April 3, 2013
Dental care for all
Navah Paskowitz knows that her 4-year-old son, Edwin, is long overdue for a dental checkup, but she’s terrified to take him for one.
About eight months ago, the Sherman Oaks resident and her husband took Edwin, who was diagnosed with autism, to his first visit with a dentist. As soon as they walked in the door, the boy started screaming.
“There was normal play going on in the waiting room, and just from the sounds of being inside a closed environment with children, he basically flipped out,” recalled Paskowitz, a member of Temple Beth Hillel in Valley Village. “We were completely mortified. We didn’t know what to do. … It was such a traumatic experience that we literally aborted mission, and we left.”
Her experience is not uncommon among parents of children with autism. Because these children often have difficulty processing sensory information, the bright lights and unfamiliar sounds and activity in a dentist’s office can send them into a panic.
For many parents, the only way to get their child’s teeth checked is to physically hold them down in the dentist’s chair or have them put under general anesthesia. Others may forgo dental visits altogether, putting their child’s health at risk.
To help address the problem, researchers at the University of Southern California (USC) and Children’s Hospital Los Angeles (CHLA) are conducting a pilot study in collaboration with Beit Issie Shapiro, which describes itself as Israel’s leading organization for people with disabilities. The research, funded by a $531,000 grant from the National Institutes of Health, is examining whether a type of multisensory therapy brought to Israel by Beit Issie Shapiro to treat children with developmental disorders and special needs can be effectively used to make dental visits less stressful for autistic children.
The therapy, known as Snoezelen, involves creating an environment that is both calming and stimulating to the senses. It includes the use of soft lighting, gentle music, enticing smells, cozy fabrics and visual displays such as moving pictures on the ceiling and transparent tubes filled with bubbles that children can touch. In the dentist’s chair, the child is wrapped in a weighted butterfly vest designed to duplicate the feel of being hugged by someone.
The researchers are working with 40 children — half diagnosed with autism and half not diagnosed with the developmental disorder — to assess their behavioral response to the therapy during dental cleanings. Sharon Cermak, the study’s principle investigator and a professor of occupational science at USC, said her team expects to complete the cleanings by June and then begin analyzing the results. Depending on the findings, the research could eventually lead to changes in how dental care is provided to autistic children, and possibly other children as well, Cermak indicated.
“Our hope is that the sensory-adapted environment will make it easier for children with autism to get their teeth cleaned,” Cermak said. “Our larger hope is that we will then be able to involve more dental clinics and use this as a model to revolutionize pediatric dentistry.”
Beit Issie Shapiro has used Snoezelen therapy in nondental settings for years in Israel as a way to treat children and adults with a variety of problems, including developmental disabilities, cancer, Alzheimer’s disease and post-traumatic stress disorder. There are now hundreds of Snoezelen therapy centers in the country.
Michele Shapiro, the occupational therapist with Beit Issie Shapiro who brought the therapy to Israel and expanded its use there, began applying it to dental care several years ago, but her research did not include autistic children. The study at USC aims to bridge that gap.
Shapiro and the head of Beit Issie Shapiro’s sensory dental clinic, Dr. Anat Baniel, will travel to Los Angeles in May to assist with the study. The organization’s executive director, Jean Judes, said she is thrilled about the research happening in California. She said such studies are critical to achieving more widespread acceptance of new therapy ideas that improve the lives of people with special needs.
“Beit Issie Shapiro is very innovative in its approach. That’s really the core of us as an organization,” she said. “We feel proud that such a wonderful university decided they wanted to replicate this with our consultation. ... This could have global implications.”
Dental care is not the only area of collaboration between Beit Issie Shapiro and southern California institutions. The nonprofit is involved in three other research initiatives at at CHLA concerning children with chronic illnesses and special needs, and the development of a movement program at the John Tracy Clinic, an L.A. nonprofit serving young children with hearing loss.
Ernest Katz, director of behavioral sciences at Children’s Hospital and professor of clinical pediatrics and psychology at USC, is involved in one of the research projects that is using methods developed by Beit Issie Shapiro to provide better care for children under age 5 who suffer from cancer and blood diseases. Katz said the kinds of therapies provided to children with disabilities can also be used to help chronically ill children.
“This local collaboration that we have with Beit Issie Shapiro [is] to the benefit not only of the children of Israel, but to the benefit of the children of Los Angeles and the Southern California community,” he said.
Experts from Los Angeles, including Katz, have traveled to Israel to learn about Beit Issie Shapiro’s practices and facilities, and to share expertise. Last December, 10 such experts joined officials from Beit Issie Shapiro in Jerusalem to present research findings at the third International Conference on Pediatric Chronic Diseases, Disability and Human Development.
He said he has also been inspired by visits to Beit Issie Shapiro to look for ways of bringing different kinds of services at CHLA together — such as hydrotherapy, physical therapy, physiological support and nutrition planning — so children and families can get the help they need in one place.
The Israeli organization also has hosted groups of visitors with disabilities from Los Angeles, including a mission last summer sponsored by The Jewish Federation of Greater Los Angeles. The Federation also helps support the nonprofit’s efforts in a joint project with Israel Elwyn to help people with disabilities in Israel advocate for themselves.
“We look at ourselves as an organization for social change and betterment of society and not just providing services to people with disabilities,” concluded Benjy Maor, Beit Issie Shapiro’s director of international resource development.