Taking all children and even some adults to the dentist can be a very stressful experience. For those carers who have a child with an autism spectrum disorder (ASD) these appointments can be even more traumatic.
This page gives you some brief strategies that can help to make the experience better for everyone involved.
Possible reasons for disliking the experience
Lack of understanding
Some people do not understand the purpose of going to see a man or woman in a white coat who looks into their mouth and uses strange equipment, whilst they are expected to lie on a chair with a large light positioned on their face. They may not have understood the importance of having healthy teeth and gums and the consequences of not having regular appointments.
Sensory issues
This is probably one of the main anxiety triggers at the dentist for individuals with an ASD. The obvious areas of difficulty will be tactile (touch) and auditory (noise). Mouths are extremely sensitive places and for a person with an ASD the sensation of a cold instrument entering their mouth could be very painful. In addition, the noise of the drills and cleaning instruments could also be a problem. Sometimes the taste of the mouth wash or the paste being used will also have an adverse impact.
It is also important to check whether there are any factors in relation to the dentist as an individual that might cause distress; for example, their perfume, moustache, or the colour of their clothing. An information sheet on ASD and sensory issues is available through our Autism Helpline.
Invasion of space
Dentists are one of the few professionals who we permit to enter our personal space. Most people find this uncomfortable but understand that the dentist needs to be so close in order to examine teeth. For individuals with an ASD this close proximity may well be extremely distressing.
The following strategies are dependent on the person's level of understanding and their individual needs and should be adapted accordingly.
Strategies to help
Preparation
As a result of past negative experiences, many carers understandably avoid telling the individual with ASD about their dental visit until the last minute or on the day of the appointment. But even though it may initially cause a behaviour pattern change, it is better in most situations to try and inform the individual as early as possible. This can be difficult if their concept of time is poor. The use of visual supports (for example, a calendar) can help to clarify when an event is occurring. For further information please see the autism helpline information sheet on visual support. (See resources list below).
If it is the individual's first visit to the dentist you may like to take them to meet the dentist and other staff prior to any treatment. You may also like to show them the equipment which the dentist will use and how it works.
It is also important to prepare the dentist and their team by giving them as much information as possible, so they can make adaptations to the procedure and be aware of the individual's needs.
Try to ensure that the appointment is the first of the day - maybe even book a double time slot. This reduces the chance of the dentist running late and provides enough time not to feel rushed.
Social stories
Social stories are an effective way of providing information to an individual about an activity and the reason for doing it. A social story could be a good way to help an individual understand what happens at the dentist and why we need to go for a check up. For further information, please see the autism helpline information sheet on Social Stories and Comic Strip Conversations. (See resource list below).
Story books
There are lots of basic story books about visiting the dentist which may help you - for example, Topsy and Tim go to the dentist.
Breaking down the visit using visual supports
It may be useful to try and produce a sequence of pictures or photos that show the stages of going to the dentist. This will allow you to cover up the different steps so they know which is coming next and when each step is finished. You may also wish to include a reward picture at the end of the sequence so they have something to look forward to. An information sheet on using visual supports is available through the Autism Helpline. (See resources list below).
Time indicators
It is important to help the individual realise that this experience does have a time limit. By using visual or auditory timers (eg sand timers, buzzers, watch alarms) they can have an understanding of this and monitor the length of the experience.
Comforters/distracters
Letting the individual take comforters into the dentist's surgery could help to occupy or distract them. For some people, taking a Walkman or having music playing in the background can act as a good blocker.
Sedation
For some people, the experience of visiting the dentist is so distressing that it may be necessary to consider sedating them. If you feel this is the case, you will need to talk to your dentist and a medical professional to discuss the options.
Professional input
There are some dentists who specifically cater for individuals with special needs. See below for the different types of dentist.
General dentist
Some general dentists have experience of and work with people who have additional needs.
Primary Care Dental Service
Primary care dental services are provided by primary care trusts in England and by health boards in Wales, Scotland and Northern Ireland. These services are usually located within Community Health Centres and are aimed at people with disabilities or other medical problems.
Hospital dentist
In order to access a dentist who works within a hospital setting you would require a referral from either a general dentist or the community dental service.
For details of dentists with special needs experience, try the following sources:
The British Dental Association's Find a Dentist
Website: http://www.bda-findadentist.org.uk
Beyond Fear
Wesbite: www.beyondfear.org
NHS Direct
England
Tel: 0845 46 47
Website: http://www.nhsdirect.nhs.uk
Wales
Tel: 0845 46 47
Website: http://www.nhsdirect.wales.nhs.uk
Scotland
Tel: 0845 4242424
Website: http://www.nhs24.com
Resources
Adamson, J. (2003). Topsy and Tim go to the dentist. London: Penguin Books Ltd
Green, J. (1999). Open Wide! - My first trip to the dentist. Hove: Wayland publishers Ltd
Rowan, K. (1999). I know why I brush my teeth. London: Walker Books
Smith, A. and Tatchel, J. (1998). Flip Flap Body Book. London: Usborne Publishing
Quick link to this page:
www.autism.org.uk/17369