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Autism and Dentistry: Dental Challenges for Families and Treating Dentists

By HERWriter
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Autistic patients – and patients with similar behavioral and intellectual difficulties – present a unique challenge for dentists. Dentistry involves bright lights, loud instruments and touching a very sensitive part of the body. Many “normal” people are uneasy about dental treatment, imagine what it’s like for an autistic person.

Autistic patients are usually hypersensitive to their environment and may react out of sensory overload. They don’t take well to a change in their schedules, new noises, smells, sounds, and activities.

Fortunately, dentists are becoming more aware of the needs of special needs patients. There are still sufficient numbers of dentists who may refuse to treat such patients usually because they’re unsure how to make them comfortable.

Programs like University of South Carolina (which has had a special patients clinic for 24 years), Special Care Dentistry Association (www.scdaonline.org), the National Foundation of Dentistry for the Handicapped (www.nfdh.org), the National Institute of Dental and Craniofacial Research, and the University of Western Ontario (London, Canada) have been cropping up in the last couple of decades to address the concerns of dental practitioners and families. Some offer services where dentists and hygienists will visit care homes, hospitals, personal homes, and treatment centers to care for patients who cannot get out to a dental office. Many will offer their time and care free of charge and offer programs whereby people can donate money to help sponsor this kind of care.

Many autistic patients have the same dental issues as “normal” patients, although sometimes these are exacerbated by improper oral hygiene (either by the patient or caregiver, or where the patient simply won’t allow even a toothbrush into their mouth) and overindulgence in sweets, often used as rewards.

Unique dental issues

For those autistic patients who engage in bruxism or self-injurious behaviors (such as picking at the gums or biting their lip) a mouth guard might be recommended so long as it is tolerated by the patient.

Dentists will be able to advise whether medications are affecting saliva production or may contain sugar. Lower saliva productions levels have been shown to increase the possibility of the development of the bacteria that causes cavities and bad breath. Add that to increased sugar intake and it becomes clear that this situation has to be monitored closely. Simply rinsing with water after taking sugary medications or treats can help.

For those with seizure disorders trauma and injury can be common. Caregivers should know how to preserve the lost or broken tooth and know to seek dental treatment right away.

Dental visit tips

1) Arrange for a tour of the office. Let the patient sit in the chair with normal overhead lights. No drills running. Let them see the trays and touch and feel everything, including the X-ray machine. Let them meet all the staff.

2) Make the first official dental visit short and as uninvasive as possible.

3) Ensure that the dentist or hygienist explains (or you explain on their behalf) what is going to happen, what is going to be touched, what instrument is going to be used, what that instrument is going to feel like, how long it’s going to take.

4) Never be afraid of insisting that you be present during the dental appointment – it’s likely inevitable that your child or dependent will require you there anyway. Make sure the dental staff is comfortable with this.

5) More extensive dental treatments, extractions, fillings and even X-rays can be done under sedation or general anaesthesia if the patient’s behavior is likely to create difficulty for the dentist in providing safe care.

Sources: www.usc.edu/hsc.dental, www.nidcr.nih.gov, http://dentalresource.org, www.nfdh.org

Add a Comment25 Comments

EmpowHER Guest

On the general anesthesia option,... I just wanted to caution folks about thinking this will work way better. My son reacts very strongly against dental work, and the Versed that is favored by my dentist doesn't help, either (it is put up his nose, for Pete's sake, as my dentist has a "thing" about not using needles/shots). I thought the general anesthesia & hospital visit to get everything done all at once would be better and less traumatic. It was NOT. My son was very scared in the hour wait we had in the hospital room, and when he came out from the sedative, he had pretty bad vomiting from swallowing so much gas.

I think, actually, that the hospital visit might have made it far worse now. We haven't gone back to the regular dental office (it's been about two weeks) yet but I am dreading it.

I wish more dentists understood the intense needs of an autistic child. My dentist tries, but it is just so hard.

June 21, 2011 - 7:22am
HERWriter (reply to Anonymous)

It's like anything else to do with medical or dental treatment. What works for one patient doesn't necessarily work for another. I don't think I've ever heard of Versed being inhaled. Usually if something is inhaled as an anesthetic it would be nitrous oxide. The advantage to the needle is that it is measured precisely for his body weight and height. Not sure the same kind of control can be had over inhaled -- but interesting way to do it.

I would also have to wonder if he was fasting before the surgery. Usually fasting is recommended to reduce the possibility of upset stomach which can be issue with general anesthesia and sedation. It sounds like the dose was too strong for him.

Also know that you can ask them to use a different drug. While they may prefer Versed, that is not the only drug they can use. Perhaps suggest as well that they arrange for you to wait in a separate room from the waiting room. Am I safe in assuming that the waiting room was bustling with people and bright lights and weird smells? Obviously, it would not be relaxing.

Perhaps the suggestions from the previous comment would be helpful. Some good thoughts there.

Thank you for sharing your story.

June 21, 2011 - 1:32pm
EmpowHER Guest

Our dentist was not able to get into my son's mouth and could not provide the care needed so he referred us to a pediatric dental specialist. It made a world of difference. (high functioning autism) He wears sunglasses to help with the lights - he wears headphones and listens to music while they work on his mouth or sometimes they play a movie on a special mounted screen that he can see while in position for them to work on his mouth. We use the same hygienist for every appointment and we go 4 times per year for cleanings because getting the teeth brushed and flossed is extremely challenging at home. Having medical professionals who take the time to get educated and then provided the right approach to a child's needs is such a relief to us as parents.

June 21, 2011 - 6:53am
HERWriter (reply to Anonymous)

Thank you for sharing your story. Yes, it makes a huge difference, and often the solutions are very simple.

June 21, 2011 - 1:25pm
EmpowHER Guest

Now I am also keen on the hygiene of my teeth.I wanted to check if anything could be done for me.
I have the worse smile ever and a few of the NHS dentist have told me nothing can be done. Both my sister and I have teeth where the gap in the middle is huge and when we do smile most f our gum comes out. I have been called the predator once because of this. http://www.alkaliaesthetics.co.uk/

July 29, 2010 - 4:55am
EmpowHER Guest

That’s very interesting, Anonymous. I am sure many other Mother’s may try this same sort of counting regime with their children. Thank you for your input.

June 30, 2010 - 1:21pm
EmpowHER Guest

For my son it was very important to have a visual schedule of the events that would happen at his dental visit - I used boardmaker and created a checklist ie.1. sit in big chair 2. doctor will put her hand in your mouth 3. doctor will scratch your teeth with a pick 4. doctor will brush your teeth, et al....having this visual check list is so reassuring to those that are schedule driven and by seeing items checked off one by one they are reassured that there really is AN END TO THIS PROCESS! For some it is hard to understand "you'll be here for about an hour" so seeing that steps are done and how many are left allows my son to collect himself and prepare for the next step. Of course there is always a positive reinforcer waiting - swimming or buy a new movie or whatever the thrill of the day is!

June 30, 2010 - 1:15pm
HERWriter (reply to Anonymous)

What a great suggestion. I know many autistic children respond well to visual aids. Thank you for adding it to our discussion. I'm sure many moms will find it helpful!


June 30, 2010 - 1:58pm
EmpowHER Guest

I am a dental hygiene student and am interested in doing a table clinic on autistism and the effects on the oral cavity. I enjoyed the article above. Is there any other information you can provide?

September 14, 2009 - 6:30pm
HERWriter (reply to Anonymous)

There is probably a lot more information out there than the sources I quoted. But, I would start with those and see if they can help.

If you want to discuss this further, you can send a message directly through empowher.com.

September 14, 2009 - 6:48pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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