Advice for parents of children with autism

Caring for your child’s teeth can be challenging at the best of times, but for
parents of children with autism there may be additional challenges.

The British Society of Paediatric Dentistry (BSPD), the organisation of dentists who care for children’s teeth, has assembled some advice for parents of children with autism. In this blog, we have summarised this advice and do hope you find it helpful. You can download a copy of this information here

Children with autism often process sensory information differently and they can be either less sensitive or extra sensitive to sights, sounds, smell, taste, and touch. Having your teeth brushed and visiting the dental surgery can really challenge the senses. Sensory issues can be one of the main anxiety triggers for the autistic child in the dental surgery.

Fear of the new and unknown can also be overwhelming. If a child has learning difficulties; they may not understand what is planned. This will mean extra care is needed both in preparation for and during the dental visit. In addition, the dental staff may not be familiar with the child’s method or style of communication.

Some children have other medical conditions in addition to autism, such as ADHD or epilepsy, which pose their own challenges too.

All these factors can influence how a child copes, not only with oral care at home but also with going to see the dentist. It is important to find a dentist who understands autism and is able to support you and your child.

Is my child more likely to get dental decay because of their autism?

All teeth are susceptible to tooth decay if exposed to sugary foods and drinks between meals, especially baby teeth which have thin enamel. Current research suggests that a child with autism is no more susceptible to tooth decay than any other child.

Some medications, however, can cause a dry mouth, which can make dental decay more likely. Some medications or supplements, which are prescribed, may contain sugar. Do request a sugar-free alternative from your child’s doctor.

Getting your child off to the best start

Tooth decay is almost always preventable and, by getting things right as early as possible, you may be able to avoid your child needing dental treatment. This is particularly important for children with autism because they may find dental treatment more challenging.

It is also easier to develop good behaviours from the outset, rather than trying to change behaviours that are bad for dental health once they have become established. As soon as your child gets their first teeth, and certainly, before their first birthday, it is time to arrange their first check-up.

Toothbrushing at home

Brushing your child’s teeth at home is really important. However, many children with autism find toothbrushing difficult to tolerate and it can become quite a battle! Ideally, toothbrushing should be introduced as soon as the first tooth comes through so that it becomes part of their daily routine. Brush before bed and at one other time using fluoride toothpaste.

Toothbrushing at home – The parent’s role

It is recommended that all children have help with tooth brushing until the age of about 7 years as they don’t have the precise hand skills to clean the teeth effectively. Autistic children may need help for longer than this. It may help to have two brushes – one for you to hold and one for your child, as this will help them feel in control of the process.

What is the best way to brush my child’s teeth?

Stand or sit behind and above your child, so that you can see where you are brushing and so you can support your child’s head. Your dentist, hygienist or therapist should be able to recommend positions and strategies.

When should we brush?

Ideally twice per day – just before bed and at one other time. Before bed is most important as the fluoride from the toothpaste will stay on the teeth whilst your child is asleep. Remember to encourage your child to spit out excess toothpaste. Discourage rinsing after brushing so the benefits of the fluoride last.

Which toothpaste should we use?

Some children don’t like the taste and texture of toothpaste and may prefer brands which are flavourless or low foaming. If you are really struggling, try brushing the teeth with water first and then rinse the brush and dab some fluoride toothpaste around the teeth. Ask your dentist about the different types of toothpaste available. The most important thing is the right amount of fluoride. Ask your dentist whether
your child might benefit from using a higher fluoride toothpaste, which can be prescribed for children over the age of 10.

Should I buy an electric toothbrush?

A child’s teeth can be brushed perfectly well with a normal (manual) toothbrush, in fact for some autistic children an electric brush can be very disturbing. However, if your child has sensory-seeking behaviours, then they may enjoy using an electric toothbrush. Older children may find it easier to use, especially if
they have dyspraxia. If you do buy an electric toothbrush, choose one with a small oscillating head.
You can buy special toothbrushes, which brush the sides and top of the teeth at the same time. This can help, especially if your child likes chewing the brush.

Because it can be difficult to brush an autistic child’s teeth, their mouths may have more plaque, and the gums might be more red and inflamed or even bleeding. The good news is that with improved and regular cleaning, the bleeding will stop and the gums will become firmer and look a healthy colour.

Diet and dental health

Dental decay is caused by sugar. There may be challenges for parents around choosing foods and drinks which are low in sugar. Your child may:

• be more likely to have feeding problems than non-autistic children (often linked to sensory needs)
• eat a narrower range of foods
• have a strong preference for foods of the same colour or with familiar packaging

It is important to try to limit the number of times a child has sweet foods and drinks during the day – try to keep them to main mealtimes. Aim for safe snacks between meals which are low in sugar!

Choosing your child’s dental team

Many autistic children are successfully treated by their family dentist but your local practice may not be an appropriate setting for everyone. Autistic children need time to settle in a new environment and you need an experienced team who will recognise this and not hurry your child.

Many parents choose to take their child to an experienced Paediatric Dentistry working in the Community Dental Service (CDS) and this is especially the case where the child has a significant learning disability or other medical conditions. You can find your nearest CDS by asking at your local dental practice. Many parents may prefer their child is not kept waiting amongst other patients or in an unfamiliar environment- so at Longwood House we encourage patients to wait in their car- and the nurse calls you as soon as the clinic is ready. Your child can then come straight in and be seen.

My child’s first check-up

From the moment you enter the waiting room, dental practices can be bright, noisy, and very busy places. Many children find this distressing but provided the practice knows about your child’s sensory needs, with some consideration and sensible adjustments, the impact can be minimised. For example:

• Make sure the practice staff knows in advance that your child is on the autistic spectrum.
• Try to arrange one (or more!) quick “hello” visits beforehand so that your child can get used to the journey to the surgery, to the environment, and to the people there.
• Ask if you can take photos on your phone to make a picture story (social story) of the dental appointment and what will happen.
• Some dentists will ask you to fill in a questionnaire, which specifically asks how autism affects your child e.g. sensory areas, likes, and dislikes, dietary preferences, and communication aids. A sample questionnaire can be found on the BSPD website for you to fill in yourself and take to the dentist: www.bspd.co.uk/resources
• Ask for a visit at the beginning of the day when the waiting room is likely to be quieter and the child will not have to wait too long to be seen or ask if you can wait in the car and be called straight when the dentist is ready.
• Take anything with you which might help your child to settle and feel less anxious in the new environment e.g. toys, iPad, blankets
• Ask your practice if there is a particular dentist who has an interest or experience in caring for children with autism.

How do I know if my child has toothache?

Children with autism may have difficulty in expressing pain. It is therefore important to keep an eye out for unexplained changes in behaviour, such as disturbed sleep, otherwise unexplained emotional outbursts, changes in patterns of eating, and self-harm.

Some children who are sensory-seeking might continually put things such as fingers or toys in their mouth, such as their hands, toys, or other objects. This is known as stimming. It is easy to think that the child is doing this because of toothache but this is not always the case. It is important to get this checked out by the dentist as these habits can sometimes damage the gums or cause mouth ulcers due to friction.

What happens if my child needs dental treatment?

If your child is found to need treatment there are usually a number of options available. The most suitable way of carrying out the treatment will be discussed with you and will depend on a number of factors. These may include:

• The type and amount of treatment needed
• Your child’s age, understanding, behaviour and communication skills
• Sensory needs

Some children are able to accept dental treatment whilst they are awake in the dental chair if their dentist and the dental team take a slow and gentle approach. Other children may need extra help such as inhalational sedation (happy air), which tends to work best for children who can communicate and are not too scared. The National Autism Society has excellent advice about going to the dentist on
its website: www.autism.org.uk/about/health/dentists

However, other children may require treatment under general anaesthesia (whilst they are asleep). The advantage of this is that all the treatments can be done at the same time. All the teeth with decay will need to be treated in order to reduce the chance of this procedure having to be repeated.

General anaesthetics are usually carried out safely in hospitals with highly trained staff. Some of the disadvantages of this approach are that the environment will be unfamiliar, the family may have to travel to the hospital, and also the child will need to have food and drink restricted beforehand.

As with visiting the dentist, you can ask the clinical team if you can prepare your child with a photo journey. Also, you can ask your dental team when they make the referral if your child can be placed ‘first on the list, to minimise waiting time.

It may be possible to work with a play therapist at the hospital who will support you and your child. You can also download symbols and storyboards (Widgit symbols, for example) from the internet to help prepare your child.

Contacting Longwood House Dental

At Longwood House Dental we are delighted to have Dr. Anand on our team. She is a specialist in Paediatric (Children’s) dentistry and Oral Surgery and completed her specialization in Paediatric Dentistry at Guys Hospital in 2006. She was further awarded a fellowship in Paediatric dentistry at the Royal College of Surgeons, England.

She is also a Consultant in Paediatric Dentistry at RNENT & The Eastman Dental Hospital and was Awarded for Clinical Excellence in 2017 by UCLH NHS Trust, London.

The staff are aware of special needs and hidden disabilities and are experienced in taking care of children with all needs.

If you would like to have a consultation with Dr. Anand call us on 020 8551 0088 to book your appointment. We will also be happy to answer any questions you may have.