A visit to the dentist’s office, with its 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.

“Autistic individuals often crave sameness and repetition,” said clinical professor Stephen Sobel. “To an autistic patient, the dental office can be a very strange new environment.”

Sobel, who instructs all USC Dental Hygiene students how to care for patients with autism and other challenges, says autistic patients can face many obstacles in maintaining good oral and overall health – an especially big worry for the dental community as the rates of autism diagnoses continue to rise.

Financial challenges are a common concern. Caregivers often place a higher priority on paying for a patient’s other medical care and forgo dental care unless a major problem arises, Sobel said.

“Caregivers can have a significant burden, and dental care is often not given priority,” he said. “In 2000, Surgeon General David Satcher stated in his report, ‘Oral Health in America,’ that one can’t have good health without oral health. Caregivers need to recognize that the mouth is not a separate health issue.”

Difficulty in establishing a good oral hygiene routine for a patient, as well as using cariogenic foods such as sweets and sodas as behavioral rewards, can cause painful – and expensive – dental problems, Sobel added.

Clinical assistant professor Piedad Suarez said practitioners in the USC School of Dentistry Special Patients Clinic work hard to identify and serve the unique needs of its patients, including the many autistic individuals they serve.

Operating the Special Patients Clinic for 24 years, USC is one of only a few dental schools in Southern California to have a clinic dedicated to treating patients with medical, mental and physical challenges, she added.

“We try to work not only with the patient but also with the whole family to keep them involved in the patient’s care,” Suarez said. “We take the time to help them create a routine and to make sure they know just how important oral hygiene is. Sometimes, we can spend a whole morning just to desensitize a patient to the feeling of a toothbrush.”

Suarez said that several regional centers, including Childrens Hospital Los Angeles, refer patients to the Special Patients Clinic for their ability to tailor the dental experience for a patient’s unique concerns, including the use of sedation, progressive exposure to the dental clinic before the first exam and employing parents or caregivers to help calm the patient in the exam room.

This individualized approach is something that many other dental practitioners may find difficult to do.

“Many dentists don’t feel comfortable treating patients with special needs,” she said. “It can be due to fear of medical complications, lack of knowledge or understanding about the patient’s condition, or the fact that spending hours with a single special needs patient instead of seeing several patients doesn’t bring in as much money.”

One can find help locating a dentist to treat a special needs patient by contacting the Special Care Dentistry Association at www.scdaonline.org, but the small number of willing dentists, compared to the growing autistic and special needs population, is still a huge concern, Suarez said. The choice between spending more money to travel a large distance to a dentist and simply not seeking dental care as often as recommended is devastating, she added.

To address this 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, filling out self evaluations and being rated by faculty members after the rotation is completed, said 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 said. “A lot of students sign up to come back after the rotation is finished.”

Mulligan added that the experience opens students’ eyes and influences their attitudes on serving those with autism and other special needs forever, which will hopefully help students to be more willing to treat autistic and 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 wrote 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.”