Making Going to the Dentist Easier for Kids with Autism | Autism and Dental Care

Many kids with autism have a hard time going to the dentist, and since dental visits only happen one to two times a year it’s hard to work on this skill. So today I’m going to show you a video and talk about strategies you can work on to make going to the dentist easier.

Each week I provide you with some of my ideas about turning autism around. So, if you haven’t subscribed to my YouTube channel, you can do that now. Many children with autism, whether they’re 2 or 20 years old, if they have limited to no spoken language they may exhibit problem behaviors related to going to the dentist or the doctor. Some will have trouble with nail clipping or any medical procedures, like blood draws, or tolerating you putting eye drops in their eyes, or shots of any kind. These kind of community outings, if you want to call them community outings, may have serious problems. A child may even have difficulty with tolerating haircuts, which shouldn’t involve any pain. I did a video blog on getting haircuts and making those go smoother a while ago, so you may want to check that out as well.

Parents may be okay with managing problem behaviors in the home, or even at a favorite store, but taking kids to the dentist or doctor’s office or for a blood draw may be extremely difficult. I do want to say that no matter what the age or the size of your child or client, you do not want to be holding kids down for these types of procedures. You don’t want kids crying during haircuts or dental visits or during blood draws, and holding kids down is not the answer. It’s not humane, it’s not appropriate, and as the child grows and becomes stronger someone will get hurt and it just usually backfires. While we’re going to be focusing on dental visits in today’s video blog, you will learn strategies that really do cross over all of these settings as well.

The first step to improving your dental visits is always assessment. Has it been awhile since you’ve taken your child to the dentist? You might have to recall the last trip and think about was the whole trip a disaster or were there parts that were okay. If you’re a professional, you may have a client, a parent, asking you how to improve or how to go to their first dentist appointment. So whether you’re a parent or a professional, you need to recall, or have the parent recall, the steps of the last dental visit and write those steps down. If you can, after you write the steps down then you may want to write down, “They were okay with this part, they weren’t okay with this part,” which of those steps caused the problem behavior. For instance, did your child get upset on the ride there, did he get upset when he saw the dental office, did he get upset when you walked in, when they reclined the chair, when the dentist came in, or when the dentist put the little mirror in his mouth to examine his teeth.

During the assessment also think about tooth care at home, because if the child has a difficult time tolerating tooth brushing they’re obviously going to have more issues probably at the dentist. If they’re younger, can they tolerate you brushing their teeth? If they’re a little bit older, can they brush their own teeth? If they’re really a lot older, can they floss their teeth and do they do a really good job with tooth brushing? We may need to think about desensitization of the tooth brushing before we worry too much about dental visits, since tooth brushing occurs a couple of times a day versus a couple of times a year for the visits.

After you get baseline data, most of the time this will be by memory or by interviewing the parent, then you should make a goal for the child. Maybe the goal is to go to the dentist and be able to tolerate sitting in the chair, reclining it, having their teeth examined just very superficially. And maybe the goal isn’t anything elaborate, like the child will tolerate getting a cavity filled, because for some kids it may only be realistic that dental visits, at least for now, include an observation and not include scraping of the teeth for the plaque and cavities being filled, because there’s a lot of variables, including pain and toleration of pain and telling you if their mouth is numb. These kinds of kids that can’t do all that may need to be put under anesthesia every few years for more invasive dental work. For some of my clients this is true, especially for children who are not consistent in tolerating and reporting pain.

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Now, before we get into the easy strategies that might help you get your child going to the dentist easily, I do want to say, that as a registered nurse, an autism mom, and as an advocate for children, I learned over the years that the silver fillings, what they call silver fillings, actually have mercury in them. And we should be asking and getting white composite fillings in our children’s teeth, and in our own teeth as well. A lot of dental offices have phased out, or are phasing out, silver fillings, but you may want to double check.

Okay, with that aside, we want to do the assessment and we want to make a realistic plan. And that plan, or that goal, could change. Maybe for now the goal is that the child just tolerates a visual exam by the dentist, but that might go up to a bigger goal. So we want to assess, plan, and then our next step is to intervene with desensitizing the child to the dentist by practicing the steps you’ve written down, at home or at school. Desensitization sounds scary but it’s really like giving the child ample opportunity to practice the skills in a more comfortable situation.

Lucas used to get uncomfortable laying back in the dental chair, for instance. And some kids just can’t tolerate the plastic bib and the chain around their neck, or the little mirror that the dentist uses to examine their teeth. I found a dental kit at the dollar store years ago that I use to practice with, and I’m sure you could get one online as well. It includes a little plastic mirror and a tool for scraping (make sure that the cap is on, so it’s not pointy, or you can take the cap off). I always left the cap on; I don’t want to be practicing and injuring the child in the process so I always leave the little cap on.

In the video (which you can view by scrolling up and clicking play) you’ll see a clip of me using that little dollar store kit with Lucas. As you can see here, Lucas is very compliant with me and these steps because we’ve used these type of strategies for years, but I still have to use anesthesia for Lucas for major dental work, like drilling for cavities or when he got his wisdom teeth out a few years ago.

I’m giving you some easy tips here to practice at home or at school, but after practicing at home or at school you’ll need to generalize to the real dentist. If you have a good dental provider that is willing to work with you, you could ask if you could go into the dental office a few days before the actual appointment, maybe even a few weeks before, and practice going into the dental office, having the child sit in the chair, not taking the dentist’s time (the dentist can do their own thing) and having you just make the child more comfortable with the setting. Use your little dollar store equipment to practice in the dental office and then the child may be more prepared for the actual dental appointment with the dentist.

Whether it’s a practice visit at home or an actual dental visit, you want to end all sessions with some positive reinforcement, like a favorite food or a toy or playing a game with the child. You want to always end on a positive note. The other strategy we sometimes use during generalization phases is when we’re ready to go to the actual dental appointment is to make little photo books of the equipment, a picture of the dentist, a picture of the outside of the dental office, a picture of the child practicing, potentially in the chair, obviously being calm and happy, or maybe a picture of the sibling sitting in the dental chair, calm and happy. And then you can keep these little books, one for the dentist, one for the doctor, one for a haircut, and that might help your child feel more comfortable.

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