Children with autism can have a higher prevalence of oral health issues due to the nature of their neurodevelopmental condition. Autism-targeted oral health education programs as well as the advent of telehealth can go a long way to addressing the problem and helping parents.
Mom-of-three Pamela Stevens has to leave 2 hours early to get her child to the dentist in Newburgh, New York just because he doesn’t want to go.
“He’ll go see his behavioral therapist because his friends are there and it’s more engaging, but he doesn’t want to go to the dentist. He’s scared, and the visits don’t go well.”
Kevin Donly, a professor of pediatric dentistry at UT Health in San Antonio, says as many as 30% of his patients have behavioral health needs but there are options for parents like Stevens.
Children with autism, ADHD and anxiety all in some way need special accommodations, but the solution depends on the level of severity. “If your kid has a mild form of ADHD it just takes a little more time to explain things. You have to be really patient,” says Donly, who recently served as the president of the American Academy of Pediatric Dentists. “We tend to be quick because kids have a short attention span but kids with behavioral challenges need more time to comprehend.”
Parents should not assume all dentists have expertise in working with kids with behavioral issues. In fact just one in three kids who see a dentist see one who has pediatric training and experience, according to Donly.
Seek dentists who can be creative. Donly’s outpatient practice uses techniques:
- Visual supports
- Low lighting
- Noise-canceling headphones
They schedule extra time for visits, too, since some kids with severe autism might need the operating room for general anesthesia. Dentists should spend a lot of time talking to parents first to help them understand that, in some cases, you can’t really work on the kids safely without anesthesia. If your child has the autism diagnosis the insurance companies tend to accept that as a medical necessity argument for having general anesthesia.
Oral health risk prevention is vital as early as age 1 but very challenging for kids on the spectrum. “We make sure the parents have access to fluoride in the tap and to mix it with their orange juice,” Donly says. “We give them mouth props to open their mouths when they’re brushing and show them techniques to use, because with sensory issues the kids don’t love the sensation of their teeth being brushed.”
Kids don’t have brush in the bathroom. Make it more fun. Stevens says her dentist suggested making a game, having her son try to complete a brushing obstacle course by brushing while walking around each room of the house until he touched each room. “It takes him a good 2 minutes, so it’s perfect! He tries to beat his time.”
At home prevention is vital particularly because there are not enough pediatric dentists in the U.S.
By 2030, the American Academy of Pediatric Dentists says there may be enough pediatric dentists to replace those who will retire but Donly sees a bigger problem. “In the state of Texas, for example, it’s very rural and so if you drive out to El Paso there just aren’t enough. So although we may technically have enough to replace, we don’t.” When he talks to lawmakers he points out that there are 10 times more pediatricians than pediatric dentists.
“It’s a distribution problem because it’s not easy to get pediatric dentists out into more rural towns.”
At present, there are only 7,000 pediatric dentists in the entire country vs. 80,000 pediatricians, so a lot of kids go to a dentist without pediatric expertise, without an understanding of autism. “We do our best to train general dentists to see these kids but it’s a challenge.”
In 2020, several insurers began to embrace teledentistry as an option to help during the Covid pandemic and this should expand into the future. Anthem partnered with Teledentistry and Dentaquest partnered with MouthWatch to provide virtual dental check ups in Alabama, Massachusetts, Oregon, and Washington. Teledent offers live video conferencing and file and photo sharing capabilities to help patients receive dental care from home.
This trend can help improve access but may be a valuable way to help children on the spectrum who have sensory issues and don’t do well at the dental office but are accustomed to iPADs and virtual learning. It has potential, says autism specialist Tammy Flores, who believes that with more adoption of virtual therapy for kids on the spectrum there is a “natural connection” to having the oral health check-in done virtually too. “At a minimum the hygienist can take some pictures, check the teeth, have a brushing contest with the kid and then, if needed, the child comes in – this could be really impactful in reducing the number of cavities and gum disease.”