Dental Care for Individuals with Autism

Beverly King, M. Ed.

Objectives

• Learn ways to teach children proper oral

hygiene.

• Discuss a variety of ways to support and

facilitate good oral hygiene practices at home.

• Learn positive behavioral strategies to

implement for dental office visits.

First Visits

• First tooth or first birthday

• Old guidelines suggested age 3– Behavior management– Damage has already occurred

Nutrition and Dental Care

Thumb Sucking/Pacifier

• Normal and healthy for infants

• Gives children a sense of emotional security and comfort.

• After age of 5 dental problems can occur

• Can cause speech problems.

• Jaws can become misaligned

• Roof of the mouth can become malformed

Positions for Brushing

Courtesy of Dr. Simon Morris, White Oaks Pediatric Dentistry, Los Gatos, CA

• Position yourself behind your child

• Tilt child’s head up

• Cradle child’s head in your arm

• Use your free hand to pull back cheek

Knee to knee position

Courtesy of Dr. Simon Morris, White Oaks Pediatric Dentistry, Los Gatos, CA

• Used for those that are uncooperative

• Sit facing another adult, knee to knee

• Sit child on your lap facing you

• Wrap legs around your waist, hold arms down

Brushing Technique

Courtesy of Dr. Simon Morris, White Oaks Pediatric Dentistry, Los Gatos, CA

• Most important areas-Gum line

-Chewing surfaces

• Use free hand to lift lip, for upper area have child

close mouth

• Use circular stokes pointed at gum line

• Two minutes (sing ABC song, use a timer)

Teaching Child to Brush

• While you brush have child watch

• Next have child brush your teeth

• Next help child brush (hand over hand)

• Next have child brush and you watch

When should parents stop brushing their child’s teeth?

• Fine Motor skills

• Writing name

• 6-8 years old

• Flouride/Spit effectively

Visual Supports and Schedules

• Visual schedules break down large tasks into separate steps, allowing the child to perform each task before going on to the next

• Can teach specific tooth-brushing steps.

• Reinforce with verbal praise after each step or multiple steps are completed

• Use social story or visual schedule to before visit for familiarization

Practice Dental Visit at Home• Putting their hands on their stomach

• Putting their feet out straight

• Opening wide

• Holding their mouth open

• Counting their teeth

• Cleaning with a power brush

• Spitting into the sink

• Taking X-rays

Provide Visual Examples

http://www.youtube.com/ Search dentist visit

Search dental visit visualhttps://www.google.com

Social Stories

• Describes the social situation

• Provides descriptive, perspective, or directive statements

• Considers the perspective of the child

• Teaches routines for new events

The Gray Center : www.thegraycenter.org

Example

Preparing For The First Visit• Check to see if your dentist has materials

available for families to access via website or prior to visit.PaperworkTask Analysis Social ScriptsFun activities

• Schedule preferred appointment time

• Discuss insurance/payment options

First Visit

• Greeting

• Introduction to staff

• Interview

• Tour of facility

• Familiarize with equipment (model)

Dental Exam

• Use clear simple language

• Give direct request

• Explain each procedure

• Break down each task into smaller steps

• Reward individual steps

• Allow use of personal items for calming

• Use a timer or count downs

Sensory Processing

Auditory High-speed Handpiece, Ultrasonic Scaler

Gustatory Gloves, cotton rolls, gauze, alginate, metal, medicaments, fluoride, paste

Olfactory Cleaning products, medicaments, fluoride, paste, perfume

Vision Florescent, Operatory, and Curing Lights

Tactile Touch (over/under reactive), Proximity to people, water, lead apron, cotton rolls, gauze, napkin

Sensory Processing(continued)

*Vestibular Operatory chair, Panoramic X-ray

*Thermoception Water, Slow-speed Handpiece

*Proprioception Positioning mouth, tongue, or body

*Nociception Pain sensor

Video Example

• http://www.whiteoakspediatricdentistry.com/videos/cleaning-with-hygienist/

Questions

Recommended books

• “I Know Why I Brush My Teeth” By Kate Rowan

• “The Tooth Book” By Dr. Seuss

• “Little Bear Brushes His Teeth” By Jutta Langreuter/Vera Sobat

• “The Berenstain Bears Visit the Dentist” By Stan and Jan Berenstain

References• American Academy of Pediatric Dentistry Clinical Affairs

Committee-Behavior, American Academy of Pediatric Dentistry Council of Clinical Affairs. Guideline on behavior guidance for the pediatric dental patient. PediatrDent 2008-2009;30(7 Suppl):125-33. [63 references] PubMed

• Elliott-Smith S. Special Products for Patients with Special Needs. Available at: www.adha.org. Accessed February 2010.

• Folse G., Glassman P., Miller C. Serving the Patient with Special Needs. Available at: www.adha.org. Accessed February 2010.

References

• The National Autism Society, Patients with Autism Spectrum Disorders: Information for Health Professionals. Available at: www.autism.org . Accessed February 2010.

• The National Autism Society, Dentist: preparing for a Visit. Available at: www.autism.org . Accessed February 2010.

• The National Institute of Dental and Craniofacial Research, Practical Oral Care for People with Autism. Available at: http://www.nidcr.nih.gov/OralHealth/Topics/DevelopmentalDisabilities/PracticalOralCarePeopleAutism.htm . Accessed February 2010.

• The Academy of Dental Therapeutics and Stomatology, Building Bridges: Dental Care for Patients with Autism, Available at http://www.ineedce.com . Accessed February 2010.