Among parents of children
with autism spectrum disorder, almost half describe their child’s dental health
as fair or poor, according to a study in the journal Pediatric Dentistry. This is not surprising, as a visit to the
dentist can present many challenges for a child with autism. The sensory
overload from the strange smells, loud noises, and sharp tools; the
unfamiliarity of the masked adult looming; and the unpredictability of the
whole process—not knowing what will happen and when it will end—are just some
of the factors that make this a particularly difficult scenario for a child
This Autism Awareness Month,
the American Speech-Language-Hearing Association (ASHA) tapped Terese Conrad, MA,
CCC-SLP, a speech-language pathologist who specializes in working with clients
with autism spectrum disorder and a former dental hygienist, to provide tips
for parents and caregivers for successively navigating a trip to the dentist.
Conrad, who works at Wichita State University, offers the following.
By the time some children
with autism first see the dentist, they have already developed serious dental
problems that may even require hospitalization. Try to start good dental
hygiene habits early.
Vocabulary: Many children
need repeated exposures to learn the vocabulary. This vocabulary is a building
block for following the directions necessary to become more independent with
home care and visiting the dentist.
children the names of the items (e.g., toothbrush, toothpaste, cup, water,
sink, towel) along with the body parts (e.g., teeth, tongue, mouth).
this vocabulary throughout the day. Read developmentally appropriate books
outside of the bathroom routine; post photographs outlining the steps in the
bathroom; and explore cartoons and short video clips that review the process.
Diet: Individuals with
autism may have limited diets and strong likes or dislikes when it comes to
food/drink. Do your best to provide a diet that reduces the risk of cavities.
sugary drinks, sticky/gummy foods (e.g., raisins, fruit snacks), and acidic
foods that can break down the enamel.
or going to bed with a bottle or sippy cup containing juice or milk can lead to
liquid pooling in the mouth, bathing the teeth. Try diluting juice with water,
slowly increasing the water over time.
you are dealing with a child with a diet that might lead to dental health
issues, attempt to brush his/her teeth before bedtime to remove the plaque and
with your dentist regarding fluoride and options for delivery (e.g.,
toothpaste, rinses, drops).
consistently do better with a clear set of expectations. Consider the following.
the bedtime routine before everyone
is exhausted. A half hour before bed, take a bath, dress for bed, brush teeth,
and read a book. Create a visual schedule to follow.
outline tooth brushing. Some families use visual timers to indicate when they
are done brushing. Some use music similar to the hand-washing songs or battery-operated
toothbrushes that signal the end of the process (e.g., the vibration ends after
older or more independent individuals, a diagram of the mouth outlining the
tongue side, tops, and cheek sides of the teeth is helpful, with a plan for
moving from one section of the mouth to the next.
Extras: These tips apply
to any child to develop a positive approach to dental care.
unclear endings. Try not to use expressions like, “We’re almost done,” or “1
more minute.” These don’t provide predicable information.
starting with the toothbrush only. A soft bristle toothbrush is recommended. Be
aware of the potential to elicit a gag—more likely for individuals who breathe
through their mouths.
that you may have to explore several options before finding a toothpaste flavor
that the child tolerates.
introducing toothpaste at the end as a reinforcer, especially if the child
consistently tries to eat the toothpaste (i.e., sucking the toothbrush and
refusing to participate in the brushing process). Many kids will go through a
phase where they chew on the toothbrush. Introducing it without paste may help
you determine if the child needs to learn to hold the mouth open for the brush.
Can he or she follow the directive to hold the mouth open?
toothpaste out of reach when you have a child who might consume more than the
pea size amount recommended.
a different location for tooth brushing (such as the kitchen sink), having the
child assist with getting the toothbrush from the bathroom and returning it, if
families find that letting the child have the toothbrush while seated in the
bathtub is the best way to develop a positive connection. Watch out for soapy
water on the brush.
turns brushing each other’s teeth promotes acceptance (i.e., the child takes
mom’s brush and puts it in mom’s mouth and mom brushes the child’s teeth).
Stick to a clear start and finish.
structure for safety and skill development. Wandering around with a toothbrush
can be dangerous.
Many parents who have
experienced difficulty with doctor appointments put off a dental visit for as
long as possible. Here are a few tips for establishing a positive experience:
Choose a dentist: Check with other
professionals or parents in your area for dentists they recommend for children
with autism and why. Parents may be given recommendations of dentists who
perform work under anesthesia only. This may be an appropriate referral, but is
not a great starting place if the goal is to develop a routine for “happy
Ask questions: Call the office
with a list of questions to learn more about how they support/provide services
to children with autism.
Plan ahead: Behavioral psychologists
frequently assist families with activities/events that are problematic for
children and families. The behavior modification strategy is called Planned
Activity Training. The goal is to plan ahead and establish a step-by-step plan,
including reinforcement, to create a positive routine/successful completion.
the steps of the dental visit (e.g., check-in, waiting room, meeting the staff,
transitioning to the operatory).
for success: Some children might need to start with walking into the office,
greeting the front desk staff, and leaving—receiving reinforcement, such as a
supports: Pictures outlining the process provide an outline/schedule, letting a
child know what to expect and when it is over.
supports: Some families use headphones to reduce the noise or sunglasses, as
the child sits in the chair, to reduce the light.
to start with “happy visits.” Some dentists will even do the first visual exam
without taking them back to the dental chair, right in the waiting room.
A dentist may allow you to walk through the office, taping the office and staff
to share with your child. This would provide a non-threatening way to see the
office without contact with the smells and transitions.
families find it helpful to let their children watch them get their teeth
checked, going through the steps of a simple exam.
of the strategy, remember that the goal is to establish a positive outcome.
Make the process as predictable as possible.
To learn more about a Wichita
State University program that helps children with autism navigate dental
visits, go to http://blog.asha.org/2015/04/21/helping-children-with-autism-successfully-navigate-a-trip-to-the-dentist. Additional resources may be found on ASHA’s website
at www.asha.org/public/speech/disorders/Autism/. Autism Speaks provides a dental toolkit that offers
helpful information at https://www.autismspeaks.org/family-services/tool-kits/dental-tool-kit.
American Speech-Language-Hearing Association
ASHA is the national professional, scientific, and credentialing association
for 182,000 audiologists; speech-language pathologists; speech, language, and
hearing scientists; audiology and speech-language pathology support personnel;
and students. Audiologists specialize in preventing and assessing hearing and
balance disorders as well as providing audiologic treatment, including hearing
aids. Speech-language pathologists identify, assess, and treat speech and
language problems, including swallowing disorders. www.asha.org/