Autism and Oral Health–What You Need to Know

My husband and I thought we had prepared our toddler, Andrew, for his first visit to the dentist. We read stories together and discussed what would happen, and he enjoyed brushing to Raffi’s Brush Your Teeth song.

Once Andrew arrived at the dentist’s office, however, he had to wait 20 minutes and anxiety set in. After he was brought into the examining room, he reached out to touch the equipment, but the dentist firmly told him to sit still. Two hygienists were called in to hold his arms down. Andrew understandably started crying. Irate, I immediately picked him up, and we left.

I fortunately found another dentist who allowed Andrew to touch anything he wanted, ride in the chair, and select stickers. He ensured Andrew enjoyed his visits and didn’t go near his mouth until he was comfortable. Andrew got to choose his toothpaste flavour and earn toys, and he couldn’t wait to return.

What dental issues do autistic children commonly face?

Autism itself does not cause dental problems. As Dr. Molly Friedman, pediatric dentist and Co-Director of Holland Bloorview Kids Rehabilitation Hospital’s Dental Residency Program, explains, “Children are not at higher risk of cavities due to their autism. Rather, it’s their oral care.”

While every autistic child is different, dental visits can be overwhelming and frightening. Challenges include exposure to a new, unfamiliar setting, the inability to communicate their feelings, and sensitivities to certain sounds, textures, tastes, and lights. In addition, a child can become distressed when their personal space is invaded.

Dr. Robert Carmichael, Chief of Dentistry at Holland Bloorview, points to additional issues:

• Previous negative medical experiences generalized to the dentist.
• Cognitive impairments that affect a child’s ability to understand how to brush and floss
• Gross and fine motor coordination difficulties
• Carbohydrate-intensive diets with sugary foods and drinks
• Behavioural challenges: a child might unintentionally be disruptive, agitated and fidgety, making it difficult to examine and treat them

Interestingly, Dr. Carmichael suspects that drooling bathes oral tissues and teeth in a buffering, cleansing fluid. Mouth breathing, on the other hand, can lead to periodontal disease and inflammation of the gums and bone.

How do dentists adapt to autistic children’s needs?

At Holland Bloorview, caregivers fill out pre-appointment “get-to-know-you” forms so the dental team can tailor each visit accordingly. They use social scripts, pictograms, story-telling, role-playing, and orientation visits to lessen the child’s fear of the unknown.

Dr. Friedman strongly believes in partnerships with parents. “Parents are the experts about their kiddos, so the best outcomes occur when we work together.” She notes many options for each child, ranging from various flavoured toothpastes to different-sized toothbrushes. Lights can be dimmed, and children can watch their favourite shows on iPads, ceiling TVs or video screens.

Dentists often have noise-cancelling headphones, weighted blankets, stim toys, chewing aids, and foam mouth rests. Chill-out chairs help a child learn to sit still for gradually more extended periods. Some children need deep touch and massage before an exam. Praise and rewards are liberally used.

If needed, appointments can be kept short, with multiple breaks and more frequent dental visits. For those children who cannot tolerate a comprehensive dental exam, laughing gas is often successful, and there are different levels of general anesthesia.

How is Virtual Reality Being Used?

Virtual reality is one exciting initiative being tested by Holland Bloorview in partnership with Shaftesbury Films. Dr. Friedman and the Holland Bloorview autism research centre (ARC) team have developed a series of 360º videos, all shot from the child’s perspective, to lower pre-appointment stress and improve the dental experience. Through engaging vignettes, the child experiences the entire dental visit, from when they arrive to the end of their exam, including external stimuli such as noise in the hallway. And the child can pause the videos at any time.

At home, the child scrolls through the vignettes on a tablet. Parents are asked to have them watch the videos every day during the week before their appointment.

While the Holland Bloorview virtual reality study is still in the research phase, parental feedback has been encouraging, with reports of calmer and more cooperative dental visits.

What can parents and caregivers do to help?

In addition to reading stories, watching videos and discussing dental visits with your child, Dr. Friedman strongly recommends limiting the intake of juices, chocolate milk and carbonated water: “Regular water is the best thing you can do for your child’s mouth.”

She also suggests:

• Introduce more frequent daily brushing as needed.
• Try different toothbrushes. Some children like a vibration sensation, while others prefer an extra-large brush.
• Try different kinds of toothpaste, with textures and tastes ranging from no grit and mint to bubble gum and unflavoured.
• Try brushing in different settings. Some children relax more in the bath or shower or even snuggled in bed.
• If your child has difficulty flossing, consider a Waterpik, mouth rinse or floss sticks.

Dr. Carmichael adds that it’s helpful to acclimate your child to someone moving around in their mouth as early as possible.

Dr. Friedman is optimistic about the future. As autism awareness grows, she sees a growing interest in dental residents working with neurodivergent children. She also finds that “many of our kids do better, more often than not, with a positive attitude towards oral health.”

The keys are to prepare your child for their next dental visit, make brushing a fun experience, praise them and use rewards charts for good oral hygiene.

There is a famous saying that the mouth is the gateway to the body. Let’s do our part to help optimize our children’s health.

Author:

Jan Stewart is a highly regarded mental health, autism and neurodiversity advocate and Chair of Kerry’s Place Autism Services, Canada’s largest autism services provider.

Her brutally honest memoir Hold on Tight: A Parent’s Journey Raising Children with Mental Illness describes her emotional roller coaster story of parenting two children with multiple mental health and neurodevelopmental disorders.