How to get the best out of your dentist

Malcolm Hamilton

Senior Dental Officer (Special Care)

NHS Highland

Roles of the Dental team

• Advice

• Support

• Assess

• Treatment

• Emergency and Out of Hours

Dentistry

• Private

• NHS

• Independent General Dental Practitioners

• NHS Trust

• Salaried Dental Services

• Community Dental Services

Community Dental Services•Often require referral

•Can be self referral

•Access through telephone/email help line

•Advantage of non time restrained

•Specialist dental teams

Special Care Dentistry

• Dentist and dental nurses with additional training

• More experience in Autism Spectrum Conditions

• Able to spend more time

• More flexibility in appointment bookings

• Trained in variety of sedation techniques

Where?

• General Dental Surgery

• Special Care Clinic

• Hospital

• Domiciliary visit

Difficulties experienced withDifficulties experienced with

– Getting people to visit the dentistGetting people to visit the dentist– Travel Travel – Getting in to the clinicGetting in to the clinic– The waiting room (both the room and actual The waiting room (both the room and actual

waiting)waiting)– The surgery environmentThe surgery environment– Dental examination or treatmentDental examination or treatment– Finishing the visitFinishing the visit

Dental Visits for People with an ASCDental Visits for People with an ASC Key Areas Key Areas

• Change in routineChange in routine• TransportTransport• Different Environment/PeopleDifferent Environment/People• LanguageLanguage• ScheduleSchedule• Touch/Eye Contact/ Personal SpaceTouch/Eye Contact/ Personal Space• Noise/Smells/Visual StimuliNoise/Smells/Visual Stimuli• MovementMovement• PhobiasPhobias

Anxiety as a function of a dental visit

• Experience of acute stress• May increase exposure to chronic

stressors e.g. .people• Relationship with mood• Relationship with self efficacy • Change in the relationship with every day

events• May increase stress behaviours e.g.. Self

harm

Resources to Make Visits to the Dentist Resources to Make Visits to the Dentist Easier for People with an ASCEasier for People with an ASC

• Introductory visitsIntroductory visits• Pre visit questionnairesPre visit questionnaires• Pre visit packsPre visit packs• Keeping surroundings the sameKeeping surroundings the same• Guidelines and routines for staff to followGuidelines and routines for staff to follow• Availability of distracters/comforters/toysAvailability of distracters/comforters/toys• Visual timetable of visitVisual timetable of visit

Does not like to be touched, but may touch others.

Does not like the dental chair to be laid right back

Does not like the dental chair moving.

Uses the following means of communication

……………………………………………

Likes………………………………………

…………………………………….…….....

Please list any other useful details, e.g. ‘best ways’ to communicate and other helpful tips below, or attach a separate sheet.

Looking after teethSome helpful hints

• Reduce sugar intake, especially in between meals.

• Check labels for ‘hidden sugars’.

• Always ask your doctor, dentist or chemist for sugar free medicines

when these are required.

• Don’t give sweets as a reward – use alternatives such as a favourite

object or activity.

• Avoid fizzy drinks, juices and squashes and replace with water or milk if possible.

• Give support for tooth brushing by demonstrating each step and taking

each stage, one step at a time.

• Ask the dental team for advice about diet and dental health

DENTAL CAREAND AUTISM

CONTACT DETAILS OF DENTAL TEAM

Useful Websites:www.bsdh.org.ukwww.autism.org.uk

Dear DentistThis form has been designed to help prepare a patient with autism for a dental appointment. Please take noteof the following advice and allow a parent or carer to repeat directions and help carry out treatment

Name______________________________

Contact details_______________________

___________________________________

Cannot wait, so please try to see promptly.

Is frightened of strange environments and this may show in unusual or challenging behaviour.

Finds loud noises cause distress.

Finds bright lighting disturbing and this can influence behaviour.

Finds smells, textures or tastes upsetting

Cannot always tell where it hurts.

May not respond to pain, or may respond in an unusual manner

• Discuss previous dentalappointments with the dental team and let them know of any

helpful tips or if it is necessary to put instruments away

• Discuss preventative dental advice with the dental team and see the back of this sheet

• Please complete and return the tear off slip to the dental team, or to those whose contact details are on the front page of this leaflet

Please tick any statement that applies and give any other information that you feel would help

With thanks to all those who have helped in the development of this leaflet

Preparing for adental visit

• New experiences can causeproblems for people with Autism,dental visits need not be a problem,

if properly planned.

• Make sure you contact thedental team before thefirst visit.

• A slow introduction to the surgery over a period of time will help the patient get used to the unfamiliar

surroundings and gain confidence.

• Ask the dental team if you can visit the surgery before the main appointment.

• Prepare & explain to allconcerned about what is going to happen and make sure that they come with someone that they know well.

• Use dental pictures or photos, books & toys to familiarise the patient before their visit.

P.T.O.

• NHS HIGHLAND DENTAL SERVICE • PRE-VISIT QUESTIONNAIRE• Completing this questionnaire will help us to make your visit to the dentist a

good experience. Please give as much information as possible about yourself.

• NAME…………………………………………………………Date of Birth……………………ADDRESS

• 1.What would help to make this visit easier?

• 2.Do you have any difficulties with communication/mobility? (eg speech / understanding etc) …

• What helps you to communicate/ be mobile

• 3.Do you have any sensitivities? (for example, light, noise, touch etc

• 4.Is there anything which particularly upsets you?

• 5.Is there a good time of day for an appointment with us?

• 6.What difficulties are you expecting when visiting the dentist?

• 7..Is there anything else that you think would help?

Pre Visit PackPre Visit Pack

• Bag or box Bag or box containing common containing common dental surgery items dental surgery items and smellsand smells

• For patient to borrow For patient to borrow or keep to familiarise or keep to familiarise them with itemsthem with items

• Can be customisedCan be customised

Before the first Appointment

• Inform reception on initial contact

• Ask for suitable appointment time

• Familiarisation visit

• Social story

• Story books

• Disposable mirrors for home use

At the Appointment

• Phone ahead to ensure dentist on schedule

• Comforters

• Distracters

• Special Requests

• Local anaesthetic or not

Examples of requests

• Turn off overhead lights

• No surgical masks

• Male or female dentist

• Appointment times

• Length of appointment

• No reclining dental chair

• Does not like to be touched

The nurse will put some green cleaner and some white sealant into small yellow pots, she will put two small brushes beside them.

The dentist will put some green cleaner onto your tooth for 15 seconds. He will use a small brush.

The dentist will wash off the green cleaner with water, the nurse will use her sucker to suck up the water.

The dentist will dry your tooth with some air, it might feel cold.

• The dentist will put some white sealant onto your tooth with a small

brush.

The dentist will put a light by your tooth.

• The light will shine bright blue for 20 seconds, it will make a bleeping noise after 20 seconds.

• This is all that is needed to make your tooth stronger.

Factors influencing treatment

• Ability to maintain good oral hygiene• Choices about healthy eating• Co-operation• Inability to express need/pain• Poor verbal skills• Lack of perceived need (from patient or

carer)• Patient/Carer/Dental team partnership

Prevention better than cure

• Regular check-ups

• Sugar free medicines

• Check food labels for hidden sugars

• Reduce sugar intake especially between meals

• Avoid fizzy drinks

• Tooth brushing

malcolm.hamilton@nhs.net