A 2007 clinical report of the American Academy of Pediatrics concluded that the benefit of ABA-based interventions in autism spectrum disorder (ASD’s) “has been well documented through 5 decades of research and, children who receive early intensive behavioral treatment have shown to make substantial positive social changes”.
When a child is diagnosed with a developmental disability as Autism Spectrum Disorder, ABA intervention can teach new skills and reduce unwanted behavior. Behavior analysis focuses on the basic elements that explain how learning takes place. Positive reinforcement is one such principle. When a behavior is followed by some sort of reward, the behavior is more likely to be repeated. Visual supports help to increase understanding and creates predictability and provides a visual structure and routine of the dental visit which can help reduce anxiety and behaviors. Often children with autism have a hard time with change in routine, new people and, new sensory stimulations.
However, applying this principles to dentistry is challenging and changes do not typically occur quickly. Rather, most patients require intensive and ongoing dental instruction that builds on their step-by-step progress. Moreover, the rate of progress varies considerably from person to person depending on age, level of functioning, family goals and other factors.
At Miami Children’s Smiles, we have created a program tailored to patients within the Autism spectrum. Although we are not behavioral therapist, we are pretty confident we can help in the creation of healthy dental habits for your child.
Nitrous Oxide: Also known as “laughing gas”. It is a very mild form of sedation that consists in giving the child a relaxing gas through a mask placed on the nose. The gas is simultaneously given with oxygen. Candidates for this method are children that are anxious or afraid but willing to let us place the mask on their noses. Children more anxious or that are crying when we attempt to place the mask on the nose need a different approach.
Oral Sedation: When a child is too young, the treatment is relatively short, and his or her level of anxiety is higher or is unwilling to let us use nitrous oxide is when oral sedation comes into place. It consists in giving the child a sedative agent which comes in a liquid form that the child drinks. This sedative produces a calming state that allows the child to cooperate with the treatment needed. It causes sleepiness, drowsiness, and loss of apprehension. The vital signs are closely monitored during the entire procedure, and the child usually recovers within an hour after treatment is completed.
Intravenous Sedation: When there is a significant amount of dental treatment to be done, and the child is very young, fearful or uncooperative and an oral sedative is not enough to control the child’s level of anxiety we offer this option. It consists in performing all dental treatment while the child is safely sedated with a medicine given intravenously. This option creates a deep sleep that insulates the child from the stress and worry associated with dental procedures. For this option we create a team in our office with a pediatric anesthesiologist that is in charge of dispensing the sedative and monitor the child while the dental treatment is performed by Dr. Gabriela Rolland-Asensi. For this treatment option we partner with Pediatric Dental Anesthesia Associates as well as with Florida Dental Anestesia.
Hospital Dentistry: When the amount of dental treatment is major and complex, the child has a complicated medical history or a special need or disability we may offer to perform the dental treatment while the child is safely asleep in a children’s hospital. This provides a safe environment with a pediatric medical team at our side to properly care for the child’s dental needs. The majority or cases for dental restoration in hospital setting are performed at two major hospital: Nicklaus Children’s Hospital, formerly known as Miami Children’s Hospital and, Baptist Health Hospital
Visits: The easier parents approach a trip to the dentist, the less likely the child will have anxiety and the more likely that the child will cooperate with the dentist. Parents should tell children about the appointment before they leave and treat it like it is an additional errand that is needed. Parents should tell children that everyone with good teeth should have routine checkups. Never express any personal anxieties you may have about dental care to the child, and under any circumstances mention the words; “shot”, “pain” or “discomfort”.
You can make comments and comparison about the importance of teeth in animals, make it fun and interesting asking questions and relating back to your child on how beneficial is to have regular checkup visits. Do not forget to mention the Treasure Chest surprise at the end of the appointment!!!
You will be received with a smile and warm welcome to our office. Your will be asked to register the name of your child or children individually. Proper identification for new patients’ parents is required. Valid forms of identification are; driver’s license, military ID, passport or any picture ID that contains your photo, name and last name. Please see that court papers are required when you bring adopted children. Divorced parents will also be requested to present proof of custody. If you decide to send your child with any family or relative for further appointments, our website portal will require the necessary authorization at time of registration. Please see that only parents can authorize any changes to treatment plans. Once you have done the proper registration, you can sit and relax being assured that your child will be taken care of as soon as possible. Please be patient if you have to wait; we do not mind rescheduling your appointment at your convenience if you see that you are running out of time.
Parents are welcome during preventive and treatment appointments. However, due to the constant handling of medical supplies and dental instruments we only allow one adult per room, regardless of the number of children in your party. A second adult may be allowed in the room at a time of consultation with Dr. Rolland or any other of ours doctors.
We are glad to be in network providers for many insurance companies. It is essential for you to know that as part of the Affordable Care Act, one the mandates contained in the law is that every policy must offer dental health care to children. Regardless of the type of plan you have, Miami Children’s Smiles will always abide by the fees of your insurance as long as payment is received in the contracted manner.
For your tranquility we pre-authorize most operative procedures, meaning that estimated treatments are sent to your insurance company for authorization, leaving us and you to be reassured that your out pocket, deductibles and co-payment obey to the right charges to you.
In order to set up an appointment, you and/or your child must have an active dental policy. If you come as a self pay patient, we would offer you our customary fees. Please understand that in the State of Florida, proof or insurance eligibility is NOT a warranty of payment. Even after our services are rendered, your insurance company may deny payment on the basis of a retroactive policy termination; leaving you responsible for the payment of such services.
Make sure to read and understand our financial policy and the way we operate when dealing with your insurance company.
Meet Dr. Gabriela Rolland-Asensi, DMD
A Diplomate of the American Board of Pediatric Dentistry, Dr. Gabriela Rolland-Asensi, is a native of Venezuela, where she attended Dental School and practiced general dentistry. Dr. Rolland moved to Miami and completed a General Dentistry Residency at Miami Children’s Hospital where she went on to become Chief Resident. Later, she completed her postdoctoral training in Pediatric Dentistry at the University of Florida. Dr. Rolland joined the faculty at Nova Southeastern University where she trained and supervised the post-doctoral students on the use of conscious sedation. While teaching at Nova, she attended Dental School again to obtain her Doctorate in Dental Medicine in the United States.
Today, Dr. Rolland is in private practice in Miami and is Chief of the Department of Dentistry at Nicklaus Children’s Hospital as well.
Dr. Tomas Marrecau, DMD
A member of the American Association of Orthodontists, Dr. Tomas Marrecau, DMD earned his Bachelor of Arts degree in Molecular Biology from Princeton University. He later attended Tufts School of Dental Medicine where he actively participated in Smile Squad, teaching the importance of oral health at local elementary schools. Upon graduation, Dr. Marrecau practiced general dentistry for two years in Philadelphia, Pennsylvania. He was then accepted to the University of Pennsylvania for his two-year postgraduate training in orthodontics and had the opportunity to practice with several outstanding orthodontists in Pennsylvania and New Jersey. Dr. Marrecau has been in private practice since moving to Florida in 2009 and joined the Miami Children’s Smiles team in 2017 to work alongside Dr. Rolland-Asensi. He is fluent in both English and Spanish.