis (17:46):

Do you find that kids have an easier time when they start young? Cause I know some parents are like, oh they're two and it's gonna be a rough time. So they kind of avoid it that way. Or do you find that it's easier to start the routine while they're young?

Dr. Hogan (18:01):

Great question. Absolutely starting when they're young. So I, I encourage parents all day long who have two year olds, especially if it's your first child, maybe the appointment's a little bit of a struggle. It sounds counterintuitive, but the earlier you start, even if they cry some during the appointment, even if it's a little bit of a struggle, the quicker they get to the point that they love it here because at two, at two and a half, they don't associate any type of negativity, meaning crying or struggling just a little bit with their experience at the dentist. All they remember are the prizes that they have a dentist, the familiarity the, the, the fun things on the walls, the toys that they got and, you know, they can cry. And then two seconds later they'll tell the parents how much fun they had, you know? And so familiarity means everything around here. I can't all day long and see three and a half year olds who are back by themselves, loving every second of it and enjoying the movies, enjoying the whole experience who at two, maybe struggled a little bit and it's just very common. So the earlier the better,

Meredith Krimmel (19:02):

I would love to hear your thoughts on pacifier use and thumbs sucking and how you support that transition, especially for children who are highly attached to that object or, or their thumb.

Dr. Hogan (19:15):

So habits are obviously a big part of pediatric life and there's lots of them. It's not just passy or thumb there's fingers, there's hair, there's nails. There's, there's lots of different there's blankets. There's lots of different things that people kids will hold onto. This is a, a very, a complex question, but I'm gonna kind of go on the simpler route just a little bit. It depends on the habit and it depends on the family. And it also depends on the anatomical presentation of the kid. I'll tell you that most habits, whatever they do cause in the mouth, whatever changes are caused can be fixed with orthodontic therapy. So, and you know, a lot of kids in my practice get braces or specific orthodontic therapy geared towards geared towards them. And so I'm not too concerned about habits, especially before the age of four to four and a half. And so what I usually explain to parents is that look, passys the pacifiers are called pacifiers because they pacify. So if it's helping your family and it's helping you it's okay. And again, this is within the range of like normal anatomical presentation. There are a few kids that have the way their bite and, and shape of their teeth come together. That the ear, it would be better to stop earlier. But for the most part I of kind of explain to parents that anything that you see can be fixed if you don't want certain type of spaces to show up from like six to 12 years old before you get braces, I recommend stopping the habits by four and a half to five for the most part. And depending on the habit, we guide them at appropriate developmental ages on how to have them stop. And it's easier said than done. It's easy to be a Monday morning quarterback and tell people how to do that. But but there are some ways that we have a lot of experience with not only just me personally with my nine, six and four year old, but also just dealing with parents a lot with this issue. And there are some better ways than others to get rid of them. But I'm pretty relaxed about 'em. And just trying to encourage the parents and take it on a case by case basis.

Meredith Krimmel (21:20):

I'm happy to hear you say that as a parent of a four year old, who is an intense thumb sucker, she has recently said she wants to stop. So hopefully we'll get there soon, but it has been a

Dr. Hogan (21:34):

Thumb is much more challenging than pacifier. You can't cut it off, obviously can't take it away. So it's always there and, but four tends to be a much better time than three to get rid of the thumb and you can call me at a different time and we can discuss all kinds of ways to do that. But there's a, there's, there's good ways to do that at four.

Meredith Krimmel (21:54):

I might be, I might be calling you,

Dr. Hogan (21:55):

That's fine.

Stephanie Landis (21:58):

This can be a little bit of a controversial thing within the speech and language world, but do you treat and see many tongue ties?

Dr. Hogan (22:08):

You're correct. It's very controversial. There are. Probably within my profession, it's the most controversial thing currently going myself and my partner are extremely conservative on tongue ties. I think that there is enough. I believe that there is enough research and enough data to support the fact that there is a very small population of children who it's extremely helpful for. I believe it to be very overdiagnosed and overdone, but that's an opinion. I think in general there are some kids who present with the anatomical issue of tongue tie that their life can be changed with that treatment, but it's in a very specific set of barriers and requirements. It is not a universal treatment that all kids need and there's lots of things that it doesn't help. And there's also lots of kids who can have some of the issues that a tongue tie can cause, and they work through them without the procedure. So, and I see that a lot in my office, so we could talk a lot more about that and we don't diagnose it a ton. We do have, you know, infants who come, who mothers tried a lot and God bless her. She's struggling. The kids struggling. They've worked with lactation consultant. It's very challenging. Kids got a humongous tongue tie. Like that's a big indication. We've got kids who have been in speech therapy for three to four years. They're six to seven years old. Nothing's getting better. I've got the SLP telling me that all the Mo the sounds that they're trying to work with them, they're not getting anywhere. And they have a big tongue tie. That's an indication to do it. So, but I don't cut tongue ties because their tongue ties does that fair.

Stephanie Landis (24:06):

That is fair and very fair. Going back to personal opinions. That is also my interpretation of the research on the speech and, and language side only, which is all that I deal with. But since it is a topic that people are out there, I just thought I get that. I get the information on it. Yeah. So once they're in your office and we got 'em in and they're comfortable if they need treatment, how do you walk children and families through that?

Dr. Hogan (24:32):

Yeah. And, and this is very kid-dependent as well, and also very experiential driven. And by that, I mean, how many times have they been to our office? Have they had treatment before, whenever we do treatment or we do any type of hygiene exam procedure on a kid, especially if they have differences. We're very specific in our notes about exactly what we did and what worked and what didn't. And so there might be some, some kid, two kids that have the exact same condition or the exact same difference, but one, we may do completely different depending on what their experience is, but just some things in general, that work heavy weighted vests work extremely well, extremely well in our chair, multiple assistants, constantly loving on them. That's extremely good keeping light as much light away as possible. That's a big one. So I try to make sure I'm very careful, only keeping it on the teeth and not in their eyes. We use sunglasses and really dark lens sunglasses to help that oftentimes we'll do earmuffs or headphones. So we don't have to hear the noises near as much. We also like to do like fidget or squishy toys. So we give them toys from the beginning, anything that they can hold and really just try to love on 'em take breaks. If I'm doing treatment that involves like laughing gas or Nitrous oxide, I'll let 'em sit on laughing or nitrous oxide for longer and have someone opportunity for hands to be held if they need to hold them from one of my assistants and really just give, give them kind of room to have some control. So they know they can always raise a hand and talk to me. I'm gonna, I'm telling 'em from the beginning, I'm to explain to you every single thing that I'm gonna do, and I do it in stepwise order. And just try to build that trust and build a level of control within them that they feel comfortable.

Stephanie Landis (26:27):

Those are some great tips and definitely things that we've used for children in other situations, weighted vest, fidgets, lovies. Yeah. Talking them through it. You mentioned earlier that you see children all the way up to college age, it seems like the neurodiverse population also goes through adulthood. Would you see adults as well? Or would they go to more of a family dentistry

Dr. Hogan (26:57):

Also very case dependent. Okay. We have, yes. And yes. So we we do have multiple adults in our practice with special healthcare needs medically compromised situations behavioral challenges. And we're happy to see 'em and do the challenge becomes when they have specific dental problems that are adult related problems that I don't do, for example, like if they need beyond fillings, like if they need crowns or bridges or implants, that's when I have to refer them out. And so I have a few like general dentistry partners that we like to work with in those situations. It also works the other way around. So I have a few general dentistry partners who will routinely see the patients for every six month visits. But if they need like fillings done, we're maybe more amenable to be able to do those, whether it involves sedation dentistry or whether it involves just more of a loving environment that's used to doing treatment on on, on differences then maybe they would refer back to us to just do treatment.

Stephanie Landis (28:08):

That's fantastic. Well, thank you so much. This has been incredibly helpful for me. So I'm hoping that our families and parents will, will learn something and feel more confident in taking their kids to the dentist, because I know it's something that is incredibly important for their health, but also something that causes a lot of anxiety and maybe then avoided

Dr. Hogan (28:30):

For sure. And it's, it's hard, you know, it's really hard in the families and we try to respect that. We try to schedule a lot of time. So especially for the first visits, so we can really educate and help and see if we can answer questions and give 'em a comfortable environment. Honestly, give us time and room to take our time. Because that's, that's what it takes sometimes, especially at the beginning. And usually what I've found is over years and over multiple times, it just gets better for the kids and gets better for the families and they know what to expect and and they trust us and, you know, we get to that point and so always encourage families to call if they have questions about that.

Stephanie Landis (29:08):

All right. Well, thank you so much. We really appreciate your time.

Dr. Hogan (29:11):

Yeah, absolutely. Thank you for having me.

Meredith Krimmel (29:16):

Thank you for listening to the Unbabbled podcast. For more information on today's episode, please see our episode description. For more information on The Parish School, visit parishschool.org. If you're not already, don't forget to subscribe to the Unbabbled podcast on your app of choice. And if you like what you're hearing, be sure to leave a rating and review a special thank you to STIG Daniels, Amanda Arnold, and Stella limo for all their hard work behind the scenes. Thanks again for listening.