Dental visits are not easy for the majority of children, let alone children with autism. Their responses towards specific sensations such as light or sound can disrupt an entire dental visit and make proper dental health care difficult to maintain. This article aims to explain the factors that render dental visits uncomfortable for children with autism, to increase public awareness and their ability to recognize behaviors associated with sensory processing difficulties for children with ASD, and to hopefully provide appropriate and potentially effective solutions to make dental visits more desirable for children with autism.
A dental visit typically lasts between 30 minutes to one hour. If one has gone through years of experiencing dental visits, one might be used to sitting for a prolonged period of time, as well as the uncomfortable feeling of dental equipment in one’s mouth and the blinding light in one’s eyes. However, a child with autism might have sensory processing difficulties that will further intensify their discomfort. Some reactions could be due to touch, visual stimuli, smells, taste, or sound. For touch, there may be unanticipated contact around the face and inside the mouth by the dentist. For visual stimuli, there may be difficulty in tolerating the bright light. For smells or taste, there may be adverse responses towards the scent of the gloves and paste used during the visit. For sounds, there may be adverse responses towards the sounds of dental equipment (Kuhaneck et al., 2012). In addition, children with autism have a lower capability to manage and express their emotions. As such, hyperactivities, low frustration threshold, and sensory issues may lead to a negative perception of dental visits. These children may demonstrate escape or reiteration behaviors if they are not properly prepared, taught, or exposed. The individual might attempt to escape first from the distressing stimuli (e.g. loud dental equipment sounds). If escape is not possible, the individual will likely become more and more physically reactive in an attempt to remove himself or herself from the stimuli (Kuhaneck et al., 2012). This reaction could escalate to physical aggression if fear or discomfort is not respected and attended to. By keeping these factors in mind, hopefully we can increase tolerance and understanding in how dental visits can be disturbing for children with ASD.
Other than sensory processing difficulties, children with autism have relatively poorer tongue coordination. Therefore, they prefer soft and sweetened foods and tend to pouch food inside the mouth instead of swallowing it. Due to this preference of food choice, long term presence of food in the mouth tends to result in a higher risk of cavities. As such, it is crucial to take the time to teach a child with autism to correctly brush their teeth daily by breaking each component into simple steps to decrease the risk of cavities.
Dental procedures in dental clinic settings can be modified to reduce sensory stimuli. The application of specific intervention strategies may help the patient to better handle uncomfortable sensations. Before going to the dentist, parents or caregivers of children with ASD can watch videos of other children going for a dental appointment so that they are informed of what to expect ahead of time. Similarly, verbal preparation to go to the dentist is encouraged, approximately 1-2 weeks in advance. In the dental chair, verbal preparation should also be provided, such as “We are going to do <this particular action> until the count of 20.” If sounds are too noisy for the child with ASD, allow the patient to listen to music with the use of headphones to minimize external sounds, such as talking and dental equipment sounds (Chandrashekhar et al., 2018). If there is something visually irritating, allow the patient to wear sunglasses to block the glaring lights, or dim the overhead lights as an alternative.
Furthermore, ABA therapy can also be incorporated into making dental visits more desirable by increasing desired behaviors expected in a dental setting. By increasing the likelihood of patients (children with ASD) accepting simple and routine dental procedures, dentists can decrease the need for more intrusive procedures, such as restraints and sedation (Kuhaneck et al., 2012). Each component of a particular skill can be taught and divided into simpler steps to make understanding easier. A child would then be rewarded for each component skill that he or she learned, such as opening the mouth wide open for 2 minutes. Afterwards, the child is reinforced to adopt the behavior and eventually full prompts decrease over time in order to develop independence in the child. In the same way, positive reinforcement, such as praise or a toy reward, may lead to enhanced compliance for sitting on the dental chair for a prolonged period of time.
Dental visits can be extremely distressing for patients with autism. Their dental needs often go unmet, perhaps due to high rates of poor cooperation during procedures. Therefore, understanding sensory processing and the sensory aspects of the dental visit may improve the patient’s cooperation and allow for better results. This may require some trial and error, but having a dentist who is more understanding of these factors will tend to be the difference between a successful and an unsuccessful visit to the dental clinic.
Written by Hannah.
References
Chandrashekhar, S., & S Bommangoudar, J. (2018). Management of Autistic Patients in Dental Office: A Clinical Update. International journal of clinical pediatric dentistry, 11(3), 219–227. https://doi.org/10.5005/jp-journals-10005-1515
Kuhaneck, H. M., & Chisholm, E. C. (2012). Improving dental visits for individuals with autism spectrum disorders through an understanding of sensory processing. Special Care in Dentistry, 32(6), 229-233.doi:10.1111/j.1754-4505.2012.00283.x