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