Posted on 20th April 2020
No matter if you work in a public or private practice, it is highly likely some of your patients will be on the autism spectrum, as Grace Lazurardi, Policy and Planning Director at the Autism Association of Western Australia, explains. “One in 100 people are on the autism spectrum, and just like anyone else, they need access to a good dental service,” she says. “So the more we can do to improve autism awareness for dentists, the better the health outcomes will be for people with autism.”
Last year, the Autism Association of Western Australia partnered with the WA Health Sector to develop training packages and resources to increase autism awareness amongst health professionals. A free online training package is set to launch in May.
Danielle Aubrey, specialist project officer at the Autism Association of Western Australia, says the training covers not only technical information, but many strategies needed to support people with autism that can be put into practice by dentists and other dental professionals, including dental nurses and reception staff. “We found people in the dental profession want to help but are not sure what to expect or how to respond,” she says.
According to Danielle, the most common question by dental professionals is how to work with an ASD patient who is non-verbal. “My answer is, they are a person first and will be just as anxious as anyone in an unfamiliar environment, not knowing what to expect,” she says. “Sometimes, a medical professional will speak ‘over’ the person, or just interact with the carer instead. Remember, it is important talk to the person and explain or show them what you are going to do.
“The dental environment is very challenging for the best of us,” Danielle continues. “For a person with autism, the bright lights, smells and sounds immediately put their senses under pressure.
“Because of this, we recommend familiarisation appointments where necessary. In this way, they experience the clinic and know what to expect. This reduces a lot of the stress associated with an unfamiliar environment and its sensory overload. The more familiar the person with autism is with the environment, the more resilient they will be in undergoing a dental procedure.”
When it comes to treating patients on the autism spectrum, Danielle says it is best to be flexible with expectations. “The filling they require, may need to wait until the second appointment until they feel less anxious in an environment that is new for them,” she says. “Getting into the chair and opening their mouth for the dentist to have a look may be sufficient for the first visit. However, this might not be the case for all people with autism. Some might come well prepared because of past visits to the dentist.”
Continuing with an appointment when anxiety levels are increasing should definitely be avoided. Also “ultimatums and telling of consequences do not work,” Danielle points out. “They only increase anxiety and a negative response. Simply accept that you might not get everything done in that one appointment.”
A final piece of advice from Danielle is to listen to the patient’s carer who knows the person, whether it is their parent or a support person. “They will know the patient’s likes, their dislikes and the things that make them anxious,” she says. “They will help you because they will know how to put the person at ease. They will know that the patient might need headphones or want to wear their own sunglasses instead of the glasses you give.”
It doesn’t take much, according to Danielle, for a patient with autism to have a positive experience at the dentist. “We have many families who regularly go to the dentist and who love their dentist,” she says. “It is not an unachievable goal if you can see the situation through their eyes and make some small adjustments.”
The Senior Dental Officer
It is very important for a dentist to have an understanding of autism in order to have a successful patient-clinician relationship, according to Dr Tamarai Selvam, Senior Dental Officer at the Special Needs Dental Clinic. “There is usually an element of elevated anxiety for ASD patients caused by over–stimulation of lights, sounds, smells, movement and strange equipment in a dental clinic,” she explains. “Many autistic patients also have high pain tolerance, and it’s not uncommon to find advanced stages of dental issues by the time they get to a dentist!”
Tamarai believes that patients with autism don’t necessarily need to see a special-needs dentist. They simply need to visit a dentist who is calm, patient and understanding of their needs.
“If the patient is identified with ASD, talking to the carers prior to the appointment about the patient’s red and green buttons might help them prepare for a successful dental visit,” Tamarai advises. “Sensory overloads, communication methods, special–interest topics that are unique to the patient are areas to focus on. Desensitising appointments are a great way to introduce chair–side dental treatment for an ASD patient.”
Tamarai notes that one of the most common mistakes a dentist makes when treating a patient with autism is assuming that all ASD people are alike. “There is a saying that if you know one ASD person, you know one ASD person,” she adds, laughing.
Paediatric psychologist Amanda Abel believes it is important for dentists and other health practitioners to realise that children (and adults) on the spectrum can become very anxious about going to the dentist, especially if it is somewhere they haven’t been before.
“A lot of children will find a medical consulting suite quite provoking,” she says. “If it is somewhere new, I always recommend preparing them prior. If the practice can provide the parents with some pictures of the practice or the treatment rooms, provide the name of the dentists the child is going to see, or give a sequence of events so they know what to expect, this can really help. We have social stories that includes this sort of information that we send to patients who might be anxious.”
Giving patients with autism some extra time can make a big difference. “If the practitioner knows they are not in a rush, they are not going to be stressed – which the kids will pick up on,” she says. “Another thing that can be very helpful is to offer the family the chance to come and look at the practice a week prior to their appointment so the child is then familiar with the surroundings.”
Amanda says it is helpful for a dentist to know their patient has autism prior to the appointment so the dentist can be prepared to have a longer appointment if necessary.
“I would recommend the information that a person has autism is on intake forms so parents have a little reminder to disclose it so the dentist can be prepared,” she says, adding that being prepared to help a person with autism feel less anxious in the dental chair can make a big difference to their care.
Make the most of desensitisation appointments
She says one of the first thing she asks prior to a medical consultation, especially if the family is going somewhere new, is if they can have a desensitisation appointment.
“This involves us going when it is quiet, usually the first appointment of the day or the last appointment of the afternoon and just walking around,” she explains. “We see what reception looks like, we meet the dental team, go into the treatment room or see if the kids are allowed to sit on the dental chair,” she says.
“I always ask for the very first appointment of the day and come prepared with their favourite thing. In my children’s case it’s their iPads,” she adds. “Having to sit in the waiting room can be a very unpleasant experience. My kids will become more and more anxious as the time ticks over, especially if the previous appointment has run late.
“Also, for my kids, the morning is when they are in their most happy place.”
Kathrine suggests to dentists to have visuals for children and adults on the spectrum. “Even photos on the practice website of the dentist, what the car park looks like, the treatment room and perhaps some of the equipment can be very helpful, especially for people who can’t get to a desensitisation appointment,” she says.
She adds that visual cards can be very helpful during an appointment for children and adults, both verbal and non-verbal. “If your mouth is numb or you are needing a filling or dental treatment, some basic cards that say ‘Yes’, ‘No’, ‘Good’ and ‘Bad’ are a fantastic tool because if the patient is hurting or needs a break they can point to those visuals.”
Kathrine also says for dentists not to underestimate the difference some understanding and compassion can make.
“I can tell you that most parents are anxious about taking their special needs child to a medical appointment, so just be human,” she says. “Show empathy and human decency and compassion. You never know the situation that the parent and child or disability worker and teen have come from. The days can be really, really hard even before 7am, so if parent or carer is frazzled and the child is starting to stress out, please just be kind.”
Spectrum Support, www.spectrumsupport.org
Senior Dental Officer Dr Tamarai Selvam makes the following suggestions for treating patients with autism: