Dental appointments can be stressful for anyone, including individuals of all ages with intellectual and developmental disabilities (IDDs) and unique healthcare needs. For children with Autism Spectrum Disorder (ASD) or individual sensory issues, the abundance of sensations and stimuli during their visit to the dentist may be overwhelming.1
Even while at home, people with ASD may have difficulty engaging in healthy dental hygiene habits, like brushing and flossing, due to sensory sensitivities.2 But with practice and preparation, not only can time spent with a dentist result in a positive experience, but best oral health practices at home can lead to favorable oral health outcomes for years to come.
Nationally, inspiring organizations strive to provide adults and children alike with IDD or ASD better oral healthcare. One of these organizations is Wheeler Health in Connecticut, our 2020 and 2021 SMILE Grant recipient.
For the past two years, the Delta Dental of New Jersey Foundation has provided $100,000 total support to Wheeler’s collaboration with Harc-Dental Collaboration. These SMILE grants supported increasing access to dental professionals that are highly skilled and knowledgeable in working with individuals who have IDD or ASD. Wheeler partnered with Harc, Inc., a Hartford-based nonprofit provider of supports for individuals with IDD, to address the dental needs of individuals with IDD or Autism. The purpose of these grants was to help make Wheeler the specialized place to go for those with special healthcare needs to access dental care.
We recently spoke with Dr. Dorota Gasior, Dental Director, Health & Wellness, Wheeler Health, and Sara Schoonover, PsyD, Program Manager/Psychologist, Autism Diagnostic Evaluation Program, Wheeler Health, to gain more insights into how Autism affects a person’s oral health, dental care for those with special healthcare needs, and tips for preparing for a dental visit and at-home care for those with IDDs.
Q: In your experience, how does Autism Spectrum Disorder (ASD) affect an individual’s oral health?
There are various levels of autism, but from personal observation, individuals with autism are less compliant with oral home care compared to kids without disabilities.
Individuals on the spectrum may have sensory sensitivities that affect their tolerance for self-care activities such as brushing their teeth, as well as their comfort in unfamiliar/possibly loud and overwhelming environments, such as the dental office, which can lead to avoidance of these behaviors. Other individuals may present with repetitive behaviors, such as teeth grinding, or self-injurious behaviors, such as hitting or head-banging, that affect oral health.
CHILDREN: Typical observation upon examination are the presence of bleeding gums, caries, and high levels of plaque. In some cases, children with autism will refuse to look in the mirror to follow home care instructions. Many will display sensitivity to noises, unfamiliar scents, or texture, as well as a preference for objects that roll and have smooth round shapes.
ADULTS: Autism in adults is not as easy to recognize as in children. Although many adults with autism live comfortable and productive lives, they can still have difficulty in situations requiring social interaction or where there is exposure to certain sounds, lights, and smells. Some issues may include problems with communication, narrow interest, and focusing on one favorite task or topic, repetitive behavior.
Q: How can children and adults who have ASD prepare for visits to the dentist?
Like with many people, comfort comes with information. Both with children and adults, providing information about what to expect can decrease fear and anxiety. For children in particular, it’s helpful to walk them through in advance what will happen, who they will see, and what they will do during the appointment.
Parents should choose a dentist who has experience working with autistic children. The child should also be prepared prior to the visit to get them used to someone touching their mouth, hearing blow noises, pressured air, electric tools, seeing sharp objects, seeing faces with etc. Nitrous oxide sedation, aka, “laughing gas,” is a very helpful tool used in many dental offices.
Q: In what ways can a dental office accommodate and work with people of all ages who have an ASD diagnosis?
It is best for providers to go slowly and be patient. Explain steps and allow time for the individual to adjust to each step. Further, minimizing sensory input, such as noise or unnecessary bright lights in the office, can help.
CHILDREN: Each dental visit should involve practices that help each visit to end on a positive note. For example, a first visit may simply involve walking into the dental practitioner’s office.
Other initial steps might include:
- Walking into the exam room
- Sitting in the exam chair for 5 seconds
- Sitting in the exam chair for 30 seconds
- Sitting in the exam chair for 1 minute
- Sitting in the exam chair for 5 minutes
- Sitting in the exam chair for 10 minutes
Familiarity is another technique that can distract the child, for example, bringing their glasses, headphones with music, favorite blanket, etc.
The underlying themes of treatment difficulty are unfamiliarity, unpredictability, and physical invasiveness. Gaining trust is one of the most important goals when treating an autistic child by “tell, show, do.” Oral commands should be short, clear, and simple sentences. It is important to maintain good, ongoing communication throughout the visits and beyond. The ability to follow directions, learn new things, and articulate wants and needs may be difficult for some patients with autism.
ADULTS: Manifestations of autism in adults can be noticed in toothbrushing and flossing habits, which can be aggressive. Often, by adulthood, patients with autism have learned to cope with sensory sensitivities and have learned more social skills which make them more successful in the dental office visits.
Q: What tips do you have for those with ASD to maintain good oral health practices at home?
For people of all ages, it is best to work with dental professionals and clinical supports (therapists, behaviorists, occupational, and others) to find materials and habits that work for you.
CHILDREN: If a child is struggling with brushing their teeth, parents should experiment with different kinds of toothbrushes until they find one that works best for their child. Some brushes are made with silicon or softer bristles. Sometimes, a child may benefit from an electric toothbrush with soft vibrations. It’s all about finding a toothbrush that they can use on a day-to-day basis.
It is important to limit sugary foods and drinks as well as acidic foods. In large quantities, foods like this can break down the enamel and make child more susceptible to cavities and tooth decay.
Parents should consider hanging toothbrushing picture cards and rinsing sheets, which can be useful tools in helping some children with autism master the necessary skills.
Q: What has the impact of your program been like for those you have served with ASD?
We observed significant improvement in autistic children’s oral health. We also support parents through education and instructions as their participation is very important in achieving goals.
Q: Do you have any resources you can suggest for families of autistic children and adults?
Autism Speaks has a Dental Tool Kit for families available here.
Wheeler and Delta Dental of New Jersey Foundation Since January 2018, through S.M.I.L.E. Grant funding, the Delta Dental of New Jersey Foundation has supported Wheeler’s efforts to meet the oral health needs of Hartford’s medically underserved population through its community health center at 43 Woodland Street. Delta Dental helped fund the initial-year launch of Wheeler’s Hartford Family Health & Wellness Center Dental Program, as well as consultation, outreach efforts, and related collateral materials. Funding for this project continued in 2019. The grant funds also allowed for the purchase of age-appropriate toothbrushes, toothpaste, and coloring books promoting preventative dental care for children. Wheeler’s dental assistant and community engagement team continues to distribute these dental care materials at health fairs, community block parties, and neighborhood events.
At Delta Dental, we love to see you smile.
1 https://childrensdentalhealth.com/dental-visit-guide-for-children-with-autism-sensory-issues/
