Dr. Shamika Strachan, associate dentist at Impressions Dental located in Harbour Bay.
Routine dental visits are bothersome for the average person, so imagine how difficult a dental visit is for individuals on the Autism Spectrum Disorder (ASD). The spectrum ranges from high functioning individuals with Asperger's Syndrome to those with more severe learning challenges who sometimes manifest a triad of impairments, which affect their ability to interact socially, communicate and understand the emotions and intentions of others. It is these three factors that present a challenge for the autistic individual to carry out dental habits and cope with the interactive and intimate demands of a routine dental visit, according to Dr. Shamika Strachan.
As Autism Awareness Month is recognized, Dr. Strachan, an associate dentist who practices out of Impressions Dental, Harbour Bay, encourages parents/caregivers to take the necessary time and steps at home to acclimate the autistic individual with the necessary steps to make dental care and visits to the dentist's office less of a task for the autistic patient and his or her parents.
The dentist said the autistic individual's exaggerated sensitivity to touch and other sensory stimuli makes tooth brushing, rinsing and flossing a difficult task, even at home with their caregivers who they love and trust.
"Caregivers should be able to imagine how much of a nightmare it is for the autistic individual to visit a dental clinic with unknown masked faces, gloves, lights, instruments, the noise of the drill and foreign smells," said Dr. Strachan. Despite the nightmare for the autistic, dental care and routine dental visits, she said, are of the same importance for parents of children with autism as they are for any other parent and patient.
To avoid development of serious dental issues, the dentist said it is important that parents/caregivers expose autistic individuals repeatedly to dental vocabulary to foster confidence in performing hygienic actions. Names of objects autistic individuals should become familiar with include toothpaste, toothbrush, water, sink and floss. They should also be familiarized with body parts that are used during oral hygiene practices, such as the teeth and tongue, and actions required such as rinsing, gargling and spitting.
"Repeating these words throughout the day may prove beneficial," said Dr. Strachan who returned home to practice last year. "Additionally, posting pictures of the steps involved is also helpful. YouTube is not a bad idea, either. If your child/dependent is engaged by videos, use YouTube clips to help reinforce the desired behavior."
She said most caregivers of autistic individuals know that routine is important, and should plan their mornings and nights in a step-by-step fashion, and ensure tooth brushing comes in that same order every time.
The dentist encourages the demonstration of brushing to the child -- showing them what it means to open wide, and getting them familiar with the feel of the toothbrush by letting it touch their fingers first, then their lip, cheek and finally their teeth.
"Because individuals with ASD are sensitive to textures and tastes, gag reflexes may be a common finding. To minimize the potential for vomiting, choose the right toothbrush [size, shape, and soft texture] for your child's mouth, encourage breathing though the nose and avoid placing the toothbrush too far back when tongue brushing."
The dentist said it might take several tries before a parent may find toothpaste that their child will tolerate, so they should exercise patience.
"It's also okay to carry out tooth brushing without toothpaste for some time, until you find one that's suitable. If the individual can rinse, the use of a fluoridated mouthwash would be beneficial to ensure fluoride exposure during the "toothpaste-less" period, if it's tolerated well."
Colgate, in conjunction with Autism Speaks has provided a dental guide with information to help families affected by ASD to begin a lifetime of good oral care. The guide suggests, parents/caregivers standing behind the child with their head on their chest, the use of a pea size amount of toothpaste, guiding the toothbrush as if brushing their own teeth and moving it in a methodological fashion -- left to right, top to bottom, outside then inside -- an outline that applies to tooth brushing for any child, not just a child that is autistic. To accommodate the autistic, Colgate advises that parents may want to attempt tooth brushing on the couch or another part of the home where the individual is comfortable. They also suggest that flossing be introduced as early as possible using the same steps outlined for tooth brushing, from behind the child.
Dr. Strachan says that contrary to popular belief, individuals with autism are not more prone to atypical dental disease than the broader public. The use of medications that are high in sugar content, she said, is what increases their susceptibility to decay. Many autistic individuals also have a strong liking for sweet, sticky foods, and there is sometimes a tendency for caregivers to give "rewards" for good behavior, or as an incentive to encourage acceptable conduct. Because of this, the doctor recommends that caregivers ensure that the autistic individual takes small, frequent sips of water throughout the day, to counter the sugary effects.
Periodontal disease (bone loss) is another dental condition that requires attention, as the incidence of the condition in autistic individuals may be compared to that of the general population. The disease develops after gingivitis (bleeding gums). If the environment doesn't change, it eventually results in the breakdown of the tooth-supporting structures -- bone, ligaments and gums (recession). If not treated or managed, Dr. Strachan says the long-term result is tooth loss.
The challenges with daily dental practices, she said, place individuals with autism at risk of developing the disease. She said oral habits such as teeth grinding, picking at the gums and tongue thrusting are other causes for more frequent trips to the dentist.
"It is imperative for autistic individuals to visit a dentist on a regular basis," said Dr. Strachan. "If possible, contact the dental office of your choice to find out whether an intake form is provided to fill out a history of your dependent -- related medical problems, their likes, dislikes etc., and do this prior to your initial visit. Once you are satisfied, proceed with scheduling. This appointment may not be focused on providing treatment at all, unless there is an emergency. The primary goal is to develop familiarity with the office staff and space. In fact, the entire interaction at that visit may transpire in the waiting area, depending on the individual, and that's perfectly fine. If possible however, it would be an accomplishment for the autistic individual to be introduced to the dental operatory and some of the equipment used during a dental visit such as the dental mirror and other tools."
Dr. Strachan says if the autistic patient is able to be introduced to the dental operatory, the dental professional should make the patient and parent aware of anything that may alarm the patient. The dentist or hygienist should get the OK before letting the patient listen to the sound of the special dental toothbrush (dental drill/handpiece) and before turning the light on. She says patients are offered shades if they are light sensitive.
When dealing with autistic patients, the doctor said dentists have to be literal and mean what they say and say what they mean, rather than engage in dental "kiddie" jargon -- which they may not take kindly to.
"Autistic individuals take things very literally... And dental professionals use a lot of dental 'kiddie' jargon, when interacting with children such as 'Open wide like an alligator', 'Mr. Thirsty' (dental suction), 'princess/prince cap' (dental crown), 'rubber raincoat' (rubber dam). This may not be taken so kindly by an autistic child who may envision an actual alligator if they're told to open wide like one. Both dentist and caregivers should be aware of this and mean what they say, and say what they mean."
Dr. Strachan said if the first visit goes well, parents/caregivers should bring the autistic child in for a second, third and fourth visit, but ensure the visits are as short as possible, introducing new terms, equipment and procedures each time to the child. She said there might be some individuals with severe behavioral challenges, who, despite all efforts, are not able to cope with the dental environment at all. In those cases it is up to the dentist to be aware of their limitations and refer the individual to a specialist for sedation if needed. But, she says, with lots of patience, love and kindness from the dental team, parents/caregivers might find that their child is better in the dental chair than they are.
Shavaughn Moss
Guardian Lifestyles Editor
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