Trips to the dentist were so traumatic for Matthew Stellato that his mother gave up on taking him. The now 10-year-old boy with autism fought having to sit in the chair. He shook his head frantically from side to side, crying the whole time, as the dentist inched closer.
“After seeing a general dentist then paediatric specialist we eventually forgot about cleanings, until a practitioner at school managed to get in his mouth to check his teeth. By then Matthew had developed a lot of problems,” says his mother, Maria, from Toronto.
For many children with autism, Down syndrome and other developmental disabilities, dental experiences are overwhelming, largely because of sensory processing issues. The bright lights; buzzing instruments; and masked, gloved strangers are just too much. Often these kids must go to a hospital and receive general anaesthesia, just for a teeth cleaning.
Paediatric Dental Group in Greater Vancouver is a community practice that takes a modified approach to treating kids with special needs.
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“It’s important to bring these kids in early and often to slowly acclimate them,” says Reza Nouri, a dentist at the practice. The team uses an approach called desensitization.
“If a child is having a hard time, I might say ‘hi’ and touch his hand. If that’s all I can do the first time, that’s good enough. They come back in a month. This time I pause to let them touch my glove. Sometimes they touch my face or mask. It takes many baby steps,” he says.
Visits can be scheduled during less busy times, and examinations are done in an enclosed “quiet room” right away, if the waiting area overwhelms children.
If Nouri can’t put a kid at ease, especically if disease is progressing, the patient is treated at the hospital under anaesthesia. “Then we start fresh, gradually working again on getting them comfortable in our office,” he says.
A hospital trip was necessary for Matthew in the end, because he needed a lot of work. Between the lengthy procedures and his confusion after anaesthesia, recovery was grueling. So after his initial dental problems were addressed Maria took him to the office where she worked, and he was gradually introduced to staff and the environment. With a few changes, like turning off the overhead light and cleaning his teeth manually rather than with a vibrating instrument, he slowly adapted.
Start in a neighborhood dental office if you can, recommends Laura LaChance, a dental hygienist in Collingwood and board chair of the Canadian Down Syndrome Society. “Ask if they work with kids with special needs or can recommend someone,” she says.
Seeing a paediatric specialist who has experience with developmental disabilities is the best route for kids with more significant needs, for instance if they don’t make eye contact, are nonverbal or have complex medical issues.
LaChance advises parents to tell staff upfront about any concerns. “If your child is a fast-moving bullet who may open every drawer or step on pedals that cause water to fly, we could turn the equipment off.,” she says. “Don’t be embarrassed to discuss your child’s behaviours, so we can remove triggers for a smoother ride.”
Pacific Autism Family Network (PAFN), a charity for children and adults with developmental disabilities, routinely fields requests for help finding dentists. So it is launching a dental practice in Richmond, British Columbia in 2018. Like the practice where Nouri works, they will use desensitization to help patients acclimate. Pictures and stories will show, step by step, what will happen during the visit. And children will be able to ask trained staff for breaks. “For some, it will mean being able to get through a dental visit for the first time. If they could already step into the exam room, it will make the experience less stressful,” says PAFN co-founder Wendy Lisogar-Cocchia.
Five-year-old Lily Bickle goes to a dental clinic at Children’s Hospital of Eastern Ontario. “She reclines on the chair, and I sit on the edge of it facing her. They sing the alphabet with Lily while they work,” says her mother, Jessi.
Staff point to a picture of an alligator with his teeth showing and ask Lily, who has autism, if he needs them cleaned. Together they count hot air balloons in a picture on the ceiling. All along, Lily holds her favourite toy. She still does not love teeth cleanings. “But she knows we will sing and look at pictures; then it will be done. And the more we’ve gone, the more she remembers the routine,” says Jessi.
Dental trips aren’t too hard for five-year-old Owen Crowson, but he wants details in advance. Among ways he gets them is through a game where he is the dentist and has a doll that is his patient. Owen, who has Down syndrome, and his mom, Jennifer from Dundas,Ont., talk about what will happen.
If the exam is too high-pressure for your kid, doing something as simple as bringing her in and having her the dentist count her teeth as she lies in the chair, can be a great starting point. As Autism Canada director Zari Yaraghi points out: “It’s all about helping kids adjust to the unfamiliar, and putting them at ease.”