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Let’s Go to the Dentist!
Oral Care and the Special Needs Child
by Becky L. Spivey, M.Ed.
For special needs children, especially children with autism, a trip to the dentist can be a great challenge. Children with certain developmental disabilities are at a higher risk for oral health conditions, so finding a pediatric dentist experienced in working with and treating these children may be the answer. Pediatric dentists have two or more years of advanced training beyond dental school. Their education as specialists focuses on care for children with special needs. In addition, pediatric dental offices are physically accessible for special patients. Pediatric dentists, because of their expertise, are often the clinicians of choice for the dental care of adults with special needs as well. Preparing your special needs child for a dentist visit is paramount for having a positive experience (for everyone!). How much preparation you do beforehand depends on your child’s particular emotional and physical needs. Regardless of how much preparation you have done, the first appointment still may be a challenging one, but at least you, the dentist, and your child will know what to expect.
How Do I Find just the Right Dentist for My Child’s Needs?
  • Start early. The American Academy for Pediatric Dentistry (AAPD) suggests that children see a dentist by their first birthday to begin their lifetime routine of preventative oral care.
  • Ask your primary care physician or pediatrician for recommendations. He/She may know a pediatric dentist that would be a good fit for your child.
  • Ask other parents with special needs children about their experiences with their dentist and carefully consider any recommendations/suggestions/advice they may have for you.
  • Contact pediatric dentists in your area (in the Yellow Pages) and ask about their experiences with special needs children—specifically patients they’ve treated with disabilities similar to your child’s. Schedule a short interview by phone or in person with the dentist if possible. In your conversation with the dentist...
  • Describe your child’s special needs and/or behaviors.
  • Discuss any problems regarding your child’s chewing, tooth pain, gum irritation, or any troubles in maintaining healthy oral hygiene;
  • Describe your child’s diet;
  • Briefly present your child’s medical history, reveal any allergies to medication and medications your child may be taking currently or routinely;
  • Discuss your child’s obsessive routines, repetitive behaviors, unpredictable body movements, or self-injurious behavior that could complicate the dental examination or procedures.
Once You Have Chosen a Dentist
  • Ask the dentist to describe the procedures he/she will be performing on the first visit, so you may prepare your child with expectations of what is going to happen.
  • Schedule appointment times when your child feels the most relaxed and rested and when the office will not be crowded—usually the first or last appointment of the day.
  • Before your scheduled appointment, take your child to meet the dentist and staff, see the equipment the dentist uses, and even lie in the chair—a “practice run” so to speak. Let the child ask questions or voice his/her concerns to the dentist if at all possible.
  • Before your “practice run” and scheduled appointment, go to the dentist’s office and fill out all necessary paperwork, medical history, insurance forms, etc. instead of waiting until you arrive with an anxious child.
  • Tell your child positive stories about visiting the dentist when you were a child and about your current visits as an adult.
If your child’s behavior is such that you would expect, or the dentist feels, the child may need sedation, discuss options for sedation or restraint at length prior to your scheduled visit. Then check with your child’s primary care physician for his approval of the sedative the dentist may use. If your child is taking routine medication, the dentist must be aware of this, so he/she may determine the best sedative that will not interfere with your child’s current prescription(s).
A visit to the doctor or dentist seems to trigger more anxiety for a child with autism than others with special needs. Because the dentist is very invasive of your personal space, children with autism or Asperger Syndrome may become agitated—even combative. Children with oral defensiveness and sensitivity become distressed when the dentist touches their face or mouth which, in turn, makes the cleaning and brushing of the teeth and checkups more difficult. Parents and caregivers may have to brush the child’s teeth at home because the child refuses to do so.
Sensitivity to sounds of machinery, cold metal tools touching sensitive areas of the mouth, other patients’ cries or sounds of distress, and light sources commonly found in the dentist’s office may also trigger behaviors of aggression or agitation. Even the taste of toothpastes, cleaners, and mouthwashes can be intolerable. For some children, the experience is so distressing that sedation may be necessary. Remember that your dentist has your child’s best interest at heart. Everyone involved with your child’s care will already be aware and prepared with the proper medications and necessary accommodations since you have already discussed this with the dentist beforehand.
When your child goes to sit in the dentist chair for the first time, let him/her take along a book or favorite small toy. Many pediatric dentists today have very child-friendly offices decorated in themes that appeal to children with TVs and video monitors to look at while the dentist is working. Some pediatric dentists are “masters of distraction!” Here’s hoping you and your child find just the right one!
Resource
Bright Tots. (2011). Oral care and autism. Retrieved from http://www.brighttots.com/Oral_care_autism_2307.html American Academy of Pediatric Dentistry. (2011). Dental care for the special child. Retrieved from http://www.aapd.org/publications/brochures/specialcare.asp
 
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