1001 Great Ideas for Teaching and Raising Children With Autism or Asperger’s
©2010 Ellen Notbohm and Veronica Zysk
Future Horizons, Inc. ISBN 978-1-935274-06-3
from Chapter Four: Daily Living
Your friend, the dentist. Old stereotypes are hard to kill, but one that richly deserves to die is the notion that dental visits are torture, something to be feared, dreaded and avoided. While the ideal of “painless dentistry” may not be 100% realistic in every instance, 21st century methods and practices are making dental visits tolerable and comfortable, even for a child with autism. There’s no denying that a dental office is fraught with innumerable sensory confrontations, but by your wise choice of a dentist who meets your child’s individual needs, those check-ups can become just another day in the life of your family.
So put away the thought that you can postpone dental care until your child is older, that those baby teeth don’t matter. They matter a great deal, and not just as place holders for permanent teeth. Baby teeth figure into language development, and the ability to chew is necessary to developing good eating habits. Oral health is critical at all ages. In a heartbreaking and well-publicized case in 2007, a 12-year-old boy died when infection from a tooth abscess traveled to his brain.
In writing this section, we asked parents of children with autism and the dental professionals who treat them to share stories and thoughts. The responses came from around the world, and they were overwhelmingly positive, even in public health settings (where parents cannot choose the dentist their child will see). Sometimes it took more than one try to find the right dentist, and what worked for one family did not work for another. The following thoughts and suggestions represent the experiences of a variety of families.
- Look for a pediatric dentist. The chances are greater that a pediatric dentist will have taken coursework and been exposed to a larger number of special needs children than a general dentist. Their offices are equipped for children, and some even offer designated days when they see only special needs children.
- If you like your general dentist, ask if he is comfortable seeing your child with autism. If the answer is hesitant or qualified, ask if he can recommend someone.
- Ask other families with children. “Even in small towns,” a hygienist told us, “there will be at least one or two dentists who have all the special kids. It’s because they’re good, and because other dentists and parents refer to them.”
Parents reported a variety of accommodations made by the dentist and staff:
- Dentist operates on time, with no long sits in the waiting room.
- Dentist and team of assistants are fast, gentle and calm, and never force a child to do anything.
- Fear of the dental chair was a widely reported issue. Some dentists will let your child lay in your lap or an assistant’s. One mom reported that her dentist gets down on the floor for a child who will only tolerate a cleaning lying flat. Ellen’s dentist treated her son in his office chair.
- Dentist will end the visit before the child becomes overwhelmed and schedule another appointment on short notice if more time is needed to finish the work.
- Dentist allows families to drop in anytime just so the child can practice being in the chair.
- Dentist offer videos, either handheld or mounted on the ceiling. (Some children love this, others find it too distracting) and/or offers headphones with music or audio books.
- Dentist offers lead blanket as a weighted calming device.
- Assistant will hold x-ray film in place rather than making child bite down, taking separate pictures of top and bottom.
- Dentist offers a mild sedative if needed.
- Dentist lets child know when and how she is going to touch him.
- Hiyah.net offers free educational software made for children struggling with language delays. Download “Going to the Dentist.”
- Choose a dentist who will let your child acclimate to the office slowly over time before the actual cleaning or checkup. First visit – look inside the door. Second visit – say hello to the dentist. Third visit – dentists looks in child’s mouth. Fourth visit – child brushes his own teeth then leaves. Fifth visit – child watches dentist work on sibling or other child. And so on.
- Deep pressure input before the visit may help: use a vibrating toothbrush, have your child wear a snug hat, leggings or a weighted vest, do some quick push-ups against the car or a wall before entering the building.
- Put together a story with photos of the dentist, the assistants, the waiting room (and toy room if there is one), the chair, the sparkling smiles at the end of the appointment.
- If your child will be seeing your dentist, schedule your appointments together.
- Don’t schedule the appointment at an hour or day when your child is likely to be tired, hungry or otherwise out of sorts.
- Don’t tell your child a week ahead of the appointment, allowing anxiety to build and classmates to weigh in with their own stories. Tell him the day of the appointment that you’re going for a check up, that’s all.
- And this from a pediatric hygienist with 32 years of experience and a son with autism: “The worst thing you can say to your child is, ‘don’t worry, honey, he won’t hurt you,’ or ‘If you’re good/brave….’ Chances are your child wasn’t worried about pain until you brought it up. And what’s ‘good?’ We do our best to ensure your child experiences as little pain as possible, but if he does, we want him to tell us, and not try to be ‘good.’”
The biggest difference of opinion between parents and professionals is the issue of whether the parent should accompany their child to the treatment room. Some parents will not consider a dentist who doesn’t allow them to “come back” with their child, while many dentists discourage it. This attitude is different from what most parents experience in a doctor’s office, where the parent is expected to accompany the child to the examination room and control his behavior. Our hygienist offers food for thought on the subject: “Please understand this is a 100% safety issue. When we are inside a child’s mouth with high-speed drills and sharp instruments, it is imperative that the child be focused on and listening to one individual only – the dentist. Any distraction, however momentary, carries the potential of severe soft tissue damage – think tongues, cheeks, gums. The best thing you can do for your child is tell him to listen to the dentist, and then wait outside.” The exception, she points out, is if your child is truly in need of your comfort during the procedure. Any dentist will accommodate legitimate need.
©2010 Ellen Notbohm and Veronica Zysk. Please contact the author(s) for permission to reproduce in any way.