Compassion and patience are two characteristics needed in every dental hygienist. This is especially important in caring for children with special needs. It is important to understand how to best care for a child with Autism Spectrum Disorder (ASD) to help ensure they are given a great experience, setting a stage for order and continuity.
Each patient should feel they are the center of attention during their appointment. This is especially true of children with ASD. According to the CDC, 1 in 68 children are affected by ASD. It is a complex developmental disorder and affects areas such as social interaction, communication and learning skills. Children with ASD typically understand descriptions as literal, making it necessary to be direct and not necessarily use analogies. It is important to know the dental history of a child with ASD. Should you be part of the child’s first dental visit, they will need to understand what the appointment will entail. It will be important to be clear about the details, so there won’t be any surprises. Discuss with the parent what habits the child may have and the sensory stimuli the child may respond to. Having as many details as possible will help you provide the best care and help to make good home care recommendations.
In school, we learn the importance of tell, show, do in discussing the appointment and demonstrating home care recommendations. Children with ASD must be allowed to told, shown and then demonstrate all parts of the appointment. I have experienced several first-time appointments for children with ASD. Many years ago, my friend scheduled her son, who has ASD, with me for his first dental visit. She had indicated he was very good about his morning care routine. He brushes with a regular brush, liked to floss and used mouthrinse. These were all habits the child and mom had developed over time. Since this was his first visit, the circumstances were unknown to him. I knew the child, and had been part of his life and was able to talk with him and knew how to respond to him. There are many times I use analogies in describing an appointment to a child. This isn’t possible in discussing the appointment with children with ASD. They understand everything literally. Using the following techniques have proven to be successful with many children with ASD in my practice.
- Use the air/water syringe to pour water into the child’s hand. They can detect the process, feel the water and see the water come out of the instrument. They will then not be surprised when the water is in their mouth.
- Use the saliva ejector to remove the water from the child. Describe the suction as a straw and show them how we remove water from their hand and mouth.
- Use the prophy handpiece and the saliva ejector suction to polish their finger nail. Allowing the child an opportunity to see the action of the handpiece and feel it on their fingers, gives them a better idea of polishing their teeth.
- Make a sensory kit. This can include multiple items for the child to identify to help them with their surroundings.
- Take pictures of what you see with an intraoral camera so that the child can see what you are seeing
- Use a lead apron to give pressure and give a sense of security.
The more comfortable the child is for the appointment, the better experience they will have.
Many children with and without special needs may enjoy using home care aids such as electric toothbrushes. It is important to discuss with the parent or caregiver what type of aids they are currently using. Electric toothbrushes are recommended to assist in more thorough brushing, however speak with the parent to ensure the child will be open to the stimulus an electric toothbrush creates. Should a child have difficulty with the action of an electric toothbrush, making the recommendation would not be personalizing the needs of the patient. Resources such as a three-sided toothbrush, smaller toothbrush heads, floss picks and floss holders as opposed to traditional floss may prove to be more beneficial. Discuss rinsing with the parent. It may be best to recommend water as opposed to a fluoride mouthrinse, if the child doesn’t have good swish and spit methods. Using tools as recommended in the CE course Managing the Spectrum of Autism Care, will help them to follow through with a checklist.
When scheduling the next appointment, remind the child how happy you are to meet them and you are looking forward to taking care of them again. Tell them how great they did at today's visit! Preparing for the next appointment can help the patient look forward to the next time they are in your office. The first step has been taken and the base of knowledge will help to make the next visit a success!