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Dental care and Autism – A guide for dentists

Some of your dental patients will be autistic. Autism is a lifelong, developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them.  This can make a visit to the dentist very stressful.  This section looks at why it is stressful and what you can do before and after treatment to make the experience less so.

1. Why is going to the dentist so stressful? 

Lack of understanding 

Autistic people may not understand that regular check-ups with the dentist are important, to help keep teeth and gums healthy. And it’s not immediately obvious that lying down in a chair with a light shining in your face and cold equipment in your mouth is a valuable experience.  

Sensory issues 

Autistic people may be over-sensitive or struggle to deal with too much sensory information (link to info on hypersensitivity). Mouths are extremely sensitive, and autistic people may find the sensation of a cold instrument entering their mouth very painful. The noise of the drills and cleaning instruments can also cause distress. Sometimes the taste of the mouthwash and dental paste can be a problem, as can other things, like the color of clothing, or the smell of perfume.  

Invasion of personal space 

You have to get very close to a patient to examine their teeth. Being this close can be very distressing for autistic people, particularly if they are over-sensitive.

2. What adjustments should I make? 

Finding out if any of your patients are autistic will help you prepare for their visits. You could include a question on medical questionnaires. Autistic people don’t have to tell their dentist of their diagnosis but giving them a chance to do so could be useful. Here are some adjustments that you can make before and after treatment to help make the experience better. You will need to adapt them to suit your patient’s needs and level of understanding.  

Preparation 

Put information on your website about the practice. It will help all patients, but it will be particularly helpful for autistic adults and children. If you can, include visual information, such as photographs.  

If you know one of your patients is autistic, talk to the patient or the patient’s family before the appointment to find out if there are any issues you need to address. Is your patient sensitive to light and noise? If so, how can you adapt your environment to accommodate that? You may not be able to alter light or the noise made by equipment, but perhaps you can provide stress balls or visual distractions.  .  

Be aware that injections and drilling, especially if accompanied by noise or other sensations such as cold water, may be particularly painful. Equally, if your patient has a low sensitivity to pain, you will need to bear that in mind when testing for pain. 

As some autistic patients find the smell and taste of dental mouthwash and other chemicals too intense, can you offer alternatives? A mild mouthwash, or none at all?  

Timing 

Waiting time can increase anxiety so you may need to be more flexible when treating autistic patients. You could book a double appointment or spread treatment over several visits. This means you can take things one step at a time, and possibly help to manage a person’s anxiety.  

During the visit 

If it’s possible, the autistic person may prefer to wait in their car or somewhere else away from the practice, and be phoned or texted by practice staff just ahead of their appointment.  

If a parent or carer comes to the appointment with your patient, it is usually best for them to be present during treatment. This may make communication better for everyone, as long as the patient is happy with this. The parent or carer will need to feel confident that they can talk on the patient’s behalf about their particular needs. Good communication is key.  

Some autistic people do not like to be touched or for people to get too close so you must clearly explain what is happening and what you are about to do. For example, ‘I will be checking your teeth to make sure they are in good condition, ‘I am going to put a small mirror inside your mouth to check your teeth. The mirror might touch the edges of your mouth.  Say the patient’s name so that they know you are talking to them, for example, “John, please open your mouth”. Autistic people  often need extra time to process information, and some may prefer information to be presented visually. See the link below to ‘visual supports. 

With some patients, you may notice unusual body language and eye contact. Some people find it easier to avoid eye contact; others may find it difficult to know how much eye contact to make.    

Autistic people can take things literally, so make sure you say what you mean. Avoid metaphors. Check that your patient has understood you, but avoid being patronizing. 

Do not rely on gestures or body language to convey information. Humour – particularly in the context of a stressful appointment with the dentist – may also be misunderstood or confusing. Keep your communication focused on what the person needs to know about what you are about to do, or what will happen next – such as the need for follow-up appointments.

3. What should I be aware of? 

When anxious, autistic people may make sounds or use repetitive movements. This may be a way of coping and should be respected. 

Anxiety, sensory overload, and communication difficulties can mean that a person shows distressed behavior (sometimes referred to as challenging behavior).  If a parent or carer is present, allow them to take control. They will know the best way to support the patient.

4. Your next steps

If your patient agrees to it, you may want to keep a note of the things your patient finds particularly difficult or the adjustments you need to make, so you are prepared for their next visit. Research showed that parents of autistic children appreciated it when dentists made notes about their child’s preferences and they did not need to repeat the information at every visit.  

  1. Find out more about autism 
  2. What is autism? 
  3. Guidance on distressed behavior 
  4. Visual supports 

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