Disclaimer: This article is for general information purposes only. If you have a child who has been diagnosed with autism spectrum disorder (“ASD”) you may want to consider consulting with a licensed professional regarding your circumstance.
Preparing for the Visit
When preparing for a visit to the dentist, it’s advisable to call the office ahead of time to inform them of your child’s needs and discuss the office’s procedures to help serve children who have ASD. As a parent, you should ask about: 1) the office’s policy on allowing you to be present in the room during the exam, 2) cutting down on wait time, 3) scheduling appointments at a time during the day when your child is best prepared and will likely be cooperative, and 4) whether the same staff members can be present at each visit for sake of consistency1. Some dental offices aren’t equipped or trained to deal with autistic children, so they may decline to render services.
To ensure that your child is accustomed to brushing his or her teeth on a daily basis, it may be advisable to work with an occupational therapist or another licensed professional to help teach the child proper oral hygiene. There are a number of techniques that parents can use in these cases, such as making a game out of counting teeth, or using electric/vibrating toothbrushes to help the child get used to the feel and sensation of dental instruments.
It may also be helpful to read the child a story about going to the dentist2. This way, the child will be more prepared for, and hopefully less surprised about, what happens at the visit. When reading the story, it’s important to address details you believe your child will enjoy or be concerned about3. In addition, it’s sometimes possible to motivate the child in other ways. For example, does the dentist have a toy chest that the child can choose a toy from after the appointment?
It may also be beneficial to schedule brief visits at first to ensure the child gets used to the dentist and staff. Ideally, these visits will be positive and will help the child grow accustomed to the office, dentist, staff, and equipment. Dr. Jill Lasky is a principal of Lasky Pediatric Dental Group, which prides itself on being a fear free zone. She suggests asking “if the staff is willing to give your child a mouth mirror, gloves, mask, or something that they can play with at home that prepares the child for the first visit.” In addition to putting the child at ease, these visits, also known as play dates, can also help you spot if there will be any possible problems in the future.
Due to the various stimuli in a dental office, such as smells, sounds, tastes, and lights, your child might become overwhelmed. Being aware of your child’s sensitivities will help you decide which coping strategy will work best. Whenever possible, it would be preferable to share these strategies with the dentist’s office beforehand. Working in tandem with the staff can be crucial to having a successful visit.
In terms of movement, some children do not like the sensation of being moved backward, so it might make sense to have the hygienist recline the chair before the child climbs into it4. Additionally, using a bean bag chair placed in the dentist’s chair may help give the child some comfort. In these cases, it would be wise to consult your child’s teacher or occupational therapist about possible approaches.
Since the lights used in a dental exam can be very bright, having the child wear sunglasses or nighttime eye covers may help put him or her at ease. However, be aware that using these methods may make it difficult for the staff to show and explain to the child what will happen next. Similarly, if the office is loud, it may make sense to ask the staff if the child could be examined in a more quiet area. Or, alternatively, headphones playing soothing music may be a solution. In terms of taste, it may be a good idea to bring the child’s usual toothpaste so that it is familiar taste during the exam.
Communicating During The Visit
Since some autistic children have difficulty communicating, they can suffer from anxiety or frustration during a dental visit. As such, it’s preferable to choose a dentist and hygienist capable of communicating clearly and effectively. One technique is “tell, show, do.” Using this approach, the dentist will tell the child what is going to happen next. Then, the dentist will show the instrument or motion they are going to perform. The dentist will then do the action. Walking the child through the process will hopefully help lower anxiety and make the process easier.
The time a child is asked or expected to engage must be treated as a priority. Generally, informing a child about the length of the visit or procedure will help put him or her at ease. The “chunking” process involves breaking cleanings and procedures into manageable time periods in between which patients are given breaks. In addition to “chunking,” Dr. Lasky is a proponent of methodical counting as it keeps children aware of how far along things are and is something they will understand.
Another technique, called “modeling,” involves bringing a relative or friend, and allowing the autistic child to watch the dentist perform an exam on them first. This may help the child get more comfortable with a procedure by permitting them to witness it beforehand.
In terms of encouraging good behavior, it’s advisable to tell the staff to compliment the child’s behavior when he or she cooperates. This will help to teach the child about consequences and encourage them to continue to be cooperative. Similarly, the staff should attempt to ignore inappropriate behavior. Remaining calm and using a soothing tone of voice may help mitigate or prevent behavioral problems.
There are all different levels of anesthetics, ranging from local numbing agents like topical creams and shots of Lidocaine (commonly mistaken for Novocaine), to laughing gas, oral sedation, and full general anesthesia. The amount of anesthesia will depend on the treatment.
How can you prepare your child for anesthetics? “The same approach goes [as with normal dental appointments],” according to Dr. Lasky. “If you are going to try to get a child with autism numb in their mouth, you may have an appointment where you just put the jelly there so they get familiar with that feeling of being numb. It’s just little chunks and little steps until they’re comfortable. Then you go to the next one.”
Other Special Issues
If a child grinds his or her teeth or is prone to self-harm (e.g. biting their lips), then the dentist may suggest using a mouth guard if the child will tolerate it. It can also be helpful if the dentist knows what medications your child is taking. Some medications, especially if they contain a sizeable amount of sugar, can contribute to the formation of cavities and a care plan developed by your dentist may help prevent this problem. Sugar is of particular concern given findings that both children and adults with autism tend to have low levels of digestive enzymes to process it5.
If your child suffers from seizures, it’s important to inform the dentist since a child may damage his or her teeth during a seizure and sometimes the dentist can create a plan to help deal with this problem. Also, a seizure may occur during the visit and it’s important to tell the staff to remove any instruments from the child’s mouth and clear the surrounding area.
Lastly, it can be helpful if a relative or friend sits in on the appointment to help communicate for a nonverbal child6.
1. ATN/AIR-P Dental Professionals’ Tool Kit
Autism Speaks Autism Treatment Network, pp 7-14
2. Autism Dental Guide
Frisco Kid’s Dentistry
3. Autism Dental Information Guide for Families & Caregivers
Southwest Autism Research & Resource Center, pp 7
4. Oral Care and Sensory Over-responsivity in Children with Autism Spectrum Disorders
Stein, Leah I; Polido, José C; Cermak, Sharon A
Pediatric Dentistry, Volume 35, Number 3, May/June 2013, pp. 230-235(6)
5. Summary of Dietary, Nutritional, and Medical Treatments for Autism – based on over 150 published research studies
James B. Adams Ph.D
Autism Research Institute, 2013, p12
6. For Children With Autism, Opening a Door to Dental Care
Saint Louis, Catherine
The New York Times, October 14, 2014