Dental care and autism spectrum disorder

Key points:

Dental care is an important part of your health and well-being but for people with autism spectrum disorder, it can be uncomfortable
There are many ways of ways to make your routine dental experiences more comfortable
Practising several things before you even get to the dentist can help make you, or your child, feel more comfortable

Concerns about the dentist

From the loud machinery, the needles, potentially invasive procedures, the light in your face and the cool sensations in your mouth, dental appointments can cause a sensory overload.

Dental care is an important part of your health and wellbeing but if the concern of sensory overload keeps you out of the dentist’s chair, there are ways to make your routine dental experiences more comfortable, including preparing for your appointment.

Autism Awareness Australia Chief Executive Officer, Nicole Rogerson said the dentist can be unpleasant for most people, let alone those living with autism.

“We all know what we don’t like about it, lying backwards in a strange chair, a bright light above us and someone prodding around in our mouths, sometimes doing things that hurt a little or are at best uncomfortable,” she said.

“Now, imagine what is like for someone on the autism spectrum who may have limited language and understanding of what is going on and additional sensory sensitivities.

“It can be downright terrifying. If you don’t have a good understanding of why this is happening and the future [health] benefit you’re ‘investing’ in, then going through this is not something you want to do.”

Practice makes progress

Ms Rogerson says practising a number of things before you even get to the dentist can help your child become more comfortable.

“For children, starting at home by ‘playing’ dentists is a good way forward. Practising brushing teeth, touching teeth — back ones too — and lying back.”

She said if this can be practised at home in the months and weeks before, it will be less of a shock on the day of the appointment.

“Watching YouTube videos of kids going to the dentist and reading social stories is another way of helping that child understand and prepare beforehand,” Ms Rogerson continued.

Ms Rogerson also explained it’s important to find a friendly and understanding dentist, particularly one with experience treating patients with autism spectrum disorder and a receptionist who will make the ‘waiting room’ experience more pleasant.

“Someone who totally understands what might go wrong and who can cope with the situation should it be challenging. You both need a backup plan of how to respond if things get tense and emotional,” she said.

“Crowds can be difficult, as can waiting. A good receptionist will phone you when the dentist is ready and can save some nervous, boring waiting in the clinic.”

Ms Rogerson says a behavioural therapist and regular practice routine had great results for her son, who is on the autism spectrum.

“I am happy to report that at 23, my son takes himself to the dentist — and now pays the bill too,” she said.

“That is my definition of success!”

Is sedation a good idea?

Many people with autism spectrum disorder do not like anyone touching their teeth or putting things in their mouth. This is where sedation can be beneficial for people experiencing anxiety around dental procedures.

However, sedation is not always necessary and there may be other ways to take the anxiety away so make sure you speak to your dentist first.

There are four types of sedation.

Inhaled minimal sedation

This is when you breathe in nitrous oxide combined with oxygen to help relax. Your dentist is in complete control of sedation that is given. You will still be aware of what is happening but should feel calmer and less anxious throughout the procedure.

Oral sedation

This type of sedation can range from minimal to moderate and is most commonly associated with sedation dentistry. Oral sedation is administered by swallowing a pill that will make you drowsy, while a more moderate dose may put you to sleep.

IV sedation (moderate)

This is a sedation drug that is administered through a vein and works more quickly. Your dentist will be able to continually adjust the IV sedation levels.

Deep sedation and general anaesthesia

This type of sedation will make you nearly or totally unconscious. While under general anaesthesia your dentist can do their work and you will be woken up after the procedure when the effects of the medication wear off.

Local anaesthesia is also used to ensure pain-free dental procedures. This numbs pain locally in the mouth and ‘wears off’ after a few hours.

Tips for parents, carers and adults with autism

Finding a good dentist is particularly important. Someone who has experience treating people with disability and understands the often complex needs of autism and sensory processing difficulties will ensure your visit is more pleasant.
Avoid changing dentist clinics and dentists unless absolutely necessary. Having a dentist and clinic you can trust is important.
Explain your needs or your child’s needs when booking the appointment so your dentist is aware ahead of time and can make necessary adjustments.
Schedule an appointment for your child to meet the dentist and staff members and become familiar with the sounds, dental tools and other processes involved in an appointment.
Ask a potential dentist if they can use a ‘tell-show-do’ approach when providing care to patients with autism spectrum disorder. This means they explain each procedure before it occurs, taking their time to show what they have explained, such as the instruments they will use and how they work.
To avoid more frequent trips to the dentist, ensure a healthy dental regime is adopted at home, including brushing, flossing and a healthy diet.
Practice ‘dentists’ at home before you book an appointment so your child learns what to expect when they visit the real dentist. You can even use stories or cartoons to explain the process.
Book a ‘familiarisation’ appointment before actually having any dental assessments or treatments.