Transcript from the HealthFirst Talks Podcast
Hosted by Michelle Dawn Mooney
Michelle Dawn Mooney:
Hello and welcome to HealthFirst Talks. I’m your host, Michelle Dawn Mooney. Today’s episode is Managing Allergy Conversations with Parents. Allergy awareness is an essential part of safe, family centered dental care.
In this conversation, we are focusing on how open, informed communication can make every dental visit safer, especially for children with known or suspected allergies. This episode is designed to empower both parents and dental teams. We will help parents understand what questions to ask, and we will help dental professionals feel confident answering those questions, addressing concerns, and demonstrating a real commitment to patient safety. Joining me today, two great guests.
I’d like to introduce you to Thomas Silvera and Doctor. Don Cohen. Thomas Silvera is co-founder and president of the Elijah-Alavi Foundation, and Doctor Don Cohen is chief clinical officer at HealthFirst.
So first and foremost, thank you so much for being with me today.
Thomas Silvera:
No, thank you for having us today. This is definitely a critical conversation to have, especially for many parents across this country that need to understand what to do when they’re going to see their dentist.
Dr. Don Cohen:
And what a great point that Thomas brings up. It is really important that you are comfortable as a parent asking these questions, and of course as the dental clinical provider, being prepared to comfortably answer those and be prepared.
Michelle Dawn Mooney:
Absolutely, and this is a tough conversation to have, as you will understand in a few moments, but it is so necessary, and I’m so happy that all of you are tuning in right now to get this information because it is so important. So Thomas, I want to start off with your personal story. If you can give us some background in how we got here today and tell us a little bit more about the foundation.
Thomas Silvera’s Story and the Mission Behind the Elijah Alavi Foundation
Thomas Silvera:
Absolutely. I’m more than happy to share this story. It’s one of the stories that I share throughout since the tragedy of my son’s passing. So to give you some background, I have two boys originally from New York City, but currently in Allentown. So I say two boys, I have one in my heart and one that’s actually, he’s thriving, thirteen years old, who also has multiple food allergies. But when we talk about my other son in my heart is his name is Elijah-Alavi Silvera. And, you know, born a very vibrant, young energetic kid, very independent at such a young age that wanted to do everything on his own.
So his first week of childcare was exciting. We’re talking about end of October, very beginning of November.
So that first week of childcare, were excited to bring him, you know, we’ve talked with the childcare centers to make sure that they can, you know, work with him. My son had multiple food allergies, he had eczema, he had asthma, and this childcare center assured the safety of our child that they can, you know, administer epinephrine in the event of emergency, we had a safe meal for him, they can manage his asthma in the event that he has an asthmatic episode. And on November third, twenty seventeen, that childcare center had failed us.
That day, outside of his original meal plan, they gave him the meal that was provided to the other kids, which was a food that contained dairy. My son was severely allergic to dairy.
They gave him that food and without monitoring him, they let his reaction just continue, which, you know, went from having a regular reaction and moving into an anaphylactic reaction, which became full blown and giving time to not call emergency services or not even call his mother. Eventually they called his mother, she got there immediately and from there she realized something was wrong. It wasn’t just asthma because they negated what they gave him. They was like, He was fine, we don’t know what we gave him.
She rushed them to the hospital, which was nearby in Harlem, Harlem Hospital, and prior from the childcare center to the hospital, anaphylaxis is already far along from that. And if you know what anaphylaxis is, once it hits the body system and multiple body systems play into that, it could be life or death. And unfortunately it was death for my son. And that tragedy literally changed the trajectory of my family’s life forever. We’ve lost, a piece of us. And my other son, Sebastian, no longer could have his brother walking alongside him.
So even in our grief, Elijah’s mother and I, we decided to just just move forward and do something. And we started an organization in Elijah’s name and his uncle, the Elijah-Alavi Foundation. And from there we worked in looking into the policies and systematic errors that happened within the childcare center and noticed there was nothing in place that actually protected children in childcare center, which was baffling. You’re talking about New York, New York State is supposed to be the leading state in legislation and everything, but unfortunately there were voluntary guidelines for K-twelve, but nothing for childcare center.
And that was the biggest thing that was baffling for us because why would you add protection from K-twelve, nothing for childcare? So, we worked with our local legislators and we wrote a whole entire provision for Elijah’s Law, and it was passed in twenty nineteen, signed by the governor at the time and we were excited about it, but also still hurt and still like feeling that pain because, yes, we did something great and it was the law that was the first in the nation actually mandate childcare centers in New York State to provide access to undesignated stock up and effort to food allergy training policies and guidance and communication with the parents.
It’s unfortunate that, you know, tragedy has to strike before you can create change.
And within that legislation, that’s where it spearheaded the change in the legislation to be passed because of the tragedy of my son. And to go back to the childcare center, what was more disappointing, they denied saying that they fed him anything until the investigation was done that there were many that said, Yes, we did feed him this grilled it was a grilled cheese sandwich.
So, it’s so I talk about it, I don’t know if you can hear the emotion in front of my throat, but no matter how many times this is my healing to talk about his story, because if you can take away something from this story from the very beginning, is to make sure you ask the right question, which we did, we crossed out T and dotted our Is, but there’s so much more. That’s why we created this foundation and we worked on passing legislation across the United States. We’ve passed a total of six legislations across the United States and two city ordinance, one in New York City and one in Kansas City. So we’re not done, we still have a lot of work to do. We do a lot of community outreach and food allergy training across the nation. So this conversation today, it’s a different perspective on a childcare setting, but it’s a perspective where parents can gain knowledge and insight and access to ask the right questions to their dental or primary care physicians and so forth.
Common Misunderstandings About Allergies in Dental Settings
Michelle Dawn Mooney:
Thomas, thank you so much for sharing that. And I can’t imagine what you went through, what you’re still going through. As you said, you have two sons, one in your heart, and the work is not finished, but I think I can speak for so many other families who are in a situation where they have a child who was also dealing with some of the issues that your son had with the allergies, and they’re thankful that more people are being educated through this. So I want to get to how can we make things better, you know, with the tragedy of your story and, you know, knowing that things could have been different for Elijah. From your perspective, what are some of the most common misunderstandings about allergies in a dental setting?
I think one of the misunderstandings is that people believe that dental products are the same everywhere and that it’s safe for everyone.
Because you believe that it’s like they’re not using anything that could hurt or harm someone, but in reality, like ingredients can vary very widely by brands. Another misconception could be is that if a reaction was mild or it did not happen last time, it’s not worth mentioning. But allergic reactions are very unpredictable and sensitivity can increase over time.
And there’s also a belief that allergies only matter when food is involved, but medical and dental environments also contain hidden exposures that is misunderstanding and can create dangerous gaps in communication and preparation.
What Parents Should Ask Before a Dental Appointment
Doctor Don Cohen:
So a follow-up to that then, what should parents be asking their child’s dentist before an appointment or procedure based on what you just shared?
Yeah, so I think what parents should ask them, you know, to also give premises like, it’s not just food allergies, there’s medication allergies, there’s instrumental allergies and so forth.
One of the things is like those who have food allergies, they also have to worry about those who have alpha-gal or who has gluten allergies, those are the big factors in that. So, what they should ask is about what products will be used during the visit and whether those products contain ingredients related to their child’s known allergies. So they should ask if the office offers latex free gloves and equipment, what flavorings are used in the polishing paste or fluoride what typical medications will be applied? Like those are some of the questions they should be asked because these products contain known and unknown ingredients to the dental, to the doctor or to the parents, so that open line of communication should be from the very beginning before even stepping into the office.
So they should definitely ask about their emergency preparedness, including whether staff are trained to recognize an allergic reaction or whether emergency medications such as epinephrine are excessively available. And another important question would be like how allergies are documented and communicated with the staff and other team members.
How Parents Can Prepare Children for Dental Visits
Michelle Dawn Mooney:
So I want to dive a little deeper there because for many people, dentists are not their favorite place. No offense, Dr. Cohen.
A lot of people are not looking forward to going to the dentist.
Some people are, but there can be some emotion and some anxiety already around it. So Thomas, how can parents best prepare then, not only to get a child to a dental visit, which could be a little taxing in and of itself, but be prepared to share relevant allergy information before the treatment begins?
Thomas Silvera:
Yeah, I know one thing I do with my son. I know he was afraid to go into the dentist because, you know, they have no idea what they’re walking into.
What is one of the things that’s fearful for us as parents, you know, it’s like what the expectations are. You know, we used to prepare our son and practice like he was in the dental chair and everything just to kind of like give him a little comfortability, but I think parents should definitely provide a complete allergy history prior to walking into that dental office to whoever’s going be working on it, whatever provider is working with them and not just a list of their allergies, but that includes what triggers the reaction, what symptoms typically appear and how quickly the reaction can progress and also what treatment has been needed in the past or present that will kind of like help. And they also should share their emergency action plan from allergist with their dental provider on a list of any medication that the child carries such as epinephrine, whether it’s an inhaler for asthma and other conditions that they should be sharing with their dental team.
Why Every Allergic Reaction Should Be Taken Seriously
Michelle Dawn Mooney:
If a child has had a mild reaction at a previous dental visit or even another healthcare office, what should parents do next then?
Dr. Don Cohen:
Yeah, I always look at mild reactions. It’s still a warning sign that a child may be sensitive to something used in a clinical setting, but parents should also explain what could happen.
I look at mild reactions as a severe reaction no matter what. So you have to treat a mild reaction, whether it’s just like hives in the skin or you have like, you know, that digestive system kind of reacting.
Those are the things that you have to stay keep watch when a supposed mild reaction is there. That’s definitely a warning sign that the child is sensitive to something and parents should also explain like what happened, how quickly symptoms could appear as I stated before, and what helps to resolve their reaction. And I always say epinephrine is the first line of defense to help with an allergic reaction.
We try to steer away from certain things, but they should also follow-up with their child’s allergist to identify potential triggers. And no reaction should be dismissed because patterns often start off small, as I stated, if it’s just like hives or simple cough or itchy throat, because patterns often start off small but become more severe within like minutes or seconds.
How Dental Teams Can Demonstrate Allergy Preparedness
Yeah. So basically all reactions are a reaction. So we want to take all of them seriously. Absolutely. Doctor. Cohen, I want to pull you into the conversation here and ask you what types of questions should every dentist and dental team be ready to answer confidently when they’re talking to parents about allergies?
I think Thomas brought out perfectly. We need, as dental providers, we need to know your allergy history.
Why “Minor” Allergy Details Matter in Dental Care
And as you just heard Thomas say, a minor allergy.
Can’t have an anaphylactic reaction unless you’ve been exposed first because your body needs to create these antibodies to the antigens, the challenges. So the reality is if we know these factors, it can change. I’ve lived through this once in a pure accident that thank goodness I did not have to deal with the same things that Thomas had.
But I had a patient who we used what we call the topical anesthetic. And that’s that stuff we put on a Q tip before we give an injection. And they’re almost always flavored.
Well, did I ask my patient if the pina colada flavor, which of course is based on like coconut, did I ask my patient if she was allergic to coconut? She went panicky when I used that topical. The beautiful thing is it was basically a synthetic flavor, so it really had no effect at all.
But it was the ultimate smack in the head for me and to Thomas’s point among the questions in our medical history, not just are you allergic to any medications, are you allergic to anything? Because that could bring out and could turn out to be literally lifesaving.
I think that’s an incredibly important thing to add to our medical histories.
Hidden Allergy Exposures: Flavoring, Toothpaste, and Dental Products
Thomas Silvera:
Yeah, and I’ve had a personal experience.
I have a tree nut allergy and I have been in the dental chair and sometimes the fancy flavored toothpaste and other things that they use and wait, what’s in that?
You know, because a lot of times you wouldn’t think that, oh, it’s the dentist.
You don’t think of food when you go to the dentist.
Training Dental Teams for Allergy-Related Situations
Michelle Dawn Mooney:
So a follow-up to that, Dr. Cohen, can dental practices then train or prepare their staff so that everyone is on the same page, they know what to say and what to do in an allergy related situation, especially considering there may be some high emotions, understandably so, for some of these parents.
Dr. Don Cohen:
And a great point. So the first and most important thing is, are you prepared for worst case? Are you prepared for these medical emergencies?
And as you heard Thomas state numerous times, are you prepared to have epinephrine auto injectors? Are they there? Are they handy? And do you and your staff recognize what those points are?
What can happen and how to deal with them? Whether it’s a lower level from using an inhaler to going all the way out and having to use those auto injectors. But no matter what we do, everything is still about, do you know your patient?
So those medical histories, they need to be reviewed every time. And there shouldn’t be an assumption that if I saw a patient yesterday, that I’m gonna remember today what was in their medical history. And I can’t state that enough.
The other thing is with these things occurring, your office staff has to regularly do drills and training. And to ask, do you have an emergency medical kit in your office, especially if you know you have a child who has issues, including epinephrine auto injectors, I think is a very appropriate question. And if for any reason it appears to not be a question that’s appropriate, maybe you need to re discuss that with your provider.
How Dentists Should Respond to Ingredient Concerns
How should a dentist respond if a parent raises a concern about a specific ingredient or product that the office typically uses? I think that’s again a great question, but it comes back down to, I can’t know what I don’t know.
So again, it comes down to that asking the right questions. Again, are there any allergies at all? Same as we would ask medical history questions, whether it’s about asthma, whether it’s about heart disease or anything, but they have to be more specific questions.
And if a patient, parent especially, seems, well, maybe you need to go in and get those answers. There are no maybes on this. We need to know what the history is and therefore how we can prevent anything occurring in that nature.
Documentation and Reassurance for Allergy Safety
Michelle Dawn Mooney:
From the dental office standpoint, what kind of documentation or reassurance can dental practices provide to show that they are taking allergy safety seriously?
Dr. Don Cohen:
Well, again, I still think the most important thing in the world is knowledge and know your patient. Did you ask in your medical history about allergies and any allergic events that may have occurred?
And it has to do with every allergy, not just one that you may think affects your office. And the documentation has to be one hundred percent and it’s a question that needs to be asked each visit because when I saw you yesterday, things were cool, but I gave you this treatment and all of a sudden you seem to have itching, you seem to have an issue.
So it’s every time, every visit, it’s incredibly crucial to never skip that step.
Communicating Preparedness Without Creating Fear
Michelle Dawn Mooney:
As a follow-up to that, how can dental professionals communicate their preparedness in a way that is going to reassure parents but not create unnecessary fear?
Dr. Don Cohen:
Because again, got a lot of emotions that you’re flying. You’ve got the dentist, you’ve got allergies. How do they successfully do that? Some of them are as simple as, and I’ve recommended this, have your whole staff be trained in CPR.
You know, if you trained in CPR, you get a card, whether it’s from the Red Cross or American Heart. We’ve always recommended that you photocopy them, put them on a post it outside on a poster of some kind. And with that statement, everybody in our office is prepared for medical emergencies, including CPR.
And we’ve actually recommended that where they would keep say their AED, that defibrillator, it should almost be in the waiting room for a convenient spot that you as a patient coming in realize, hey, this office really is prepared and they’re ready.
So that’s just a thought.
Best Practices for Parents: Advocacy and Communication
Michelle Dawn Mooney:
So Thomas, from your standpoint, you have your son who is thirteen. When you are going through this, what we’re talking about here, having the dental visits, how are you handling this? What are some of the best practices that you can pass on to other parents here?
Thomas Silvera:
I think from my perspective, you know, he’s been to the dentist a lot and it’s the open line of communication. Basically you being your child’s advocate, depending how old they are, even if they’re like a teenager or an adult, if your parent is there, I think everyone should advocate for each other just to keep that open line of communication.
What I’ve done was, you know, have that communication with his dental provider prior to going to the dental office and asking what medications will be used, possible topical anesthetics, instrumentations and so forth, so I can ask those questions, those needed questions, it’s like, can you see what ingredients are in the active and inactive ingredients?
Because there’ve been times that we’ve worked with a dentist provider and there was a paste that had an ingredient that contained a dairy.
So my son Sebastian is also dairy allergy, so having that communication can actually put the right safeguards prior to going to the dentist and even going there, working with the dental provider to reassure you that whatever that they’ll be using with your child or a teenage child as well, that these are all allergen safe for, particularly for this person, because everyone is different.
As Todd was saying, as Dr. Cohen was saying, it’s like, you know, your reaction one day could be fine, but the next day it can be different. Some people have onset allergic reactions unbeknownst to anybody.
So it’s always having that open line of communication, having that communication with the staff, and also understanding that to remove the fear, we have to have that clear communication with the team members at the dental office that they can handle an emergency in the event of something happening. So, preparedness should be framed as a standard of practice in these places and especially to give parents kind of like peace of mind. So, definitely advocate early and clearly, don’t assume allergy information is already known, ask questions and share details; even if they seem small, I think parents should know their child best and also play a critical role in keeping them safe as well.
Questions Parents Should Ask Before the Visit
Michelle Dawn Mooney:
And you mentioned preparedness and early because I think as far ahead of the game as you can get, the better. And I think about from a restaurant standpoint, having a food allergy again, you always prep before you go to a restaurant. What are the menus?
What do they use in the same fashion? The earlier the better to also give the dental team and dental office lead time to be able to look into necessary information.
I want to ask you a follow-up to that too, Thomas. Top questions maybe that every parent should ask their child’s dentist when you’re making that list because it can be a little overwhelming and you may not think of something that you should be asking.
So what’s your take there?
Thomas Silvera:
Oh, I mean, as we look at it, you know, it’s interesting because across the board, whether it’s a restaurant, whether it’s a school, whether it’s a dental office, or you’re a primary care physician or a pediatrician, or even allergist, like the questions is again, it’s an open line communication asking what are in these topical solutions, what medication is going be used, even the prescribed medication, whether it’s an antibiotic that’s going to be provided to the child in the event, you know, just to ward off infection.
A lot of those questions have to be asked like if you were going into a restaurant, you’re like, hey, can I see your ingredients for this particular food? It states that it’s, you know, allergen friendly or gluten free, may I see the ingredients?
Because sometimes these products, whether it’s food related, whether it’s medication related, can contain inactive or active ingredients or made in a place that actually has that allergen and the possibility of that seeping into that medication. So it’s asking questions and questions and questions.
And it’s not like you’re being a burden or helicopter parent, it’s like you’re trying to keep your child safe. And it’s like being an advocate, working with your dental provider or your physician and so forth.
You can again add those added safeguards into removing that fear and providing safety on both ends from the provider and also the parent for their child.
One Key Tip for Parents and One Key Practice for Dentists
Michelle Dawn Mooney:
So Thomas, let me ask you this. If you could summarize here by giving parents one key tip before their child’s next dental visit, what would it be?
I always keep saying, advocate early and clearly. Don’t assume the allergy information is already known and definitely we want them to work with their child to remove the fear and also provide safety.
Because again, it’s like parents know their child best and they play a critical role in keeping them safe and also letting the providers, the dental person house know about their child And everyone, I think that open line of communication just keeps everyone safe in its entirety.
Michelle Dawn Mooney:
And Dr. Cohen, for dentists, what is the single most important way to demonstrate commitment to allergy safety in everyday practice?
Dr. Don Cohen:
I think, again, it comes back to what Thomas is saying, being open and engaging with the parent with regard to any of their questions, and certainly in your documentation and your histories, including everything that should be there.
As I said, I’m a firm believer that if you show your patients, even before they get back into the back of the office, that you are prepared for medical emergencies, there’s a certain comfort level that exists.
But without a doubt, those questions that are asked are most appropriate. And as a provider for a whole bunch of years and teaching for a whole bunch, I always loved the advocate rather than the person who just sat there.
I know that the advocate is not just concerned, they’re knowledgeable, and they want to help me to take care of their child.
Mental Health, Fear, and the Importance of Clear Communication
Yeah, no, you mind if I just sat in because a lot of, you know, we haven’t touched this, but a lot of mental health aspects falls under this. For instance, we want to remove the fear, you know, so when a patient is going into the office, you know, those mental aspects are not affecting them.
Because prior to that, a lot of them are affected in the worry of something happening is the imminent fear of something and we want to remove that.
So I was like, it’s, we don’t want them to be scared, we want everyone to be prepared in a sense. So a lot of that happens with those who’ve had reactions prior to going to a visit and scared to having a reaction with a topical anesthetic or whether it’s the toothpaste or whatever it may be.
So that’s what, again, comes down to the advocacy and the open line of communication with your dental team.
Final Thoughts
Michelle Dawn Mooney:
Final thoughts here, Doctor. Cohen, I’ll start with you.
Dr. Don Cohen:
I guess I just have to, I look at Thomas and Thomas provides a lesson for all of us and all of us should be well prepared and listen and learn and recognize how can you avoid any issue like that occurring in your practice.
Michelle Dawn Mooney:
And Thomas, final thoughts from you.
Thomas Silvera:
The whole idea of this communication for parents and for everyone is like, we want to make allergy safety visible upon routine visits into the dental office or to your doctor.
This includes like making sure that the providers that you’re going to are consistent and they are also trained in understanding the signs and symptoms of allergic reaction.
And that we talked about that clear, open communication and also culturally where concern are taken seriously when safety is built into a daily workflow, it becomes part of the practice identity and it also provides the safety and removes the fear when so many, those who have multiple allergies, whether it’s to food, whether it’s to medication, whether it may be, you know, it provides that practice identity of safety.
Michelle Dawn Mooney:
Thomas Silvera, co-founder and president of the Elijah-Alavi Foundation, Dr. Don Cohen, chief clinical officer at HealthFirst, I want to thank you both for your time today.
Thomas, a big thank you to you for being so vulnerable to be able to share this story.
As Dr. Cohen mentioned, the fact that we are saving lives here with the information that you’re putting out here. So thank you for sharing that and Doctor. Cohen as well for your input here of how to save more lives to avoid what happened to Elijah.
Really appreciate your time here.
Thank you so much for being a part of this.
Thank you. Thank you again for having us on this episode. If you want to find out more about the Elijah-Alavi Foundation, you can reach out to us at www.ElijahAlaviFoundation.org. You can find out more information about what we do, what we offer, and what we have in store for this year.
And I want to thank all of you for tuning in and listening. Be sure to visit HealthFirst Online Knowledge Base at HealthFirst.com for additional resources on medical emergencies, including more information on anaphylaxis and allergies in the dental practice setting. Thank you again for listening to HealthFirst Talks. I’m your host, Michelle Dawn Mooney. We hope to connect with you on another podcast soon.
