Dental appointments can be particularly challenging for children with autism. In fact, their behavioral issues often make it less likely for them to receive dental care than their typically developing peers. But desensitization techniques such as repeated visits and practice at home could help these young patients, improving their experience as well as the quality of their care, according to researchers at the University of Washington Center for Pediatric Dentistry.
“For a child with autism, even a simple preventive dental visit can be overwhelming. Bright lights, unusual smells, and chairs that move can seem scary and unusual for people with sensory sensitivities,” said Travis Nelson, DDS, MSD, MPH, lead author of the study.
“Children with autism also face communication challenges that make it difficult for them to express themselves and interact with the dental team. Ultimately, this can contribute to ‘fight or flight’ stress behaviors at the dental office. It may also cause some families to completely avoid routine preventive care,” said Nelson.
The researchers retrospectively reviewed clinical behavioral data and pre-visit questionnaires for 168 children between the ages of 4 and 6 years, 7 and 12 years, and 13 and 18 years with autism spectrum disorder who attended a university-based dental desensitization program. Data elements included demographic, treatment, and behavioral characteristics. The primary outcome was receiving a minimal threshold examination while seated in a dental chair.
“In school and other educational settings, children with autism receive behavioral therapy to develop new life skills,” said Nelson. “In this study, we adopted techniques that are used in that context. We started by having parents complete a detailed questionnaire about their child. That gave us an idea of the patient’s strengths, communication style, and stimuli that ‘trigger’ negative behaviors. The approach was tailored using that information.”
Next, the researchers offered a “dental story” before the first visit to help familiarize patients with procedures and to eliminate their fear of the unknown. The dental story is a series of photos with short descriptions detailing step by step what happens during a dental appointment. The researchers also gave families disposable dental mirrors so they could practice the examination procedure at home.
“Prior to each visit, we agreed upon a goal—eg, brush the teeth and examine with a dental mirror,” said Nelson. “During the visit, we focused on completing the goal, allowing the child to learn the new skill at a pace that was appropriate for them. When the child successfully completed the goal, we provided a patient-specific reward.”
According to the research, 77.4% of the children achieved a minimal threshold examination within one or 2 visits, and 87.5% achieved it in 5 visits or fewer. Factors that predicted a successful dental examination included an ability to be involved in group activities, ability to communicate verbally, understanding of most language, and moderate versus severe caregiver-rated autism spectrum disorder severity.
“The protocols we used are very simple and could be implemented elsewhere to help children with autism access needed dental services,” said Nelson.
The researchers concluded that desensitization is effective in achieving minimal threshold examinations for most children, while children with a milder presentation of autism are more likely to be successful. Also, the Center for Pediatric Dentistry offers a parent questionnaire, fact sheets, social stories, and other online resources to help parents and practitioners alike improve dental visits for children with special needs.
The study, “Predicting Successful Dental Examinations for Children with Autism Spectrum Disorder in the Context of a Dental Desensitization Program,” was published by The Journal of the American Dental Association. Nelson additionally recommends “Educational and Therapeutic Behavioral Approaches to Providing Dental Care for Patients with Autism Spectrum Disorder,” published by Special Care in Dentistry.
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