Oral health care for autistic people
Everyone experiences some anxiety about going to the dentist, but this anxiety increases and can become a real challenge for autistic people if they cannot count on the necessary support.
There are strategies that can greatly improve the experience at the dental office, but the most important thing is prevention to avoid, as much as possible, having to go frequently.
Oral hygiene
Oral hygiene is essential and the best prevention against many dental problems . It's important to raise awareness from a young age about the importance of brushing our teeth at least twice a day and to establish this hygienic habit. To promote dental hygiene, in addition to setting a good example, there are some materials and tools (videos, songs, stories, apps, etc.) that can be very helpful. We should determine what support works best for each person and guide them through the process of developing this habit.
Some stories:
- Brush Your Teeth! (Health and Wellbeing for Kids). Elena Blanco, Gonzalo Oñoro. Illustrations by Esther Bernal. Timunmas Publishing.
- Learn to brush your teeth . Susaeta Team. Illustrations by Graham Ross. Susaeta Publishing.
- Short stories for brushing your teeth . By Abel Amutxategi. Illustrations by Antonio Navas. RBA Publishing.
Some songs and videos:
Some applications:
Experts recommend brushing your teeth for three minutes after each meal (you can use a timer to keep track of the time). It's also important to use mouthwash (in your preferred flavor: strawberry, mint, etc.) for thirty seconds and not just rinse with water, as this diminishes its effectiveness. This should be our goal, but we must proceed gradually, without rushing, and with care.
In some cases it will be advisable to gradually regulate the brushing time, starting by counting to five or ten when brushing each area of the mouth.
The first step is to assess our starting point. It's different for someone who puts the toothbrush in their mouth but hasn't yet learned how to brush properly and maintain a consistent brushing time, compared to someone who resists even picking up the brush, let alone bringing it to their mouth. For each situation, we need to consider the steps to take and the strategies we'll use to achieve small milestones that will lead to improved brushing and dental hygiene.
For example, in some situations, we can start by using a soft toothbrush and let the person handle it and become familiar with it. People with hypersensitivity are better off practicing with a manual toothbrush first and can gradually transition to an electric toothbrush if necessary. In other cases, it's advisable to gradually increase brushing time , starting by counting to five or ten when brushing each area of the mouth, until reaching three minutes of brushing.
Strategies to improve communication with children with ASD
Some recommendations for oral hygiene:
- Always use the same type and color of toothbrush so the person can get used to it and easily identify it. The toothbrush should always be soft. We recommend replacing the toothbrush at least every two months.
- Visual sequences can be very helpful in anticipating and planning the teeth-brushing process.
- Initially, toothpaste will only be used with some people, as the most important thing is that they brush their teeth well. The toothpaste will be introduced gradually and in small amounts, checking which toothpaste is most suitable (type, flavor, etc.).
- People who know how to rinse and spit are advised to use a mouthwash at the end of brushing.
- It is essential to accompany the person in the process of brushing their teeth until they are independent.
- Oral hygiene before bedtime is the most important of the day; it is necessary to provide specific support at this time to ensure that the teeth are thoroughly cleaned.
- Brush teeth in quadrants , from back to front, starting with the bottom left, bottom right, top left, and top right. Count to at least 10 before moving to the next quadrant, or use a timer. Also, teach children to brush each tooth individually, from the gum line to the tip of the tooth, both inside and outside the teeth, and including the tongue.
Maintaining proper oral hygiene will lead to better dental health , improved overall health, and a higher quality of life. Even so, regular dental checkups and visits to the dentist for dental problems are still necessary. In this case, it's worth asking the clinic where you plan your visit if they have experience treating autistic individuals, so you can better plan your appointment.
Minimize the impact of going to the dentist
Medical procedures in general can generate fear or anxiety , or can be invasive for anyone, but for autistic individuals, these feelings can be even more significant and can lead to a lack of cooperation, oppositional behavior, unexpected reactions, heightened anxiety, psychomotor agitation, and episodes of self-harm or aggression towards others. At Sant Joan de Déu Hospital in Barcelona, the Child Life team is dedicated to minimizing the impact that a hospital stay or undergoing medical or surgical procedures can have on any child.
In the case of a visit to the dentist, it can always be complicated for people with autism, especially due to the number of sensory elements that can be stressful for them, such as:
- Open your mouth.
- To introduce medical material into the mouth.
- The use of water with different pressures and temperatures.
- The pain.
- Performing techniques in a supine position and without the possibility of visual control.
- The noise from the instruments used.
Therefore, the Child Life team provides psychological preparation before the visit, also for the family. Through symbolic play and language , this preparation facilitates understanding and anticipation of what will happen. It explores whether the child has had any previous experiences and how they coped, explains the procedure, and addresses any doubts or fears . The team also assesses the need for strategies and tools that can help the child cope with the visit and provides materials (pictograms, graphic materials, etc.) so they can continue working on the topic at home or at school. All of this is done taking into account the individual's developmental level, language skills, comprehension, and sensory experience.
Sensory stimulation for people with ASD
It is also important to create a document outlining the "profile" of the person receiving care, which includes all their sensory, behavioral, and relational characteristics. This document will be provided to the professional team providing care to foster a suitable environment and interaction, always in a coordinated manner. The Child Life specialist also assesses the need to accompany the person during the visit and to offer them other resources that may be helpful, such as animal-assisted therapy.
Ensuring that the person with autism has a positive experience during this visit helps them to cope with and experience future visits with less impact.
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