PFA Tips: Going to the Dentist

By Dr. Tracy Bowden, Pediatric Dentistry in Timonium, and Shelly McLaughlin, Director of Safety Programs, Pathfinders for Autism

Download a printable version of Going to the Dentist


For some of us, going to the dentist is no big deal. But, there are others of us who begin to stress about the appointment the minute it goes on the calendar. Whether it’s your first visit, or your tenth, here are some tips to make it less stressful.
little girl at dental visit
“When our children have special needs we have found that many people are not as well adapted as we would like them to be to handle our children. The noise our kids make can sound very different to others than it does to us. We know that others don’t always appreciate and understand our children’s “screams of joy” or awkward movements as much as we do. When it comes to dental visits we know it can be a challenge for everyone involved. We see that some can be seen in the dental chair and some will not allow it. When we think of the variation in our children we can see that we need varying solutions.” –  Tracy Bowden, DDS, and father

Start’em while they’re young
We’re fighting fires and we’re dealing with the crisis of the day. So if there are no mouth or teeth emergencies, calling the dentist may keep dropping on the list of things we need to do. But that may only contribute to bigger problems later on. Start when they are young and may not need as much done. You really don’t want that first visit to be one that involves drilling, injections, root canals, fillings, or a lot of time. For all patients, the first dental visit should take place at 1 year of age and every 6 months thereafter. Dental disease is the number one chronic disease in children. (Parents, raise your hand if you knew that.) Not only do young children get cavities, but they are commonly born with malformed or poorly formed teeth. When teeth don’t form properly they may be far more likely to decay more quickly, and have large cavities before they are fully in place. Also, decay can become considerably worse in just 6 months.

Parents, you’re getting schooled too
Early visits are also for Parental Education. Dentists want children’s teeth to be flossed daily and brushed with fluoridated toothpaste twice daily. Diet and tooth position along with orthodontics should also be discussed. If the teeth did not form properly, additional supplements may be used to strengthen them.

Scope out the place
Scope – get it, Scope? Like the mouthwash?? (Oh yeah, by the way, we don’t endorse products.) Walk through and assess the office environment. Are the visuals “loud”? Are the dentists and hygienists loud? Is it a crowded office with lots of drills and toothbrushes running at the same time? Can the overhead lights be adjusted? What are the smells like?

Prep with a social story
Social stories provide information to individuals on what to do in certain situations. It prepares them for new experiences or scenarios by calmly walking them through what they should expect. Download one from our social stories link, or create your own using pictures from your actual dentist’s office.

One small step for man (or child….)
Talk to your dentist about setting up a practice session where perhaps all that your child does is go and sit in the chair. Then in the next visit, sit in the chair and have the dentist maybe touch your child’s teeth with his fingers. Next visit, maybe add counting the teeth with an instrument. It may mean nine appointments versus one, but nine happy appointments may be worth it over a disastrous one filled with anxiety.

Be first or last
The first appointment of the day is typically on time and requires little waiting. However, the last appointment of the day might allow the dentist to spend more time with your child and not hold up the next patient. It may also be a calmer time as maybe not every chair is filled at that time of day. Talk with your dentist about which is a better option for you.

Rule out pain
Noted speaker and author, William Stillman, points out that all behaviors are communication, and that it’s critical that when a “bad behavior” is occurring, that you rule out pain as the culprit. Follow this both in and outside of the dentist’s office. Your child who is banging his head or face may be trying to indicate mouth pain.

I wear my sunglasses at night
Well, or maybe in the dentist chair. Those overhead lights can be bright. Really, really bright. Pack a pair of shades in case your dentist office doesn’t have them available.

Use a visual schedule/checklist during the visit
Individuals with autism often tend to be visual processors. Anxiety might be lessened when the activities and the steps during the appointment are predictable.

Weight it out
We know that some individuals with ASD respond well to deep pressure as it can help them feel calmer and more relaxed. It might be worth draping the person with an x-ray apron if they appear agitated to see if that helps.

To sleep or not to sleep
Conscious sedation and general anesthesia may at times be necessary while allowing patients to be treated with respect. General anesthesia may be needed for some patients in order to acquire x-rays which allows the dentist to make more accurate diagnoses. General anesthesia in the Baltimore area is usually done in an outpatient setting at local hospitals which are equipped for dentistry. The work can typically be done in one visit. One question you may want to ask a prospective dentist is if they work with local hospitals if treatment is necessary.

Explore treatment options
See if your dentist is up to date on treatment options that may be less invasive than some traditional procedures. For instance, new procedures may be available where drilling was once the only option.

Pass the remote control
Some offices have TVs or DVD players in the exam rooms which may serve as great distractions during the appointment.

Yuck versus yum
Ask your dentist if they have a flavor selection your child can choose from. Picking a favorite flavor could be that single tipping point that determines if your child wants to go back.

Bribes aren’t illegal if you’re the parent
Don’t fact check this on me… I don’t really know. But as a parent, I’ve purchased many LEGO sets to get us through blood draws, and my kids’ dentist has a giant toy box full of “good visit rewards”. Sometimes the right incentive goes a long way, especially when it helps get our kids through something that’s necessary for good health.


Additional Resources

Find a dentist

Dental resources by age

Dental Tool Kit from Autism Speaks

Social Stories for visiting the dentist’s office

American Academy of Pediatric Dentistry

D-Termined Program
This 40+ minute video program is intended for dental professionals. There is another, 12 minute video for parents.

Treating Patients with Autism in a Dental Setting
Free online continuing education course from Procter & Gamble for dental professionals.

 

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