THE ART OF TAKING CARE OF PATIENTS WITH AUTISM
(PART 2 OF 2)
Providing dental care to patients with autism requires patience and modification of skills we use on a daily basis. Our first article on autism and autism spectrum disorders (ASD) focused on the etiology and diagnosis of these disorders. We also discussed tips on how to get the staff and office ready for that most important first visit. Lastly, we reviewed specific questions to ask the caretaker prior to the first visit in order to familiarize oneself with the patient, their likes and dislikes, and also their fears and habits. (Please call or email our office if you would like a copy of part 1 of this article) In this issue, we will discuss some practical aspects of care in the office setting.
Plan the first appointment for patients with autism or ASD as a desensitization visit. Schedule them during a quiet time for the office, and place them in a private examination room away from the busy areas. To accommodate the child, it helps to find out, prior to the visit, the preferred time of day for each particular patient. This initial visit will help the patient become familiar with the office, the equipment, and the staff. A simple show and tell approach usually works best. Sometimes, just getting patients to sit in a dental chair may be a challenge. If multiple office visits are needed, try to use the same room and staff. Remember the first exam may be a cursory visual exam, and using a familiar object such as a toothbrush will be help the patient relax.
A general detail to anticipate beforehand is patients with autism may be sensitive to light. It is important to keep the lighting consistent throughout the office. If possible dim the lights of the office and the procedure room because walking from a dimly lit room to a bright examination room may render the child uncooperative, even before the exam starts. Also, make sure the exam light is not shining directly in the patient’s face. This bright light can also startle the patient and cause a difficult office visit.
During a dental examination, a quiet environment is best; however, some children with ASD are mesmerized by television or music. If this is the case, then make it an advantage and provide a familiar movie or music for the patient. The number of loud noises should be kept to a minimum. If parents are present, make sure they turn their cell phones off and avoid unnecessary conversation. Turn on each instrument individually so the child can see what each instrument does and get acclimated to the sound. Also, remove clutter in the office and decrease any possible distractions, which may make the child anxious. Let children and parents know what you will be doing. Your movements should be gentle, monotonous, and consistent. Sudden movements may startle the child.
Children with ASD may get agitated by the powder or scents on some gloves. After putting on gloves, rinse hands with water or use a wet gauze to clean the gloves off. If using scented gloves, make sure to do a smell test prior to starting the exam to make certain the child likes the scent.
When to Stop
If the child or parent gets restless or uncooperative, it is time to end the session and continue at the next appointment. Each visit should end on a positive note. Positive reinforcement such as an age appropriate toy is an excellent reward. Make certain to provide clear and accurate information for the child and parent for the period between visits.
Consider giving parents some homework to do for the next session. Flossing kids can be rewarding for parents and children. One method of flossing children and desensitizing them for dental visits, is for parents to sit on the floor or on a bed and for the child to lay supine in the their lap. Flossing from this angle will help children get accustomed to having their mouth examined. Since this approach is similar to the dentist’s approach, if performed daily, it may get children more accustomed to having dental procedures.
It may be necessary to repeat these steps over several appointments to familiarize patients and build trust to perform a complete dental exam. Working with the families and caretakers on this process will build a stronger relationship. The extra steps are well worth the rewards, as it will build a foundation for good dental care and oral health in this difficult to treat population. I hope we can make a difference together.