A look at how parents can find the right dentist for their child with sensory sensitivity.
Finding a dentist for children can be a struggle, but it poses additional concerns for parents of children on the autistic spectrum. Nationwide, more than 52 million people in the U.S. have special needs. Unfortunately, less than 10% of dentists treat patients with disabilities because of their lack of training and the patients’ adverse reactions to standard dental procedures. For this reason, access to specialized care such as dentistry is among the leading healthcare concerns for people with special needs.
As the parent of a child on the autistic spectrum, I can attest that the search for a dentist who would make my son comfortable was not an easy one. I want to help parents in a similar situation better navigate the process of finding their child the right care—and also how to prepare him or her for a trip to the dentist.
Why children with special needs require special care
Going to the dentist can be incredibly overwhelming for children with sensory issues or autism spectrum disorder (ASD). The bright light, the feeling of the cleaning, the loud noises, or even X-rays (if necessary), can create not just anxiety but physical discomfort.
“One of the most common facets of care for patients on the spectrum includes the use of desensitization visits,” said Dr. Mallory Marquie of Tooth Works. Tooth Works is a female-led pediatric dental practice located in the Upper West Side of Manhattan. They specialize in providing comprehensive dental care for both children and special needs patients.
“While a neurotypical patient may be able to complete an exam, cleaning, and X-rays all in one appointment, children on the spectrum may require several appointments to work up to just one aspect of our check-up. These shorter, focused visits help build trust with the provider and establish familiarity with the patient regarding various dental experience components.”
“Perhaps the most important factor in tailoring our treatment approach involves taking cues from the patient to help create an environment that eases any anxiety surrounding the visit,” she adds. Modifications in lighting, the use of headphones and sensory-stimulating toys, the presence of weighted blankets, and even just the consistency of returning to the same room each visit are some of the various ways we approach care for children on the spectrum.”
Dr. Marquie further explains: “Parents, caretakers, and therapists are our greatest resources for making these visits successful, so their knowledge of the child’s responsiveness to prompting and modeling and how the patient tolerates flavors, textures, and touch is immensely helpful in making progress as a team.”
Dr. David Jourabchi, DDS of The Pacific Dental Services® (PDS) Foundation Dentists for Special Needs, agrees. PDS Foundation is committed to making oral healthcare more accessible and provides individualized care through a first-of-its-kind dental clinic in Phoenix, AZ, with future clinics, training, and advocacy.
“The obstacles to care for individuals on the spectrum can vary greatly,” said Dr. Jourabchi. “However, they typically include varying speech levels, tolerance to sounds, lights, and new sensory stimuli. When patients arrive, they are introduced to our sensory room. We have sensory stimuli that can be modified for each individual’s preferences, including sensory tiles, fish tanks with bubbles, and galaxy lights. The sensory room allows patients to interact with team members and prepare for their dental experience. Following introductions in the sensory room, we show our plans to visit the patient and parents through pictures and words. This helps relieve some fear of the unknown as we embark on our dental journey.”
Both dentists stressed how vital communication with the parents or caretaker is. Questions include the following: Do they dislike certain sounds, textures, feelings? Do they like certain songs? Or does watching a certain show help them get more comfortable?
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“With our individualized approach, we anticipate obstacles to care for each patient and modify our approach to providing care,” Dr. Jourabchi shared. “We celebrate all goals and accomplishments and understand that all individuals learn at a different pace. Our goal is to allow the patient to become desensitized to the dental office, and we work with the patient to know their comfort level and help them achieve the next step.”
Dr. Marquie also recommends employing symbolic imagery, also referred to as the picture exchange communication system, for patients with limited communication abilities. If you are a parent, she recommends creating picture boards for patients. This can help outline the visit’s objectives, include images of various parts of the office and tools to be used, and create a streamlined visual order of the appointment for the patient to follow along. She also encourages children who communicate through soundboards to use them during their visits.
A dentist’s training and experience matters
While any dentist can treat children or patients on the spectrum, it doesn’t mean they have the understanding or the skills required to handle special needs patients optimally. For example, the doctors at Tooth Works all completed an additional two-year residency in a hospital-based program.
Their specialty training incorporated care of medically compromised and special needs patients, vast experience addressing dental emergencies and traumatic injuries, and completion of dental procedures in both the operating room and clinic using advanced sedation techniques.
The PDS Foundation Dentists for Special Needs have specially trained staff and an integrated sensory facility. They also host a residency program for pediatric residents from New York University Langone Dental Medicine. The program provides residents with one-on-one training focused on providing comprehensive oral health care to special needs patients. The program also offers pediatric residents training on special needs advocacy and guidance. Programs like this are crucial in helping dentists feel more confident in treating special needs patients.
When asked why so few dentists are prepared to work with those who have special needs, Dr. Jourabchi answered: “Providing dental care for individuals on the spectrum requires attention to detail, patience, effort, and the ability to think a little out of the box to achieve a successful visit. Behavior modification protocols can help increase our patients’ tolerances to unfavorable stimuli, and most dentists learn them through their professional education. However, these interventions require flexibility, time, and patience.”
“I think it comes down to a lack of experience for many providers,” Dr. Marquie explained. “The curriculums and clinical training vary widely amongst dental schools, so a large percentage of new practitioners might not have gotten the opportunity to care for any patients on the spectrum before graduation. With the rise of pediatric dentistry and general practice residencies, doctors obtaining additional education can garner wide-ranging skills and broader knowledge caring for different populations, ultimately expanding access to care for special needs patients.”
Advice for parents and patients
Early visits to the dentist (six months after the first tooth erupts or by 12 months old) and oral motor stimulation are vital for all individuals, especially those with special needs. These experiences can help kids learn about the different stimuli they can expect at the dentist early on from a playful perspective.
Dental providers also play an integral role in evaluating dental-facial development and providing feedback on individualized home care, diet, and lifestyle goals. Starting early helps develop healthier long-term habits.
“When searching for a dentist, you can reach out to their pediatrician, therapists, and support groups who may have providers that they can recommend,” Dr. Jourabchi suggests. “Your dental provider may recommend scheduling more frequent dental visits (i.e. three month or four-month exam/cleaning) in place of six month recalls to allow kids to become more familiar with the office and provide your dentist more opportunities to closely monitor your child’s oral health and provide timely feedback.”
Dr. Marquie also recommends speaking to other parents of children on the spectrum. “The process of establishing a dental home for your child may take time, but completing multiple consultations with different offices is a great way to gauge each doctor’s approach and your child’s response, if you can do so. Many offices will also allow your child’s occupational or ABA therapists to accompany your family to the office, as they can be a great help in guiding the visits!”
Dentists should also provide you and your child with items and methods to prepare for the appointment at home. Ask for samples of the materials used during the appointment to work with your child at home, so he or she can become used to them—practice sitting in a chair, laying back, and opening the patient’s mouth. If there are any verbal queues used at home to calm or engage the patient, communicate those.
For those old enough who understand their sensory limitations, Dr. Marquie advises you to convey your preferences and needs to your doctor in any way that you can. “Verbalizing or giving cues regarding your sensitivities can start your relationship with your doctor off on the right foot,” she said. “The doctor-patient relationship is a collaboration, and any provider who has experience with patients on the spectrum will gladly accommodate your needs when providing care.”
Dr. Jourabchi concurs that communication is critical. “Work with the office to make them aware of your limitations,” he recommends. “And realize that everyone deserves the best care, so don’t settle. There are many great videos and pictures on what to expect at a dental visit to help you feel more prepared. Realize that your dentist is here to help make your mouth and the rest of the body healthy, and they will have tips and tricks to make your visit more comfortable.”
This article was featured in Issue 126– Romantic Relationships and Autisms