Dental visits made easy for children with autism

Dr. Phoebe Tsang and her research team would like to extend a big thank you to all participants in her study, focused on helping children with autism cope with their dental visit, at BC Children’s Hospital (BCCH).  She was also very grateful for the opportunity to collaborate with BCCH psychologist, Dr. Janet Mah in the last few years.  Their hard work has been recently published in the Journal of Clinical Pediatric Dentistry.

Here is the abstract of the study for those who are interested.  You can find the full article in with the following citation:   Journal of Clinical Pediatric Dentistry Volume 40, Number 5/2016.

autism awareness

Visual Schedule System in Dental Care for Patients with Autism: A Pilot Study

Objectives:  A pilot study to test whether a visual schedule system using picture communication symbols can help children with autism have successful routine dental cleaning visits.

Study Design: 14 boys with autism between three- to eight-years-old presented to the dental clinic for four weekly consecutive dental appointments. Patients were randomly assigned to either the control group who received the tell-show-do method (i.e., standard of care), or the test group who received the tell-show-do method plus the visual schedule system.

Results: Patients in the test group completed an average of 1.38 more steps, at 35.52 seconds per step faster, and with 18.7% lower levels of behavioral distress than those in the control group.

Conclusion: The use of a visual schedule system, along with repeated weekly visits, showed some promise in helping children with autism successfully complete more steps, progress at a quicker rate, and exhibit lower levels of behavioral distress within a dental appointment, compared to a traditional tell-show-do approach.

Visual Schedule for dental visit

October is Autism Awareness Month – home care tips for your child’s oral care regimen

Providing oral care to children can be challenging, especially for a child who has autism spectrum disorder.  You may have to be creative and add a little twist to your everyday routine in order to adapt to your child’s situation and ensure the child is comfortable in maintaining his or her good oral health.  Patients with autism may have social, behavioral, and intellectual impairments which are challenging for the caregivers.  Also, making progress in oral care with these children may be slow at first,  but with both patience and determination, it is not hard to see positive results!

Some strategies that parents may find helpful at home:

  • Position for Brushing: Some autistic children will need their teeth brushed for them.  If this is the case it is important to consider where you stand when providing care.   For younger children, laying the child down is a good position which allows better visibility and control during brushing.  For older children or those who may not tolerate the lying down position, try standing behind the child and even lean against a wall for additional support.  You are then able to use your arm to hold the child’s head gently against your body.

  • When brushing use a pea-sized amount of toothpaste with fluoride. However, if the child has swallowing problems,  fluoride may bother them and you can just use water to brush first and smear the fluoride toothpaste on at the end of your brushing so your child still gets the benefit for the fluoride protection on their teeth.  You will want to provide water for the child to rinse, if they have trouble rinsing allow them to have a small drink of water or you can absorb the liquid left inside their mouth with a finger wrapped in gauze.

  • If your child can brush on their own but has difficulties holding the toothbrush, there are creative ways to solve this.  There are Velcro straps or elastics that can be used to make it easier to hold, toothbrushes with larger handles and you could even insert the toothbrush into a tennis ball through a small slit in the ball, which would allow the child to hold the ball while brushing.

  • Autistic children may also have magnified responses to stimuli and unpredictable body movements.  As a parent you are probably aware of your child’s habits and anticipated movements since you observe them more than anyone else.  This can work to your advantage when helping them with their oral care since you will know how to work around their movements or even blend your movements with that of the child so oral care becomes a more natural interaction for them.

  • An electric toothbrush may be helpful as it often has a timer to ensure the brushing time (2 minutes) is adequate.  Also, it may provide more effective brushing in corners that are hard to reach in the mouth.

  • Preventing Dental Caries and Periodontal Disease: The use of fluoride and sealant on the child’s teeth can be effective ways to prevent caries. Some children benefit from occasional use of an antimicrobial mouthwash, like chlorhexidine but long term use of the such agent is not recommended.  Take caution using medications that contain sugar or those that reduce saliva eg. Concerta, Ritalin, Risperdal, Zoloft, Tenex, Catapres and always ensure the child brushes or rinses with water after taking medications. Rewards for good behavior are often given to children and many times the rewards that entice them are food or beverages.  Try to minimize sugary, sticky and starchy foods and beverages to prevent caries and periodontal disease.

  • Positive Reinforcement and Attention: Children love receiving verbal praise, hugs, kisses, pats and smiles, just like we all do!  If they don’t receive enough positive attention for their good behaviors, they may resort to behaviors that result in negative forms of attention.  If you use positive attention for your child during procedures and situations that they would not normally behave in a positive way, it can motivate them and over time they will learn what an appropriate or acceptable behavior is – this is especially important with autistic children.  This can be modeled at home when helping your child care for their oral health and will be continued when they come in for their dental appointments.

Some tips on how to show effective positive attention:

  • Be specific/immediate when praising a good behavior

  • Make eye contact and use an enthusiastic tone

  • Keep it simple

  • Try to get in the habit of catching your child’s good behavior as often as every 5 minutes

  • Give rewards that your child wants and will be receptive to (being mindful of those sweet food and drinks)

At the Children’s Oral Care Centre, we love to work with your child and provide them with successful dental visits.  This can be done by tailoring the communication style specific to your child (eg. using a social story or boardmaker pictures – see picture below).  Another way we can do this is to plan appointments to help your child familiarize with the dental environment in a step-by-step process.  This could take several visits without any actual dental work being completed but practice does makes perfect!!  We love to hear from you and find out ways that you think it is going to make the experience easy for them.  If you think your child would be receptive to this process do not hesitate to book an appointment with us.

Boardmarker seq 1 open mouth

Reference: HANDS In Autism, 2013

Copyright 2013 The Children’s Oral Care Centre