Dental Care For Autistic Patients

Autism – a developmental disability that significantly affects communication (both verbal and non-verbal) and social interaction. This disorder is usually evident before the age of three, and can adversely affect educational performance. Other characteristics associated with autism spectrum disorder include, repetitive activities and movements, resistance to environmental change or change in daily routine, and unusual responses to sensory experiences.

- About 1 percent of the population of children in the U.S. ages 3-17 have an autism spectrum disorder.

- The prevalence is estimated at 1 in 88 births.

- Around 1 to 1.5 million Americans have an autism spectrum disorder.

Autistic patients, as well as patients with similar behavioral or intellectual challenges, require special care from dentists. Most dental procedures use bright lights, loud noises, and possibly x-rays. Most people feel apprehensive about dental treatments, imagine what this is like for a child or adult with autism. 

Being hypersensitive to one’s environment is usually a telling trait for most autistic patients. This makes dental care challenging for the dentist and the parents, as the individual may react negatively to the sensory overload. Autistic patients do not like changes to their daily routines, new noises, new people or new activities. In the past, some dentists would turn away these types of patients, but in modern dentistry, this is no longer the case. There are many dentists who have training to help make patients with special needs comfortable. 

- Poor Dental Hygiene. The autistic population has an increased risk of poor dental hygiene, although other patients can have this as well.

- Higher Chance of Tooth Decay. Poor dental hygiene and tooth decay go hand in hand. There is an increased risk of this occurring due to many parents and/or caregivers using sweets as a reward. The increased exposure to sugar and leaving carbohydrates in direct contact with the tooth surface over prolonged periods, can lead to an increase in tooth decay.

- Teeth Grinding or Bruxism. Many people suffer from this condition, however, we have seen a higher rate of patients with autism exhibiting this behavior.

- Self Injury. Some autistic patients may bite or pick at their gums which can create a dental issue. A mouth guard may be recommended if the patient can tolerate it.

- Medication Related Issues. A patient with autism may suffer from seizures and need to take medication for it. These medications can lead to decreased saliva production which can lead to dry mouth, bad breath and tooth decay.

Helping Autistic Patients in the Dental Chair

1) Set up a Pre-Appointment Tour. Parents should talk to the dentist ahead of time to let him/her know about their child. This includes what helps to soothe their child and what sets them off. Setting up a pre-appointment can let the patient tour the dental office and see the people there. Let them see the trays and the chair that they will sit in. This should include the x-ray machine so they are familiar with it for the actual appointment. Meeting the entire dental staff is very important.

2) Keep Initial Visit Short. Make the initial visit quick and as noninvasive as possible.

3) Always Communicate. The dentist and dental hygienist should discuss a treatment plan for the child, what instruments will be used, what might happen, and about how long the appointment will take. The child should be able to ask questions, and be taught hand signals to let the dentist know if they need a break. 

4) Have Parents in Room if Needed. This is a personal choice between the parent or caregiver and the dentist. Some patients feel more comfortable with the parents in the room and some do not. This is a case by case decision. Never be afraid of insisting that you be present during the dental appointment –  your child may require you to be there. Make sure the dental staff is comfortable with this beforehand.

5) Potential Use of General Anesthesia, Sedatives or Restraints. For more lengthy and invasive dental procedures like tooth extractions, dental fillings and even radiographs, they may need to be done under sedation or general anesthesia. If the patient is unable to stay calm or still this can be a safety hazard. Restraints can sound scary, but with autistic children, especially those with Asperger's, they are calmed by a tight pediwrap. Children with Asperger's often squeeze themselves in a hug or wear tight clothing to self soothe in difficult situations. 

Dental Care for Autistic Patients

Autistic patients have to work through challenges every day and can learn to manage them. Visiting the dentist can make anyone uneasy, especially an individual with autism. The challenge can be overcome with patience between a dentist, patient, and parent/caregiver. With proper planning, a patient with autism can achieve a healthy smile through regular dental appointments and a good dental hygiene routine.