Providing Optimal Dental Care for Children with Special Needs
As the daughter of a dentist, I was surprised to learn this as proper oral health was paramount in my own childhood home, and those strict lessons have since transferred to each of my children — two of which have special needs. Fortunately, my children seem to have an innate love of the dentist — possibly due to my own personal perspective — or perhaps due to the superior dentist we’ve chosen.
Yet not all families have the same good fortune, and instead struggle with not only finding a dentist they like, but also finding one who will accept their child with special needs as a patient. The main reason cited behind dental care being the leading unmet health care need among children with special needs, according to the OHRC, is the fact that many general dentists refuse to treat children with special needs, making it challenging for parents and caregivers to find a local, or even regional, practitioner. Much of this reticence stems primarily from concerns relative to a child’s incidence of anxiety, which tied to any physical or developmental disability can make routine dental procedure challenging.
However, plenty of neuro-typical children and even adults fall victim to anxiety when it comes to the dentist. The mere pain of a toothache, sound of a drill, or sterile dental office smell can stimulate negative memory triggers and often severe stress. For children with special needs, similar stressors can result — or even become amplified — should they feel scared, unprepared or carry sensory inhibitions.
With greater understanding of anxiety and how it manifests, many in the dental industry, particularly pediatric dentists, have advanced a diverse array of tactics and unique approaches to support the needs of every patient. Yet general dentists too are well aware that the population of patients residing in their communities contain plenty of patients with diverse needs, encouraging even general dentists to consider adding to their own knowledge base to ensure that every family can be cared for equally.
Pediatric dentists differ from general dentists, given that their training frequently includes an additional two to three years of specialized training post-dental school graduation, during which they learn how to properly manage complex dental cases. Given the OHRC’s data, the American Academy of Pediatric Dentistry recently released additional information and a handful of tips to support families of children with special needs:
Find a dentist that makes you feel comfortable. According to the American Academy of Pediatric Dentistry (AAPD), all children should visit a pediatric dentist by their first birthday or upon eruption of a child’s first tooth. Unfortunately, many parents and caregivers maintain concerns and anxiety relative to their child’s tolerance of a dental appointment and, therefore, postpone dental visits until their child is older. In some cases, the parent’s own anxiousness or previous lifetime dental experience can further add to mounting stress, ultimately debilitating an entire family.
“It’s important not to let oral health slip to the back burner,” says Dr. John Hendry, pediatric dentist and AAPD member. “Parents should plan to bring their children in early so we can do preventative work versus treating problems which may require uncomfortable, lengthy procedures.”
“Dentists are trained to treat all patients the same, so in our practice, we believe the most important first step is to get to know each of our patients and allow them time to get to know us,” says Dr. Andrea Biondo of Biondo & Foley Dental in Wilmington. “We take our time with each patient as what may be routine for one — with or without special needs — may be a traumatizing trigger for another. We feel it is a huge responsibility and sign of trust to be chosen as someone’s dentist, and we don’t take either lightly.”
Provide details about your child prior to the first visit. Parents clearly know the most about their children, so the best way to prepare for an initial dental visit is to share the details. Parents regularly complete HIPPA and medical background forms for all health-related appointments, yet anything additional that can be shared with your chosen dentist will be of great benefit.
“Make note of anything about your child that could help the visit go smoothly,” Dr. Hendry says. Pre-visit is the perfect time to ask questions, voice concerns, and make sure that you and your new dentist are on the same page. For example:
• Does your child absolutely need to understand every step taken by the dentist or hygienist prior to being seated in the chair?
• Does your child require sunglasses to minimize bright light and glare?
• Does a favorite Disney character or movie resonate strongly with your child? And perhaps serve as a source of comfort?
• Is your child highly sensitive to noises or vibration?
• Do sterile scents cause hyper stimulation?
Dr. Biondo shared that on some first visits, very little dental work is done as the dentist may spend time simply familiarizing their patient with the dental office and the dentist, and vice versa.
“We encourage a lot of talk and interaction with our patients,” she says. “As children get to know and trust us, we are able to successfully deliver preventative care in a comfortable manner. If they simply want to look, touch, and experience the office the first few times, that is completely fine as we know from experience that the more often we see them, the more comfortable they will be, and the greater the care we can deliver.”
Prepare for and build excitement around your child’s first dental visit. Some children require very little advance notice prior to a first introduction to something new, yet children with special needs often fare far better with a little head start. Once your appointment is arranged, parents may want to write it on the calendar (complete with stickers of teeth and smiling faces), bulletin board or something similar, to help visually prepare their child.
Dr. Hendry also suggests parents be as positive and excited as possible when discussing the first dentist visit. To help orient and familiarize each child with the dentist office’s location, he also recommends that parents and caregivers consider driving past the dentist’s office once or twice prior to the appointment.
Finally, non-verbal or visually-oriented children may benefit from a “social story,” a written and visual series of interactions, situations, desired behaviors, and events that advise readers of something yet to come. A simple Google search nets a number of social story options for first dental visits that can easily be customized, printed, and shared. Dr. Biondo also recommends establishing a routine of regular dental visits. All children benefit from routine so that each visit becomes expected and familiar.
Social Story From DentalCare.com:
A social story is a short story that describes to an individual the relevant social cues and common responses in a specific situation. It explains what happens and why the situation occurs. A social story is designed to prepare an individual for an uncertain event, to share information, or to provide him/her with a strategy to deal with an event effectively with a thought-out plan and guide. The story should be read to the patient several times before the first appointment. Here are links to two different social stories for the dental office.
Visit to Dentist’s Office:
Going to the Dentist:
Support the dental professionals caring for your child. Dental practices realize how stressful a visit can be and many do much to accommodate the needs of each of their patients. As parents, we may tend to “hover” over our children, which can, in some cases, create greater stress. By sharing details about your child in advance of an appointment, parents arm the dental practice with extremely useful information to help ensure the appointment goes as smoothly as possible.
Most pediatric dental offices will invite and even encourage parents to be present in the treatment room and will provide as much time as is necessary to establish comfort in the environment and with the staff. This is an opportunity for your child to interact and take counsel from a trained adult, one who will support their efforts to build strong oral health habits to benefit them for a lifetime. Once your child is seated in the dentist’s chair, it is often best to take the role of advisor and audience rather than show stopper. Trusting your chosen dental team to support your child and your family will go far as each team member is a highly skilled, educated and knowledgeable individual who, at the end of the day, wants exactly what you want — a healthy and cared-for child.
Two Ways Parents Can Encourage Good Dental Health From the Start
Prevent tooth decay from the start. Unlike many of the health conditions faced by patients with special needs, tooth decay is mostly preventable. Children with special needs often have greater chance of dental challenges including teeth crowding, grinding, and bite and poor jaw position. Additionally, children may also take longer to experience the emergence of baby and adult teeth.
By visiting a dentist early on and regularly, parents and caregivers will take a major step towards positive oral health as all children benefit from preventative care, including proper brushing, flossing, limited snacking and regular dental checkups. Dr. Hendry further adds that consistent routines to promote oral health, such as drinking water throughout the day, can be an important measure in helping to keep teeth clean at home. Other important suggestions include the avoidance of sugary drinks, especially bottles in bed or juice at bedtime; limiting “sipping” sugary drinks as the lengthier contact of sugar and teeth leads to greater risk of decay; and oral cleansing using a warm washcloth even before the teeth fully erupt to help stimulate oral sensations that minimize sensory defensiveness.
Practice, practice, practice.Given physical or sensory issues or developmental delays, some children with special needs require more assistance and practice in caring for their teeth. For example, children with autism may struggle with the sound or sensation resonating from a spinning toothbrush or perhaps the scent of particular toothpastes. Others may struggle with dexterity and find reaching the far rear of the mouth difficult.
Parents are encouraged to work with their children several times a day to experiment with different options (regular toothbrush versus spin brush, floss holders versus regular floss, rinses and adaptive aids for toothbrushes) to find options that work best. Your dentist can provide optimal recommendations especially if the sensation of brushing or flossing causes discomfort. Other things to consider include whether your child is properly holding and manipulating their toothbrush or reaching far enough towards the back of their mouth to cleanse rear teeth. Any effort or ideas to encourage regular brushing will make a difference.