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Autism Spectrum Disorder


Dental chair from Richmond VA Dental Arts

Taking your son or daughter with an Autism Spectrum Disorder to the Dentist


Taking your son or daughter on the autism spectrum to the dentist poses many challenges. This article hopes to make you aware of some of these challenges prior to your visit, as well as provide some useful ways to deal with them. Included in this article are three main areas that are most often in need of attention: preparation, sensory issues, and communication.

Preparation


When seeking a dentist, call the office and discuss your son/daughter’s needs. The more you know ahead of time about their practices and why they do them, the more comfortable you will be to ask.

Ask if the office has experience with children who have an autism spectrum disorder (ASD) and if they have special procedures in order to optimize each visit. Ask about those procedures.

Dr. Hart can personally relate to your concerns about Autism. Dr.Hart’s son is on the autism spectrum. She can share helpful information for the patient and caregiver, while maintaining a calming environment with her well-trained staff.

Some things to ask about your child’s dental appointment are: accompanying your child in the room while the dentist does the exam; having an appointment at a time of the day when your child is at their best; having a short waiting time; and having the same staff at each visit for consistency.

If you are not comfortable with the answers to your questions, consider another dentist. Some dentists may refuse to treat your child because they’re unsure how to make them comfortable.

Is your son or daughter accustomed to daily tooth brushing? If not, consider working with an occupational therapist (OT) or an autism or behavioral professional to teach the child good hygiene habits. Using visual routines and a timer are helpful for good daily brushing habits.

Use their toothbrush or a plastic tooth mirror (available at local pharmacies) and get your child used to letting you put it in his/her mouth. Make a fun game out of counting their teeth. Vibration toys that are safe for oral use, or even electric toothbrushes, are also excellent for getting your child used to the strange sensation in their mouths.

One of the most effective preparatory steps you can take is to create and read a social story about going to the dentist with your son/daughter. The social story should take the uncertainty out of what will happen at the dentist’s office. Be sure to highlight things that you think your child will like or be concerned about.

Another idea is to include an incentive/motivator for when the appointment is over. Does the dentist have a prize basket? Can you stop for a treat afterward? There are many good books about practicing good oral hygiene and going to the dentist that you can read with your child.

To get your son/daughter off to the right start with a dentist, scheduled a few short “happy visits” to start off with. Keep these visits very positive and short. Let your son/daughter get used to the office environment; try out the dental chair; let the hygienist look in their mouth or count their teeth, and listen to the sound the drill makes.

These may not all happen on the same visit. Use these visits to slowly desensitize your son/daughter to the experience, as well as discover what could potentially be difficult at future visits.

Sensory Issues


There are many potential sensory challenges at a dentist’s office – tastes, smells, textures, sounds, lights, and proprioceptive. Know in what areas your son/daughter tends to be sensitive will help you know what coping strategies to try. Share your son/daughter’s coping strategies with the dental staff before the visit. Collaboration and teamwork are essential for a successful trip to the dentist.

To be comfortable with the doctor’s chair, you may want to ask the hygienist to lean the chair back before your son/daughter gets in it, as sometimes they don’t like the feeling of being moved backward. Deep pressure can be used before and during the visit for calming. Consult your son/daughter’s classroom teacher or OT for suggestions. Wearing the x-ray vest may be similar to wearing a weighted vest. This can be discussed with the dental staff prior to the visit.

Consider a heavy work task to be done before and after the visit for calming. Let your son/daughter stretch a therapy band in their hands, or even wrapped around their ankles while they are in the dental chair. Lighting in a dental office is often too strong for children with autism. Let them wear sunglasses and request that the staff try and keep the lights out of their eyes as much as possible.

Night-time eye covers can be used, but will make it difficult for the staff to show your son/daughter what they are going to do. If the noises of the office are upsetting, request to be moved to a more quiet or private place. If not available, the use of headphones or an iPod music player are good ways to limit noise. To ensure that tastes are familiar and favorable, bring your son/daughter’s own toothpaste and toothbrush to the visit.

Communication


For a child who may not be able to verbalize or recognize a problem, the accompanying feelings of anxiety and frustration can be overwhelming. The impact of these feelings or behavior can be very significant. Having a dental professional who can communicate effectively will be very important. Below are some tips to improve communication at the dentist's office.

Tell/Show/Do. This is a shorthand way to explain to staff what they should do first. First, Tell your son/daughter what they are going to do. Next, Show the tool or action they are going to use (let your child touch the tool, if possible). Then, Do only after they’ve done the other two. This verbal preparation and demonstration will help eliminate some uncertainty for your son/daughter and put them more at ease.

Modeling is very effective for some children. Bring along a sibling or friend and let your son/daughter with ASD watch as the doctor or hygienist performs the task on them first. Letting the child know ahead of time how long something is going to last can be very helpful. Instruct the staff to prompt the child with time durations as they work. Some examples:
•  "This will be all done when we finish counting to 10."
•  "I need to touch 20 teeth... help me count them all."
•  "That gritty cleaner will only be there for 1 minute and then you can rinse and spit out."

Instruct the staff that your child responds to immediate praise for good behavior. When your child does something they want, staff should not delay their praise. This will help your child make the connection between what he/she does and the consequences. Some examples:
•  "Great job keeping your mouth open."
•  "I like how you are..."
•  "You did great while I cleaned the front of your teeth, now I'm going to clean the back of them."

Ignoring inappropriate behaviors is also something you will want the staff to do. Have them try to ignore inappropriate behaviors as much as they can, maintaining a calm voice may help minimize behavior problems.

Other Issues


There are some unique dental issues that you will want to discuss with your dentist if they apply to your son/daughter. For those who engage in bruxism (grinding their teeth) or self-injurious behaviors (such as picking at the gums or biting their lip) a mouthguard might be recommended so long as it is tolerated by your son/daughter.

The dentist should also review your child’s medication and/or supplements. They will then be able to advise whether medications are affecting saliva production or if they contain a lot of sugar, both of which will increase the chance of cavities.

Seizures may accompany autism, and if your child has seizures you will need to discuss this with your dentist. The mouth is always at risk during a seizure; children may chip teeth or bite their tongue or cheeks. The dentist should be able to help you develop a treatment plan for these challenges.

Be prepared to manage a seizure if one occurs during the dental visit. Instruct staff to remove any instrument from the mouth and clear the area around your child. A simple trick is to attach dental floss to rubber dam clamps or mouth props before putting them in so that you can remove them quickly if needed.

Sedation is sometimes used with patients, usually in the case where the child has a high level of anxiety or discomfort that prevents good coping skills, for those with uncontrolled movements, or for those requiring extensive dental treatment. Sedative medications cause most children to become relaxed and drowsy. Unlike general anesthesia, sedation is not intended to make a patient unconscious or unresponsive.

You and your dentist should select a technique based on the specific needs of the child and discuss the benefits, limits, and the risks involved.

Conclusion


Taking your son/daughter to the dentist presents challenges for both the parent/caregiver and the dental office staff. By working together, challenges and anxiety can be reduced. Using ideas presented in this article, the child with ASD may have a better understanding of what to expect when he/she visits the dentist for the first time and may have a greater chance of experiencing a successful dental visit.

Reference


Indiana Resources Center for Autism

American Academy of Pediatric Dentistry.(n.d.) Sedation.

Bennie, M (n.d.) Dental Dilemma from Autism Today

Dyna Vox Mayer-Johnson, 2100 Wharton Street, Suite 400, Pittsburg, Pa. 15203

Indiana State Department of Health, Sumy Start Initiative. (2009) Dental Care: Options to Access Dental
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