Optimizing Orthodontic Care for Children with Autism
As orthodontic specialists, it is our duty not only to provide exceptional care but also to ensure that our approach is adaptable to the needs of all our patients, including those with autism. Going to the orthodontist is a “normal” part of growing up in America and in many cases, families of children with autism crave the normalcy of bringing their child to an orthodontic appointment. Dr. Barbara Sheller, chief of pediatric dentistry and an orthodontist at Seattle Children’s Hospital, offers insights into tailoring orthodontic treatments for children with autism. “Almost every orthodontist has had an experience with a child with autism; how the orthodontic team responds and accommodates makes a difference to the child and their family.”
Understanding Patient Needs
Children with autism often experience sensory sensitivities that can make traditional dental environments challenging. Dr. Sheller points out that understanding the needs of a patient can help you identify simple adjustments to make the appointments go smoother. Spending time with the parent before the first appointment to understand the child’s specific triggers and ways of calming can help you adjust your treatment. One question she asks is about the child’s school environment. Are they in an inclusive classroom with other children without autism; are they in a resource classroom, special education classroom, or another special setting? It really helps to know how the patient is learning so that you can be intentional in your approach.
Before the first visit, create a supportive environment
Children with autism benefit from a consistent and supportive environment. One of the tools that can be used is an initial visit that includes a parent or behavioral therapist. Discussing with the parents who the child feels most calm with is helpful. Whether it is the parent or a therapist, that person should accompany the child to the first appointment. Dr. Sharon Leach, pediatric neuropsychologist at the Stearns Center in Burlington, VT, stresses the importance of sensory adaptations, saying, “Sensory pieces and pre-exposure to the office really helps.” Introducing the child to the orthodontic setting through an office tour helps them feel comfortable with the sites, smells, and sounds of the office for when they come for treatment. Even more effective is if the autistic child has a sibling in treatment, having them observe the sibling can be very beneficial. “Modeling great behavior really helps to teach them how to be great patients,” Dr. Sheller adds.
Once you understand the triggers of the patient you can modify your environment accordingly. Examples that may enhance the comfort level of these patients include decreasing ambient sounds, dimming lights, or using a private room. If you know the child is triggered by bright lights, give them a timer to visually help them to understand how long the treatment with lights will take and then give them a break which allows them time with something which they have an affinity with, like 2 minutes with the iPad, etc. “If the sounds are less strong or the lights are less bright, you can ameliorate those triggers before you even start,” says Dr. Sheller
Scheduling Considerations
Timing of appointments can also significantly impact the experience. Dr. Sheller points out the value of scheduling visits when the child is most receptive and alert, and when the office is less busy to minimize stress. Many children with autism are on medications to help them focus or stay calm during school hours. Scheduling children when they are most attentive is important to their experience. “If they cannot be scheduled during school hours when they are generally the most focused, you may want to have discussions with parents about using “rescue dosages” of medications which will help the patient feel more comfortable during their visit,” says Dr. Leach.
Leveraging Technology and Innovations
Technological advancements have made a huge difference in how patients can be treated. Innovations such as digital scans and clear aligners offer less invasive alternatives to traditional methods. These tools are not only more comfortable but also less intimidating for children with autism. Dr. Sheller notes, “Aligners and scans without goopy trays help them have an easier time.”
Communication Strategies
Once you have the patient in the office, it important to help them feel as comfortable as possible with their treatment. Understanding each child’s unique communication method is essential, whether it’s through devices like iPads or using social stories to explain procedures. Dr. Sheller advises, “Learn from the parents what is being used at the dental appointments for checkups.” Involving the child’s behavioral therapist during appointments can provide continuity and comfort. A visual schedule, whether on an iPad or on paper, showing what to expect and allowing children to check off tasks as they proceed can significantly reduce anxiety and improve cooperation.
Taking Breaks
Dr. Leach emphasizes knowing the signals of when a child needs a break is really important, especially for those who are nonverbal or have difficulty regulating their emotions. “Knowing the signals of anxiety with a child can help you determine when to take a break. You can learn these signals by discussing them beforehand with the parent or therapist,” she advises. In many cases, when performing tasks that the child may find demanding it is important to advise the patient that after that task is done they may take a break. Many children with autism find it necessary to perform repetitive movements and helping them to understand that after a specific time frame they will be able to take a break helps them to control those feelings.
Tailored Treatment Goals
Setting realistic treatment goals is another critical aspect Dr. Sheller highlights. “My bar for success may be in limited treatment goals instead of going for perfection; I may prioritize improvement in the most esthetically important teeth.” This approach focuses on making meaningful improvements that enhance the child’s appearance and dental health without overwhelming them.
Every child is unique, and as Dr. Sheller aptly notes, “Every child has strengths and interests, and if you can find a way to connect, that can take you a long way.” As orthodontists, our approach should not only be about adjusting bites but also about adjusting our methods to meet the needs of our patients. “With patience, understanding, and flexibility, we can provide effective and compassionate care to children with autism, helping them achieve not just a functional bite but also a smile they can proudly share with the world.”