DISCLOSURE: Noelle Copeland RDH is an Oral Care Specialist and Dental Consultant who provides content for Brilliant Oral Care and Baby Buddy.
Oral care for children with autism spectrum disorder (ASD) can have its challenges and coexisting conditions. As a healthcare provider, I am very aware of meeting the needs of my patients, no matter who they are or what their struggles may be. Those needs are not always physical either; I have found, in many instances, I must meet someone’s emotional and sensory needs first before they will allow me to meet any other requirements. Autism is particularly specific when it comes to this circumstance.
Not only are there specific things you can do to help your autistic child accept oral care more readily, but there are also some factors to consider when looking for a clinician who can treat your child. First, let’s discuss how you can start oral care at home and how to continue it with some positive reinforcement. Then we will review how to find a great dental professional to come alongside you in this journey.
Start Oral Care Early
Starting oral care early is the #1 preventative tool for anyone and everyone, which is why I advocate it so rigidly. For families of children with autism, this can be a game-changer early on. Autism is often not fully diagnosed until sometime after age two. Autism typically has some sort of “highly sensitive sensory measure” that can make oral care a potential challenge.
When a routine is started early in infancy, a child comes to expect it and may often find comfort in its repetitiveness. Children with autism might have a much harder time letting go of an established routine, so keep an oral care routine as a regular, comforting part of the schedule.
- Start wiping your infant’s mouth after feedings.
- Use silicone toothbrushes to brush and rub their gums starting at three months old.
- Whenever the “First Tooth” erupts, introduce a soft bristle toothbrush.
- Use pastes and gels with fluoride and Xylitol to help protect the teeth.
- Be cautious of strong mint or cinnamon flavors.
- Floss their teeth for them.
- Train them to help with oral care, but plan to be the one doing all the toothbrushing to remove plaque and bacteria.
- Find a pediatric dentist early, before age 1. Plan to see a professional that specializes in special needs oral care if needed.
Make Oral Care a Familiar Process
- Use appropriately sized products, not too big, not too small, and something you, as the parent, are comfortable holding since you will be doing all of the oral care.
- Keep it “simple” as much as possible. Of course, if you are struggling and need whatever tool has all the bells and whistles that make a task or routine easier, then, by all means, do whatever you need to. But start simple and go from there.
- One step at a time. If you can’t get toothbrushing done in one session, split it up into several mini sessions.
- Tell-Show-Do. Sometimes this involves you, as the parent, too. I’ve had great success in instructing parents to allow their ASD child to brush their adult teeth; at the same time, they are brushing their child’s teeth.
- Use language they understand and accept. Now, this is the exception to keeping it simple. If your ASD child LOVES something specific, then utilize that in language or drama for cooperation. This could be a song or tune that you sing or play on your phone, a particular character you learn to mimic like Mickey Mouse, Lightning McQueen, or Fancy Nancy.
Provide Oral Care Protection
Oral trauma doesn’t have to be inevitable for children, but most kids experience some sort of injury or trauma to the mouth during their childhood. For families with ASD, trauma can happen from an injury to the mouth due to a fall, self-harm, clenching and grinding the teeth, biting and chewing on non-food items or objects, oral disease, and even cavities are considered trauma. Protecting their mouth and teeth as much as you can is worth the time and investment. Try some of the suggestions below, and of course, talk to your dental professional about any special treatment.
- Use Fluoride and Xylitol to protect the teeth. Introduce flavors slowly and ask for plain versions whenever they are available.
- Mouthguards may be possible for some ASD children. This can be tricky to determine and maneuver, so it must be prescribed by a dental professional and custom-made from a dental office/lab. Mouthguards, night guards, or sports guards can be very helpful for children who are prone to self-injury, have seizures or epilepsy, or other co-conditions that put teeth at risk of being fractured or broken.
- Diet and Nutrition. I know how difficult food acceptance can be for ASD children and the best advice I can give is to leave sugar and highly refined carbs out of their diet as long as possible. Nothing feeds the pathogenic bacteria in the mouth faster and easier than processed sugar and carbs. If crunchy is the desired food texture, try apples and carrots before giving them crackers or cookies. If soft is the desired food texture, try applesauce and cheese before sugar-filled options like gummy bears or pudding.
Applied Behavior Analysis Therapy
- System of treatment that is different for every patient.
- Utilizes positive reinforcement, accolades, and rewards for planned activities.
- Encompasses an understood (based on the patient’s ability) explanation of consequences.
- Communication between the parent/specialist and the child is fine-tuned during therapy and vital to the process.
- The parents, ABA therapist, and Dentist should all be on the same page when treating the child.
- A clear understanding of autism is essential for any caretaker. A willingness to be patient, calm, and helpful can positively address a child’s dental care needs.
According to ABA, when a “desired behavior” is performed and backed up by something that the individual values, it is more likely to be repeated. This encourages positive behavior change over time that helps people work on tasks and skills that provide more independence and success.
ABA Therapy Techniques for Oral Care
- Discrete Trial Training: The ABA Therapist will provide a cue, ask for the desired behavior, and reward the behavior with positive reinforcement. Discrete trial training can help ASD patients to develop social and behavioral skills. This is an excellent method for encouraging independent brushing at home. The cue can be music or something else that is sensory attentive for the individual.
- Modeling: The modeling technique is one of my favorites for oral care. I recommend it to parents when they are toothbrush training their children. This method involves demonstrating the desired behavior by personally doing it or providing a video/audio example of what needs to be done.
- Reinforcement Systems: Reinforcement systems teach individuals about some of the negative consequences of underperforming behaviors. For example; If the individual doesn’t engage in the demonstrated behavior, like toothbrushing, prompt them again. If they continue to resist, withhold reinforcement until the behavior is performed. Reinforcement for children can be coins or tokens collected and exchanged for toys and special privileges. I encourage my parents not to use food as reinforcement since most food rewards are sugar-filled treats that tend to be sticky, gummy, or chewy.
ABA Therapy Techniques for Visiting the Dental Office
- Explain the planned treatment.
- Describe what will happen.
- Clarify expectations during the treatment.
- Outline the steps of the treatment.
- Show pictures of each step.
- Allow the use of headphones to lessen noise and sunglasses to reduce the glare of operatory lights.
- Visit and talk to the dentist and staff to get to know them before the appointment.
Now that we covered oral care therapies for home let’s go over some pointers for finding help in the professional world.
- Ask friends and family for referrals- A good referral is a great indicator of the mannerisms and likeability of a professional. If someone had a good experience somewhere, a referral is the highest compliment that a professional can get so the practitioners who get referrals from their existing patients are typically the really good ones.
- Do an online search- Check reviews and the official websites for potential clinicians, including their social media pages.
- Join and connect with other families with special needs- The most helpful information about the special circumstances in life usually come from those who have already been through it and experienced the ups and downs of it. This is especially true in the special needs community. If there is a particularly good or especially awful provider in your town, you can be sure that the community is telling each other about it. So find your tribe of people and get to know them and who they trust.
- Call each referral- Once you have a good handful of referrals and organic potentials, narrow down the list and start calling each one. Ask questions about their protocol for special needs accommodations. Do they offer sedation, do they have hospital privileges, do they give more time than usual in appointments for sensory breaks, and any other questions that you feel would benefit your child. One important question may be “Do they allow a parent in the treatment room”? Some clinicians are very strict about this and stay firm on their “NO PARENT BEYOND THIS POINT” policy. Personally, this is ALWAYS a deal-breaker for me. If I can’t be present while you are treating my child then you are not the right fit for my family and I don’t have a problem with telling anyone that!
- Schedule a meet and greet appointment or what’s typically called a “Smile Visit”- This is your opportunity to vet the dentist in person and their staff. It’s important that the entire dental team is on the same page and shares the same philosophies on special needs care. A smile visit also allows you to see how your child responds as well. They may immediately love the office and everyone there or they may be turned off by something like a smell, the temperature, or the noise level experienced within the building.
- Characteristics to look for in the staff and dentist- They should be patient, knowledgeable, passionate, experienced, nurturing, and able to bend and flex to suddenly changing demeanors. Don’t be afraid to directly ask someone about their level of patience or experience either. If they have it, they will confidently engage in a conversation with you about their skills, if they don’t have it, you will be able to tell by their lack of formal conversation which usually is evident by them responding with a quick “sure I do” or a simple “yes”.
If you were looking for effective and healthy ways to establish oral care routines with your family, you found the right place. If you want to try the best toothbrush for kids or the best baby finger toothbrush, look no further than Brilliant Oral Care. https://brilliantoralcare.com
Be sure to check out our selection of toothbrushes for individuals with special needs. This includes our silicone toothbrushes that make oral care easy to start. Our DINOSAUR, PENGUIN, and DUCK character sonic toothbrushes make oral care fun. And our special soft toothbrush with our most extensive bristle count and the softest texture brush we offer.
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Noelle Copeland RDH is an Oral Care Specialist and Dental Consultant who provides content for Brilliant Oral Care and Baby Buddy.