Taking my autistic 3 year old to the dentist?

Question

My 3 year old daughter has her first dentist appointment tomorrow. I am really nervous because I know she is not going to tolerate the dentist touching her teeth. (This is why I have not taken her in sooner!) Does anybody have any related experience or advice?

Answer 1

I have a write-up, but don't have the web-link.  So, pasting the page.  Hope this helps

Dentistry for the Disabled Child and Adult



I. INTRODUCTION

II. FINDING A GOOD DENTIST FOR YOUR DISABLED CHILD/ADULT

III. LEVELS OF ANESTHESIA TO CONTROL BEHAVIOR

IV. WHY NOT JUST LET THE BABY TEETH ROT AWAY AND FIX THE PERMANENT ONES?

V. TOOTH BRUSHING FOR DISABLED PEOPLE

VI. BRUXISM (GRINDING OF THE TEETH)

VII. EDUCATIONAL MATERIALS

VIII. RESOURCES

I. INTRODUCTION

Hi all,

I am a new kid on the our-kids block but have noticed many posts with questions regarding dental care for our children. Some parents sound very concerned about this subject. I noticed we have a lot of people with varying dental experiences and a very fine dental hygienist on the list, Peggy Oba, RDH, but we don't have anyone else quite like me. I have been a full time practicing dentist in St. Louis, MO for 17 years and have an area of interest in special needs patients--mentally and physically disabled, behavior disordered, medical problems, dental phobics, etc. I have an extra year of training in hospital dentistry and am an assistant clinical professor at St. Louis University School of Medicine. I'm on the faculty of a dental residency training program at St. John's Mercy Hospital here in St. Louis. I am on staff at four local hospitals including Cardinal Glennon Children's Hospital. I feel most qualified to give advice and have put some of my thoughts below. Feel free to forward or repost this on any other lists but remember, these are just in-general comments and I would never intend this to apply to all disabled children and adults or to have it supersede what your own private dentist says after a thorough exam, radiographs and an individual diagnosis. All are my own opinions and are based on treatment of thousands of disabled patients of all descriptions.

II. FINDING A GOOD DENTIST FOR YOUR DISABLED CHILD/ADULT

Your local branch of the American Dental Association (info below) is a good place to start. Ask for a dentist particularly skilled/experienced in treating disabled patients. This will probably be a general dentist or pediatric dentist. Don't be afraid to take your grown adult disabled children to a pediatric dentist. If your city has a dental school, call the department of Pediatric Dentistry, Community Dentistry or any Advanced Education Programs for general dentists. These are called AGD or GPR programs. I'd suggest not going with a regular dental student but seeking out the faculty member that teaches the students how to work on disabled patients. Many graduate (i.e. graduated dentist) students would probably be okay as a second choice. Ask for advice from some of the parents you meet who have older children with the same disability as your child. See how long they have been going. Ask what techniques the dentist uses and if they like the dentist. They'll feel honored that you asked them; we're all family. I totally agree with Peggy Oba's advice about first visits and trying to start out making the visits fun before they have cavities and pain. If the first visit you make is for relief of pain or infection and the child is scared, it is much more difficult for the dental team to avoid frightening your child even more.

III. LEVELS OF ANESTHESIA TO CONTROL BEHAVIOR

Most severely disabled people need some type of special help to cooperate. For some, this is just knowing the dentist and having some level of trust that they won't be hurt or that any pain will be slight and will just last a few moments (i.e. a shot). Depending on the individual patient's needs, here is what I use in decreasing order of strength when patients don't know me or won't ever cooperate:

   1. General anesthesia in a hospital as an in- or an out-patient. In the US now this is very safe and the anesthesia is usually kept at low levels for general dentistry. Oral surgeons can safely do general anesthesia in their offices. Anesthesiologists are better than nurse anesthetists. All anesthesia personnel are aware that special needs people present more risks than non-disabled people and they take this into consideration when they recommend anesthesia. If you are skeptical about this, discuss risks with them far in advance of the procedure. Call the hospital and make a special trip just to have your child prescreened by the anesthesiologist, if you are worried. We do.

   2. Intravenous sedation in the hospital or a private office. Many states require a special permit to do this. Your physician should give an H+P and an okay before this is done in a dentist's office, as an extra precaution.

   3. Nitrous oxide (laughing gas) and oral sedation together: This is safe for many patients as long as the oral medication is not given in too high a dose. In some rare instances dentists who do not have hospital privileges or a permit to do IV may be tempted to give a dose of oral medication that is too high. Ask your physician about the dose if you suspect this.  Nitrous oxide is generally safe except in a few cases--those who don't or won't breath well through their noses sometimes just temporarily due to nasal congestion), some types of asthma and in those who can't handle being 'high'.

   4. Nitrous oxide or oral sedation by itself. See comments above.

   5. Psychological Techniques: Sorry to put this near the end, but in my experience this only works on mildly frightened patients. These techniques include systematic desensitization, tell-show-do technique, modeling good behavior (as by an older cooperative sibling), distraction and a host of other tricks. I have not tried hypnosis, acupuncture or biofeedback because I suspect that they won't work reliably in most patients.

   6. Electronic anesthesia (TENS unit, CEDETA dental unit, etc.) is not a very strong technique but may work in some cases as long as the disabled person is not the one controlling the unit (usually the patient IS allowed control the electricity).

   7. Local Anesthetic ('Novocaine') by Itself: Consider yourself lucky if this is all your dentist has to do. I find I can do this on only about 20% of my patients with disabilities due to a variety of reasons and that is only after they know me. If your dentist is now doing this with great success and doesn't need any other assistance with your disabled child, give him some cookies next Christmas.

Please do not go to a dentist that uses any of these techniques: Papoose board, hand-over-mouth technique also called H.O.M.E.), scolding or restraints if the child is terrified. I think a papoose board is probably all right if the child needs it to help control involuntary movements but I feel it is cruel to use it against the child's will if he is scared and can't calm down. There are better techniques. Restraints are okay if the child simply needs reminders to keep hands away from mouth, etc. How do you know if these techniques are being used? Go in the operatory with the child and watch the procedure. If the dentist is uncomfortable or thinks your presence is making it harder to control the patient ("Mommy, come and rescue me from this strange person."), stand outside the operatory where the child can't see you. You can leave and wait in the reception room if you trust the dentist.

IV. WHY NOT JUST LET THE BABY TEETH ROT AWAY AND FIX THE PERMANENT ONES?

On the surface this seems sensible to harried parents who spend most of their energy/money on major medical problems, but it's a bad idea. Why? Baby teeth can get just as infected and abscessed as permanent (adult) teeth. Both children and disabled people of all descriptions tend to avoid telling parents when they have toothaches. A child with or without a disability who has a toothache, REALLY has a toothache.

V. TOOTHBRUSHING FOR DISABLED PEOPLE

All people with teeth need brushing. Brushing followed by flossing is better if possible. If your child will not let you near his mouth due to fear, unfamiliarity with the brush or tactile defensiveness around the face, here is how you systematically desensitize them:  Start with just some wet gauze or a washcloth wrapped around your finger and move it around the lips until the child will accept this. Use a massaging motion. Put something sweet on it to give him extra incentive if needed. When he gets accustomed to this and seems to like it (this may take quite a few sessions), start to go inside the mouth. Back teeth seem to be less sensitive than the front ones on most tactile defensive people, so start on the back ones. Be patient. Don't worry if he clenches; you are making progress and he'll open later. When this has become routine, start putting the brush in the mouth to do the cleaning.  If he doesn't like the bristles on the brush, just use the other end (the handle part) to desensitize him to the feel of that. Use a soft or ultrasoft bristle brush. Heat the bristles in hot water to soften them if needed, anything to get the child to take that first step. Stop if you are gagging him. Give him an old brush with something on it to make it taste good and let him play with it and chew on it by himself before or after the tooth brushing session. Expect that this systematic desensitization program will take several weeks but it is well worth the effort. Do it at the same time and in the same place every day. Give him/her a reward after the session is over.

Mechanical (electric or sonic) toothbrushes are all right only if your child will accept something like this in the mouth and they have learned to accept a regular brush first (NOTE: Children with seizure disorders should consult their physician before using any electric or sonic toothbrush as in some cases this may trigger seizures). Use toothpaste sooner or later in this series of steps but remember it is supposed to fe

Answer 2

Take her to the dentist, don't cancel the appointment.  Most good dentists have "tricks" they use to soothe and calm kids who don't like the experience.  I hope you have already notified the dentist that your child has special needs and will likely have a difficult time cooperating.  If your dentist is absolutely not able to work with your daughter, I know there are pediatric dentists who specialize in working with special needs kids.  Ask your dentist for a referral if it becomes necessary.

Answer 3

Thats tough. Just see what happens

Answer 4

she may have injured teh tooth--this happened to a couple other kids I knew--nothing can be doen about it---just wait for teh permant tooth--no big deal----may turn purple soon--don't worry--

if need be and there is a serious problem-consider sedation...

at the very least--go to a PEDIATRIC dentist who will be more comfortable with screaming children-

my state has a referral list of various medical professionals that have worked well with chidlrne with autism--look into a state organization--ask them if tehy can recommend a dentist--or look into a supprt group--find anotehr parent that can recommend someone taht will work with you-

One of teh kids I worked with had a cavity--teh dentist wanted to tie him down--tightly---teh dsound of teh drill would make him hysterical--he woudl have been seriously hurt...not to mention--often baby teeth don't need to be fixed----------they went to a different dentist..

the 2 kids I knew that had a dead tooth never had any complications--one is very proud of his purple tooth---and he's 6 so it will fall out soon--he's had it about 2 years........

I would want to wait and just monitor for complications--not do a preventative procedure...

Answer 5

My advice is to wait.  Really, my mother in law is an RN and says many children are not ready and are simply tramatized by the situation.  They do not really need to go until five.  I know what the "experts" recommend but the bottom line is you know your child best.

Answer 6

hold her hand and try to keep her calm

Answer 7

Hi,

My son is 4 and diagnosed with autism. There is no way he is going to manage with a typical dentist. He is presently on a waiting list here in Montreal, Canada to see the dentist at the children's hospital. The dentist  tomorrow may be able to get a close enough look to tell you if you need to do anything about her tooth. If work needs to be done and he is unable to help, he will refer you to the right place.

Good Luck, I'll keep my fingers crossed for you

Answer 8

Nope. But I do wish you luck.

Answer 9

OK, since you've already got the appointment, here's exactly what I would do.  I have a daughter that has autism, she's now 9-1/2, so I've BTDT.

First, make sure the dentist office understands that your daughter has autism, that she probably won't be very cooperative, and that much might not get done at this appointment.  Explain that you really want to work with them to help your daughter learn to be comfortable and tolerate a dentist visit. That this visit is more of a learning experience than anything. Ask if they can look in your mouth as well, so it's "Mommy's turn, then Daughters turn" type thing.  

I have no idea your daughters level of understanding, but mine wouldn't have gotten it a bit at this age.  For mine at 3, I wouldn't really bother trying to prepare in advance, I'd just treat it as an adventure at the time, very positive and fun, "look at all the cool stuff" type thing.

If your daughter would understand talking about events that will happen tomorrow, I'd get a childrens video with a dentist visit (favorite characters if possible) or a book with a dentist visit and show her really excited, "Look what we get to do tomorrow, just like ......."

At the visit, remain calm. Remind staff that it is likely that no much will be accomplished, but see if the dentist can at least get a glimpse of that front tooth.  We had the dentist "COUNT THE TEETH"  so he could get a quick look. My daughter loved numbers and this fit nicely with her obsessions.  The other trick I used was "you only have to keep your mouth open for 20 seconds" and I would count out loud, pacing myself so the dentist could do the exam.  Believe me, once those 20 seconds were up, her mouth shut like a bear trap.  

It's likely that the tooth is dying, or dead, and nothing really needs to be done.  This can happen from trauma to the tooth. Since it's a baby tooth, I'd keep it in place if possible, to keep the space open.  I had such a tooth as a kid. Usually it causes no pain, mine didn't.  Only problem is that it's hard to tell when your child has autism. They often can't tell you about the pain, or feel it much "hyposensitivity".  

If she has older siblings, bring her along to appointments so she can observe. Take it slow and don't force it.  If she won't sit in the chair, you sit in the chair and see if she'll sit in the assistant chair. Then switch places. Make it a game. See if she'll sit on your lap in the chair.  

You're setting up lifetime patterns here, and you don't want her forever scared of the dentist by a traumatic experience.  Kids with autism really hold onto things like that.  I wish you lots of good luck!  I now have a little girl who has no problems going to the dentist, though she still hates teeth cleaning (I still do the counting).  Her fist filling and major x-rays were done under general anesthesia. Since then, she's done very well with a little laughing gas and once, some novicane.

Answer 10

well, with my daughter we started at age two or three and just took her every three months to just sit in the chair and look around. no dentist ever even touched her, just came in, said hi and left. We really built it up slowly lol!

Around age five or six, we got to where the dentist could count her teeth, but not with the metal pointy thing in his hand! By seven, we could use that to count, by nine we did her first x-rays.

We took french fries (her fav food) and just really rewarded her for going in, sitting down, for STAYING down, and for letting people look in her mouth. Our hygienist was great, she didn't get grossed out by the food, said she'd seen worse lol! Just stay really positive for your daughter, keep emphasizing how easy this will be. YOu might tonight write down everything that will happen, and go over it like a bedtime story, so she can prepare for what will happen next, and next and next. Like a social story. Do it tomorrow in the morning. Do it on the drive there. Do it in the waiting room, and do it while she's in the chair. Just keep repeating what's going to happen next and emphasize to the dentist how important it is to let her know what will happen next (and if it differs, say "Sorry sweetie, mommy didn't know, first this and THEN we'll do what I said" And sometimes when my daughter was little, I would hold her in my lap while they looked at her. She's eleven now and I still sit beside her chair and hold onto her arms to help keep her grounded in her space.

I know you're concerned about that tooth, but my sons' did that, when the root started to die to have the baby tooth fall out. It' not a bad thing really, just unusual. All baby teeth have the roots die and start to recess before they can fall out. It might just be happening earlier. I think Sam's was like that for two years before it fell out (embarrassing, yes, but not unhealthy) Don't freak yourself out yes :-)

Answer 11

If she is truly not going to tolerate the dentist touching her teeth, you should look into a dentist for special children- one who has the proper sedation.