Courtesy of the American Speech-Language-Hearing Association
By the time some children with autism first see the dentist, they have already developed serious dental problems that may even require hospitalization. Try to start good dental hygiene habits early. Among parents of children with autism spectrum disorder, almost half describe their child’s dental health as fair or poor, according to a study in the journal Pediatric Dentistry. This is not surprising, as a visit to the dentist can present many challenges for a child with autism. The sensory overload from the strange smells, loud noises, and sharp tools; the unfamiliarity of the masked adult looming; and the unpredictability of the whole process—not knowing what will happen and when it will end—are just some of the factors that make this a particularly difficult scenario for a child with autism.
This Autism Awareness Month, the American Speech-Language-Hearing Association (ASHA) tapped Terese Conrad, MA, CCC-SLP, a speech-language pathologist who specializes in working with clients with autism spectrum disorder and a former dental hygienist, to provide tips for parents and caregivers for successively navigating a trip to the dentist. Conrad, who works at Wichita State University, offers the following.
- Vocabulary: Many children need repeated exposures to learn the vocabulary. This vocabulary is a building block for following the directions necessary to become more independent with home care and visiting the dentist.
- Teach children the names of the items (e.g., toothbrush, toothpaste, cup, water, sink, towel) along with the body parts (e.g., teeth, tongue, mouth).
- Reinforce this vocabulary throughout the day. Read developmentally appropriate books outside of the bathroom routine; post photographs outlining the steps in the bathroom; and explore cartoons and short video clips that review the process.
- Diet: Individuals with autism may have limited diets and strong likes or dislikes when it comes to food/drink. Do your best to provide a diet that reduces the risk of cavities.
- Limit sugary drinks, sticky/gummy foods (e.g., raisins, fruit snacks), and acidic foods that can break down the enamel.
- Napping or going to bed with a bottle or sippy cup containing juice or milk can lead to liquid pooling in the mouth, bathing the teeth. Try diluting juice with water, slowly increasing the water over time.
- If you are dealing with a child with a diet that might lead to dental health issues, attempt to brush his/her teeth before bedtime to remove the plaque and bacteria.
- Talk with your dentist regarding fluoride and options for delivery (e.g., toothpaste, rinses, drops).
- Routine: Children consistently do better with a clear set of expectations. Consider the following.
- Begin the bedtime routine before everyone is exhausted. A half hour before bed, take a bath, dress for bed, brush teeth, and read a book. Create a visual schedule to follow.
- Clearly outline tooth brushing. Some families use visual timers to indicate when they are done brushing. Some use music similar to the hand-washing songs or battery-operated toothbrushes that signal the end of the process (e.g., the vibration ends after 2 minutes).
- For older or more independent individuals, a diagram of the mouth outlining the tongue side, tops, and cheek sides of the teeth is helpful, with a plan for moving from one section of the mouth to the next.
- Extras: These tips apply to any child to develop a positive approach to dental care.
- Avoid unclear endings. Try not to use expressions like, “We’re almost done,” or “1 more minute.” These don’t provide predicable information.
- Consider starting with the toothbrush only. A soft bristle toothbrush is recommended. Be aware of the potential to elicit a gag—more likely for individuals who breathe through their mouths.
- Expect that you may have to explore several options before finding a toothpaste flavor that the child tolerates.
- Consider introducing toothpaste at the end as a reinforcer, especially if the child consistently tries to eat the toothpaste (i.e., sucking the toothbrush and refusing to participate in the brushing process). Many kids will go through a phase where they chew on the toothbrush. Introducing it without paste may help you determine if the child needs to learn to hold the mouth open for the brush. Can he or she follow the directive to hold the mouth open?
- Store toothpaste out of reach when you have a child who might consume more than the pea size amount recommended.
- Try a different location for tooth brushing (such as the kitchen sink), having the child assist with getting the toothbrush from the bathroom and returning it, if possible.
- Some families find that letting the child have the toothbrush while seated in the bathtub is the best way to develop a positive connection. Watch out for soapy water on the brush.
- Taking turns brushing each other’s teeth promotes acceptance (i.e., the child takes mom’s brush and puts it in mom’s mouth and mom brushes the child’s teeth). Stick to a clear start and finish.
- Create structure for safety and skill development. Wandering around with a toothbrush can be dangerous.
Many parents who have experienced difficulty with doctor appointments put off a dental visit for as long as possible. Here are a few tips for establishing a positive experience:
- Choose a dentist: Check with other professionals or parents in your area for dentists they recommend for children with autism and why. Parents may be given recommendations of dentists who perform work under anesthesia only. This may be an appropriate referral, but is not a great starting place if the goal is to develop a routine for “happy visits.”
- Ask questions: Call the office with a list of questions to learn more about how they support/provide services to children with autism.
- Plan ahead: Behavioral psychologists frequently assist families with activities/events that are problematic for children and families. The behavior modification strategy is called Planned Activity Training. The goal is to plan ahead and establish a step-by-step plan, including reinforcement, to create a positive routine/successful completion.
- Outline the steps of the dental visit (e.g., check-in, waiting room, meeting the staff, transitioning to the operatory).
- Plan for success: Some children might need to start with walking into the office, greeting the front desk staff, and leaving—receiving reinforcement, such as a sticker, immediately.
- Visual supports: Pictures outlining the process provide an outline/schedule, letting a child know what to expect and when it is over.
- Sensory supports: Some families use headphones to reduce the noise or sunglasses, as the child sits in the chair, to reduce the light.
- Strive to start with “happy visits.” Some dentists will even do the first visual exam without taking them back to the dental chair, right in the waiting room.
- Videotaping: A dentist may allow you to walk through the office, taping the office and staff to share with your child. This would provide a non-threatening way to see the office without contact with the smells and transitions.
- Some families find it helpful to let their children watch them get their teeth checked, going through the steps of a simple exam.
- Regardless of the strategy, remember that the goal is to establish a positive outcome. Make the process as predictable as possible.
To learn more about a Wichita State University program that helps children with autism navigate dental visits, go tohttp://blog.asha.org/2015/04/21/dental-distress-helping-children-with-autism-successfully-navigate-a-trip-to-the-dentist/. Additional resources may be found on ASHA’s website at www.asha.org/public/speech/disorders/Autism/. Autism Speaks provides a dental toolkit that offers helpful information at https://www.autismspeaks.org/family-services/tool-kits/dental-tool-kit.
ASHA is the national professional, scientific, and credentialing association for 182,000 audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. Audiologists specialize in preventing and assessing hearing and balance disorders as well as providing audiologic treatment, including hearing aids. Speech-language pathologists identify, assess, and treat speech and language problems, including swallowing disorders. www.asha.org/
View all ASHA press releases at www.asha.org/about/news.