Planning a Dental Visit for Autistic child



                                                       



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Taking the child to a dentist can be a very stressful experience for both parents and child. Children with ASD or other developmental disabilities often have difficulties with sensory stimuli, and communication and increased levels of anxiety.

Long waiting queue, lack of communication, background sounds, the smell of different medicines and chemical solutions, being touched by dentists, and finally having a dental equipment within the mouth are some of the challenges an Autistic child face during his visit to a dentist. All this makes him anxious and impulsive during and after the check-up leading to uncooperative behaviours and negative experiences. 

Anxiety may be caused by various reasons such as fear of unknown, sensory sensitivities and communication difficulties. Children usually display noncompliant, impulsive and restless behaviour when they are unable to communicate their feelings of anxiety while meeting new people, going to public places, sensitivity issues such as tactile defensiveness and auditory sensitiveness.


Concerns for the parents:
  • Will visit be will a  successful or an embarrassment?
  • Number of aspects contributing to uncooperative behaviour and alleviated anxiety:
  • Child's sensory sensitivities (Noise, tactile defensiveness, different odours)
  • Lack of communication
  • Increased levels of anxiety

Here are some supportive strategies which can ease child and parent’s concerns and develop the better understanding regarding oral hygiene care.

Prepare child as early as possible:

It will be best for the parent, the child and the dentist to meet and
develop a plan ahead of the visit. Inform the child about dental visits as early as possible. Telling him at last minute can lead to extreme anxiety resulting in a distressful situation. Although behavioural changes are expected, but knowing about check-up much before the visit will ease the anxiety. Communicate and educate him about the purpose of visit to release or reduce his anxiety levels. Use visual support such as a calendar to explain date of visit or days remaining for the check-up.

Talk to the Dentist:

  • Tell the dentist as much as you can about the child’s sensory sensitivities and behavioural strategies’ that are successful. If this is child’s first visit to dental surgery, it is always better to ask for help from staff and communicating to the dentist about your child’s condition.
  • Let dentist know about child’s sensory issues such as:
  • The doctor may not approach or touch the child without informing him or taking permission to touch.
  • The dentist may avoid if not essential  or be cautious while entering into child’s intrapersonal space as it can be uncomfortable and stressing for him.
  • The dentist may speak slowly as information processing takes time. He must ensure to use simple and short sentences while communicating.
  • He may give answers to all questions asked by the child as not getting answers can quantify anxiety and mental tension.
  • Lastly, the doctor should tell the child what he will be doing. Showing equipment to be used during check-up can help the child calm down and stay relaxed.

Sensory Strategies’:

  • Use headphones to block the background sounds.
  • Use music for distraction and as calming strategy. I-pods, music
    player or headphones can he used.
  • The dentist can be requested to turn down the loud noises in the room.
  • A child can wear a weighted vest, hat or carry a weighted bag pack to get heavy work activities done to get needed proprioceptive input.
  • Carrying a weighted blanket, lap weight in the car can be used as an effective strategy after check up to calm down the anxious or agitated child.
  • Use Theraband or resistive tubes to stretch the body after a check-up.
  • Wobble cushion or wobble wedge can be added to a dental chair with dentist’s support if the child feels comfortable having it.
  • Stress Balls: Always help’s child to reduce stress, anxiety in different settings.
  • Massage hands and feet of child before going for an appointment.Carry Massage Rollers or massage sticks along with you. 
  • Hug more often.
  • Vibrators can be very calming for oral cavity however should be used under Occupational Therapist's guidance. 
  • Doing heavy work activities for deep firm pressure will relax the child.

  1. Wall Pushes
  2. Chair Pushes
  3. Rolling Therapy ball over the whole body with firm pressure
  4. Star Jumps
  5. Specific Yoga poses
  6. Animal Walks (Frog walk, Crab walking)


Fidgets:

They are the best source to source to keep the child focused on the task. It helps to reduce anxiety levels, and keeps the child calm and mind diverted. 

Different fidgets can be used according to developmental age groups such as key chains, finger squeezers, giant nut and bolt, Bluetac can be used by teens or adolescents for challenging in-hand-manipulation skills, and fine motor control whereas fleece bags, Chewy bangle Bracelets, Playdoh can be provided to young ones for play and engagement purpose.


Visual Reminders:

The pictorial presentation is always helpful for an individual to understand the sequence of events and know what will come next. Visual Reminders reduce stress, anxiety and ambiguity. It helps the child to stay organised and well informed. Visual schedules may be used to depict the steps involved in brushing one’s teeth and what steps are involved in completing a dental procedure. You may find picture cards for scheduling at www.do2learn.com


Sand timers:                                                 

They are a visual resource of teaching a child about the duration of brushing. They encourage the child to brush regularly and develop early dental hygiene habits. The child understands that for how long he needs to continue brushing. Resource


Tooth-brushing: 
A child should brush their teeth two minutes twice a day. It is essential to supervise child until he is seven or eight years old. It is important to choose toothpaste and mouthwashes with the correct amount of fluoride to help protect teeth decay. The toothbrush should have the small head to ensure brushing around the back easily.

Tooth brushing timers: They are the great source for showing a child visual representation of time required to brush teeth.

Mirrors: They help child and parent to examine the teeth well. They enable the child to check areas that are missed while and after brushing.

Types of Toothbrushes: 

The Oral-B Stages 1 toothbrush can be used for young children aged from 4-24 months.

Oral-B Stages 2 toothbrush can be used for children aged 2-4 years. It has a narrow head and easy-grip handle to hold properly. Different 
characters are designed to encourage brushing.

Oral-B Stages 3 toothbrush can be used for children aged 5-7 years. The bristles target to hard-to-reach back teeth. It has  grip handle for the hands still learning to brush.

Oral-B Stages 4 toothbrush are meant for children aged 8 years and above.

Electric Toothbrushes: They are much easier to manipulate around the teeth and encourages the child to brush their teeth. It should be used for children having oral hyposensitivity for awakening the oral sensory receptors. These toothbrushes help to control drooling, and provides massage and sweeping within the oral cavity.
Play Brush: Play brush is a manual toothbrush add-on that makes tooth brushing interesting and fun for kids of all ranges. It works via Bluetooth and teaches the child to brush properly. It improves oral hygiene, grip control while holding a toothbrush, and encourages the child  to brush more often since mobile games engage  him to perform brushing precisely and effectively. The smart device toothbrush can be used as an effective plan for children who likes to play games and works better with technology.


Books & Apps:

References:

National Autistic Society, UK
Autism Speaks Family Services Community Connections
Sensory Integration Network, UK
Oral Healthcare for the Dyspraxic Child (Anna Vaguhan)