A look at how parents can find the right dentist for their child with a sensory sensitivity.
Finding a dentist for children can be difficult, but it creates additional concerns for parents of children on the autism spectrum. Nationwide, more than 52 million people in the US have special needs. Unfortunately, less than 10% of dentists treat patients with disabilities due to a lack of training and adverse patient reactions to standard dental procedures. For this reason, access to specialized care, such as dentistry, is among the top health care concerns for people with disabilities.
As a parent of a child on the autistic spectrum, I can attest that finding a dentist who would make my son comfortable was not easy. I want to help parents in a similar situation better navigate the process of finding the right care for their child—and also how to prepare them for a trip to the dentist.
Because children with special needs need special care
A visit to the dentist can be incredibly overwhelming for children with sensory issues or autism spectrum disorder (ASD). Bright light, the feeling of being cleaned, loud noises or even x-rays (if necessary) can create not only anxiety but also physical discomfort.
“One of the most common aspects of care for patients on the spectrum involves the use of desensitization visits,” said Dr. Mallory Marquie of Tooth works. Tooth Works is a women-run pediatric dental practice located on the Upper West Side of Manhattan. They specialize in providing comprehensive dental care for both children and patients with special needs.
“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 multiple appointments to meet just one aspect of our screening. These shorter, focused visits help build trust with the provider and familiarize the patient with various elements of the dental experience.”
“Perhaps the most important factor in tailoring our treatment approach involves taking cues from the patient to help create an environment that alleviates any anxiety surrounding the visit,” she adds. Modifications in lighting, use of headphones and toys that stimulate the senses, the presence of blankets, even the consistency of returning to the same room each visit are some of the different ways we approach caring for children on the spectrum.”
Dr. Marquie further explains, “Parents, caregivers and therapists are our most important resources in making these visits successful, so their knowledge of the child’s response to prompting and modeling and how the patient tolerates tastes, textures and touch is extremely useful progress as a group.’
Dr. David Jourabchi, DDS of The Pacific dental services® (PDS) Dental Foundation for Special Needs, agrees. The PDS Foundation is committed to making oral health care more accessible and provides personalized care through a first-of-its-kind dental clinic in Phoenix, AZ, with future clinics, education and support.
“Barriers to care for people on the spectrum can vary greatly,” Dr. Jourabchi said. “However, they usually include different levels of speech, tolerance to sounds, lights and new sensory stimuli. When patients arrive, they are ushered into our sensory room. We have sensory stimulation that can be tweaked for each person’s preferences, including sensory tiles, bubble fish tanks and galaxy lights. The sensory room allows patients to interact with team members and prepare for their dental experience. After introductions to the sensory room, we show our plans to visit the patient and parents through pictures and words. This helps alleviate some fear of the unknown as we begin our dental journey.”
Both dentists emphasized how vital it is to communicate with the parent or guardian. Questions include: Do they dislike certain sounds, textures, feelings? Do they like certain songs? Or does watching a certain show help them feel more comfortable?
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“With our personalized approach, we anticipate barriers to care for each patient and modify our approach to care delivery,” shared Dr. Jourabchi. “We celebrate all goals and achievements and understand that everyone learns at a different pace. Our goal is to allow the patient to be desensitized in 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 the use of symbolic imagery, also referred to as a picture exchange communication system, for patients with limited communication skills. If you’re a parent, she recommends creating picture boards for patients. This can help describe the goals of the visit, include images of different parts of the office and the tools that will be used, and create a streamlined visual sequence of the patient’s appointment. She also encourages children who communicate through speakers to use them during their visits.
A dentist’s training and experience matter
While any dentist can treat children or patients on the spectrum, this does not mean that they have the understanding or skills needed to optimally handle patients with special needs. For example, Tooth Works doctors all completed an additional two-year residency in a hospital-based program.
Their specialty included caring for patients with medical problems and patients with special needs, vast experience in dealing with dental emergencies and traumatic injuries, and completing dental procedures both in the operating room and in the clinic using advanced sedation techniques.
PDS Foundation Dentists for Special Needs has specially trained staff and a comprehensive 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 patients with special needs. The program also offers training to pediatric residents in special needs advocacy and mentoring. Programs like this are vital to helping dentists feel more confident treating patients with special needs.
When asked why so few dentists are prepared to work with people with special needs, Dr. Jourabchi responded, “Providing dental care to people on the spectrum requires attention to detail, patience, effort and the ability to think a little outside the box to achieve a successful visit. Behavior modification protocols can help increase our patients’ tolerance of aversive stimuli, and most dentists learn these through their professional training. However, these interventions require flexibility, time and patience.”
“I think it’s because of the lack of experience for a lot of providers,” Dr. Marquie explained. “Curriculums and clinical training vary widely among dental schools, so a large percentage of new doctors may not have had the opportunity to care for any patients on the spectrum before graduation. With the rise of pediatric dentistry and general practice specialties, physicians who acquire additional training can acquire a broad range of skills and knowledge of caring for diverse populations, ultimately expanding access to care for patients with special needs.”
Advice for parents and patients
Early dental visits (six months after the first tooth erupts or by 12 months of age) and oral motor stimulation are vital for all individuals, especially those with special needs. These experiences can help children learn about the different stimuli they can expect early on at the dentist from a playful perspective.
Dental providers also play an integral role in assessing facial dental development and providing feedback on individualized home care, nutrition, and lifestyle goals. Starting early helps develop healthier long-term habits.
“When looking for a dentist, you can reach out to your pediatrician, therapists, and support groups who may have providers they can recommend,” suggests Dr. Jourabchi. “Your dental provider may recommend scheduling more frequent dental visits (i.e., tri-monthly or four-monthly exam/cleaning) instead of six-monthly recalls to allow children to become more familiar with the office and give your dentist more opportunities to monitor your child’s condition closely. oral health and providing timely feedback.”
Dr. Marquie also recommends talking to other parents of children on the spectrum. “The process of establishing a dental home for your child can take time, but completing multiple visits with different practices is a great way to gauge each doctor’s approach and your child’s response, if you can. Many offices will also allow your child’s occupational therapists or ABA therapists to accompany your family to the office, as they can be very helpful in guiding 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 they can get used to them—practice sitting in a chair, lying down, and opening the patient’s mouth. If there are verbal cues used at home to calm or engage the patient, communicate them.
For those old enough to understand their sensory limitations, Dr. Marquie advises communicating your preferences and needs to your doctor in any way you can. “Expressing or giving clues about your sensitivities can start your relationship with your doctor off on the right foot,” she said. “The doctor-patient relationship is a partnership, and any provider who has experience with patients on the spectrum will be happy to accommodate your needs when providing care.”
Dr. Jourabchi agrees that communication is critical. “Work with the office to let them know your limitations,” she recommends. “And realize that everyone deserves the best care, so don’t settle. There are lots of great videos and pictures about what to expect at a dental visit to help you feel more prepared. Realize that your dentist is here to help you keep your mouth and the rest of your body healthy, and will have tips and tricks to make your visit more comfortable.”
This article was featured on Issue 126 – Romantic Relationships and Autismsmall
