We all know that dental health is important, but it can present extra challenges to children with autism.
Taking care of your children’s teeth is an important aspect of their overall health and can prevent more serious problems from developing later on. Most dentists advise brushing your child’s teeth from the appearance of their first tooth but some children will take longer to adapt to a dental care routine than others. If you are working towards a regular dental care routine, it will probably take a while — and this is fine.
Brushing your autistic child’s teeth
Your child may find the sensation of tooth brushing alien and very unpleasant. If they are struggling in the atmosphere of the bathroom, why not try moving to a more comfortable atmosphere, such as your living room?
If you’re initially unable to use a toothbrush, there are other alternatives that you can start with, just to get your child used to the process. As well as the standard toothbrush, you can try baby-friendly brushes or a washcloth to start. These aren’t ideal, as bristles are best from a dental perspective, but are a good starting point. Many also children prefer fruit-flavored toothpaste to mint — just make sure that whichever toothpaste you use has a suitable level of fluoride to protect their teeth.
When you move on to a toothbrush, you should acclimatize them slowly, getting them used to each stage of the tooth-brushing process. You can prepare for this by discussing tooth-brushing beforehand and putting it into their daily planner. Make sure that their toothbrush is soft-bristled and the right size for their mouth; there are several autism-friendly toothbrushes available. Your child may be happier if they are allowed to come shopping with you and choose a toothbrush themselves. It can be a good idea to buy two so that a broken or missing toothbrush can be replaced without fuss.
A lot of children learn well by example — if you let them watch you brush your teeth they have more of an idea of what they need to do. Try using a visual aid, such as an egg timer, to show your child how long is left once they have started. And don’t forget to praise and reward them along the way.
Electric toothbrushes, once your child is more used to brushing their teeth, can make the task a lot easier as they often have inbuilt timers and require far less manual action. Some children prefer the look and feel of an electric toothbrush while others will not. Don’t despair if you have to cycle through a number of different options before you find something that your child is comfortable with. If they adapt to using an electric toothbrush, make sure that you keep it fully charged as a toothbrush with low battery will feel and sound different.
Reasons your child may struggle with the dentist
Your child will need to visit the dentist regularly, especially if they are prone to fits or bruxism (tooth grinding), both of which can damage their teeth. Dental visits can be a distressing experience, especially if your child is more sensitive to new sensations like the sound of the dental drill or the feeling of a gloved hand in your mouth. Luckily there are ways you can prepare your child — and your dentist — to make sure their treatment is as calm and problem-free as possible.
Ways you can prepare your autistic child for the dentist
One of the best things that you can do is make sure that your dentist and your child are both fully prepared for the experience.
A key element is finding the right dentist. Does your dentist have prior experience treating patients with autism? No two children are the same, so a dentist who may have treated one case isn’t necessarily prepared for another, but experience is always helpful. If they have no experience, would you be more comfortable with someone who does? Is there a paediatric anaesthetist on staff who is experienced with sedation if you feel that this may be needed? There is a range of options for people who find the dentist’s distressing, including conscious sedation. Don’t be afraid to find another dentist if the first one you visit isn’t suitable.
If your dentist has treated patients with autism in the past, would you find it useful to write a short letter outlining your child’s specific needs? They may be able to make adjustments to the examination room ahead of time to help make them more comfortable. They will also need to know about any other conditions they have, such as epilepsy, any allergies or chemical sensitivities and any medication they might be taking.
Although some parents will prefer to not inform their child of their visit until they reach the surgery, it is often best to let your child fully prepare for their visit — mark it on the calendar. Let them know why they are there and how long the appointment will take.
One resource that is widely available are visual guides — social stories — written specifically for autistic children which give a clear outline of what they can expect to happen with their dentist. It might also be worth playing through the dentist situation at home. Try using some of the standard dental equipment (such as a torch and dental mirror) to get them to practice opening wide. If they are likely to need x-rays, see if you can get some bite wings from your dentist ahead of time to practice biting down on — this is well worth doing as they are potentially quite an alarming feeling, especially for children with a strong gag reflex.
If you can, take your child to visit the dentist before their appointment, allowing them to become familiar with their surroundings and the equipment that the dentist uses. Ideally, you should be able to schedule a few mini no-pressure appointments to allow them to acclimatize. Let them sit in the dentist chair and see the equipment and over a few sessions work up to the basics, such as counting their teeth.
When it comes to booking their appointment, try and schedule it for the morning, or the time of day your child is at their best. An early morning slot stops the dentist from running late and seeing you later than expected.
Different ways dentists can accommodate you
Dentists will usually be happy to book a double slot for any patient with special requirements. If your child has a sibling who has no problem with the dentist, bring them along and have the dentist perform an exam on them first so, much like brushing their teeth, they know what is going to happen.
Do they have any comforters and distractors that work well for them? Using noise-cancelling headphones will block out some of the sounds in the waiting room and may be useful during treatment.
See if you can download a visual schedule from the Internet for you both to look at — you can laminate it and check off each step as it occurs. Ask your dentist to clearly explain each step before they do it, as well as how long it could potentially take — e.g. “Now I’m going to put a small mirror into your mouth to look at your teeth. It will take around two minutes.” They should speak in a calm and soothing voice and give instructions rather than asking questions.
Some children may find dental equipment frightening or fascinating; give them time to get used to the look, smell and sound of them. They might have trouble with is the tastes and smells — are you able to bring toothpaste and mouthwash from home rather than using an unfamiliar kind?
If you have decided that sedation is necessary, you should discuss this with your dentist and a medical professional well ahead of time to make sure that this is the right choice medically. If they require injections or drilling, these may be particularly painful to more sensitive children.
If your child has trouble communicating, agree on some signals to stop the procedure. Make sure the dentist is aware of them. If your child doesn’t like to be touched, make sure your dentist is aware and can minimize contact while giving them plenty of warning.
There are several different factors that might help your child to relax more during their visit, depending on their needs. It can often help to dim the bright lights present in the room, and many surgeries provide sunglasses. They will also be happy to turn off the radio or any background music if this is something your child finds distressing. You can also request that they turn on the instruments before putting them in your child’s mouth so they are aware of what is going on. Many children will dislike the feeling of the dentist’s chair moving under them, so ask if they can lay the chair back before your child sits on it.
The most important thing is not to give up! Your child may need several sessions to complete a full dental exam but any good dentist will be sympathetic to this.
With all forms of dental care, you will most likely need patience and resilience to establish a good dental hygiene routine and a good relationship with your dentist. It will take time but the rewards — better hygiene, reduced risk of dental problems and decay, not to mention the other benefits of good dental health — are worth it in the long run.
Dr. Raj Wadhwani BDS LDSRCS(ENG) DGDPRCS(ENG) MFDSRCS(ENG) MClinDent (Prosth) MSc (Imp) is the Founder, Clinical Director and Lead Clinician of Antwerp House Group, a dental practice in Cambridge. He has a special interest in using advances in technology to further the practice of dentistry, specifically laser dentistry and CAD/CAM dentistry. He teaches and mentors at the Royal College of Surgeons.
This article was featured in Issue 47 – Motherhood – An Unconditional Love