Dental Care and Autism

A visit to the dentist’s office, complete with strange sounds, sights and smells, can give even a seasoned patient a twinge of anxiety. For patients with autism, many of whom are extremely sensitive to changes in routine, the experience can be downright horrifying. The neurological disorder impairs communication and social interaction, which makes introducing the patient to an unfamiliar office and keeping him or her calm during a cleaning or dental procedure difficult.

“Autistic individuals often crave sameness and repetition,” says Stephen Sobel, D.D.S., professor of clinical dentistry at the USC School of Dentistry. “The dental office can be a very strange new environment.”

Sobel, who instructs all USC Dental Hygiene students on how to care for patients with autism and other challenges, says autistic patients can face many obstacles in maintaining good oral health—a worry for the dental community as the rates of autism diagnoses continue to rise. Difficulty in establishing a good oral hygiene routine is a common challenge that puts special needs patients at increased risk for painful—and expensive—dental problems such as gum infections, tooth decay and possible tooth loss, he warns.

Piedad Suarez, D.D.S., assistant professor of clinical dentistry, says practitioners in the USC School of Dentistry Special Patients Clinic work hard to identify and serve the needs of their patients, including many autistic individuals. USC has operated the Special Patients Clinic for 24 years and is one of the few dental schools in Southern California to have a clinic dedicated to treating patients with medical, mental and physical challenges, she adds.

To accommodate autistic children’s needs, Special Patients dentists gradually introduce patients to toothbrushes and other oral hygiene supplies to desensitize them to the clinic environment; early appointments may involve nothing more than letting a patient get accustomed to sitting in the chair and having a dentist touch their teeth lightly. Clinicians also may bring caregivers into the exam room to help calm the children and may employ sedation if necessary.

Caregivers can locate a dentist to treat a special needs patient by contacting the Special Care Dentistry Association at scda@ scdaonline.org. However, the small number of willing dentists compared to the growing autistic and special needs population is still a huge concern, Suarez says.

To address the crucial need for dentists willing to treat those with autism and other special concerns, the USC School of Dentistry requires every dental student to spend a weeklong rotation in the Special Patients Clinic, says Roseann Mulligan, director of the Special Patients Clinic and associate dean of Community Health Programs with the School of Dentistry.

“When the students first walk in, they’re nervous, but they leave feeling comfortable,” Mulligan says. “A lot of students sign up to come back after the rotation is finished.” Mulligan adds that the experience opens students’ eyes and influences their attitudes on serving those with autism and other special needs. The understanding they gain encourages the students to treat special needs patients once they graduate and begin practicing outside of the school. To back up her claim, she need only refer to the words of the students themselves.

“By treating these patients, I felt I was able to better understand their ailments and feel empathy for their everyday struggles,” one student writes after completing the rotation, with many others echoing the remarks. “Not only could I help them in a dental setting, but I could put faces to certain maladies as well, thereby making me, in my estimation, better prepared as a health care provider.”

Strategies to help From the National Autistic Society at www.autism.org.uk.

» Try to schedule the first appointment of the day, and perhaps book a double time slot. This reduces the chance of the dentist running late and provides enough time not to feel rushed.

» Check your local library for appropriate books about visiting the dentist.

» For children with sensitivity to lights, sunglasses could be worn while the overhead light is shining. For children with sensitivity to sounds, either sound-canceling headphones or a radio/portable DVD with headphones might provide comfort and lessen their fears.

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