“Remember, we are JUST looking at the tools. Nothing else,” my son reminded me as we passed through the doors of the dental clinic. His sweaty hand clutched mine, motivated only by the promise of a trip to the rock and gem store after the exam.
While it’s not uncommon for patients to feel anxious at the dentist, people on the autism spectrum often have heightened sensory sensitivities and paralyzing fear of unfamiliar settings. More dental clinics in the Portland area are developing inclusive flexible programs to serve special needs patients and promote good oral hygiene as early as possible.
“Perhaps as important as our formal training and board certification in this specialty is our comfort and desire to provide for special needs children and young adults,” said Dr. David Cavano, owner of Pediatric Dental Group in southwest Portland. “We practice a family-centered approach to care and communicate with families and the child’s physicians and therapists to create individualized opportunities for children to succeed in our office.”
The 40-year-old clinic has a long and ongoing commitment to serving the special needs community and recognizes the unique and complex medical conditions and sensory sensitivities that some patients may have. Cavano, the father of a special needs teen, said parents could create a plan with the clinic to prepare for a patient’s first visit and gain an understanding of expectations.
“Preparation and ongoing communication greatly help in easing parental concerns and help to assure a comfortable dental visit,” Cavano added. “Pre-teaching at home using social stories, reviewing a visual schedule or sequence (many of us are visual learners) as well as desensitization techniques are all tools for preparation for visits to health care providers.”
Dr. Michelle Stafford, owner and pediatric dentist at World of Smiles Pediatric Dentistry, works with her team to provide a positive experience for all children. The clinic developed its Acclimation Program, a comprehensive program that can be adapted to an individual child’s needs. The staggered visits include a program screening, play time visit, a “comfy” room with stuffed animals that eases the child into the dental office and finally, the “big kid” visit.
With more than 100 autistic patients, the phased approach supports their mental, physical, and emotional needs as they bring new knowledge of a dental office into their everyday routine, Stafford added.
Dr. Monisha “Mo” Gagneja, pediatric dentist at Providence’s Specialty Pediatric Dental Clinic, echoes the “dental home” approach to providing a collaborative dental care plan for the patient with autism.
“We approach them first as a person,” she said. “We address their dental needs second.”
Identifying a patient’s interests, explaining the tools and instruments, knowing triggers and respecting limits helps gain trust and confidence. Explaining each instrument, allowing patients to hold and touch the tools and explaining sounds and smells shows respect and gives some ownership over the experience.
With close to 85 percent of the Providence clinic having an autism diagnosis, the staff strives to focus on the daily goal of serving the child first. Seeing the need for a unique dental clinic that recognizes the varying necessities of patients with special needs, Providence Health formed its Specialty Pediatric Dental Clinic with the goal of being a dental home for children with special health needs and their siblings from birth to 25 years old.
Providence Health models its Specialty Pediatric Dental clinic around gaining children’s trust with experienced professionals well-versed in working with children that experience a variety of special needs. Whether it is using heavy blankets, eliminating flavors in the dental cleansers, providing a dimly lit environment or using social stories, flexibility and commitment are the common thread when treating their patients with ASD.
“We modify ourselves according to the child,” Gagneja said. “Not the other way around.”
Providence’s dental staff regularly attends behavior management training and consistently follows up and communicates with the families to monitor care and follow up. And because each patient with ASD has different needs, the group understands the importance of a phased approach to care and treatment.
Dr. Stafford takes a similar approach.
“Each stage follows a child’s lead, works on transitions, demonstrates techniques and instruments, and allows for exploration of the office’s designated rooms,” Stafford said. “Prior to the first visit, we have an interactive coloring book that we designed to give children a picture story on what to expect during their dental visit.”
These local efforts mirror national trends of accommodations and specialized programs for patients with autism in hopes to improve and build the importance of good oral hygiene.
The Healthy Smiles for Autism, a program of the National Museum of Dentistry, created a useful 36-page guide on preparing children for a dental visit, home oral hygiene and much more. The guide contains visual aids, step-by-step guides, tips for behavior and sensory modifications, using social stories and more. To download the guide, visit www.healthysmilesforautism.org.
Special diets, medication, poor motor skills or sensory issues can inhibit proper dental care in children on the spectrum, according to the Healthy Smiles website. Paired with a heightened sense of fear or anxiety, many patients delay dental visits adding to the long-term risk of cavities, gingivitis and periodontal disease.
With some education, encouragement and knowledge of the programs available, patients can stay on top of their dental care.
Beginning at home
Professionals recommend that children learn best with parents or caregivers as a model. Demonstrate good dental habits by flossing at the same time as brushing; choosing toothpaste without artificial colors and flavors; assist the child with brushing and flossing using explanations that fit their understanding.
As with many hurdles, involving the child in the process can be helpful to give them ownership of their hygiene.
Healthy Smiles indicates that families can make it fun for kids by letting them pick out a favorite toothbrush, decorate with stickers or non-toxic paint, try a few toothpaste flavors and pick a new cup to use only in the bathroom. Buy a special new “toothbrush towel” used only to wipe mouths after brushing—the more involvement, the more a child will hopefully gain excitement and understand the importance of oral hygiene.
Over time, allow your child to take over the steps to brushing and flossing and always reiterate your availability to help with any problems or fears.
Finding the right fit
Gagneja reiterated that, as with any professional involved in the child’s care, a trusting relationship is being formed. With many autistic children, fear of the unknown and unpredictability leads to panic attacks, emotional breakdowns and stress for the entire family. It’s important to complete the circle of care by adding the best dental provider to other treatment and therapists.
With years of experience working with children with special needs and their families, Gagneja understands the importance of a strong dentist-family relationship.
“We can be a part of their family—of their team.”