Dental care and autism

A few years ago Temple Grandin came as my guest to Louisville, Kentucky. I had the opportunity to pick Temple up from the airport and then take her to the Seelbach hotel where she would be staying for a few days. After freshening up for a while at her room Temple came down and we went to the hotel’s restaurant. I was looking forwards to spending some time with Temple and at the same time enjoying the delicious food at the hotel’s restaurant. Unfortunately, the evening was marred as Temple had a toothache that did not allow her to enjoy dinner to the fullest.

Temple’s tooth pain was a throbbing dull ache of moderate intensity. It really bothered her. Because I was concerned, I asked Temple whether she was experiencing sensitivity to hot or cold foods or liquids and whether it stabbed her when biting down on food. Her symptoms seemed to be all over the place. It was clear that she needed to go and see a dentist and Temple recognized the fact. The pain had been ongoing for quite a while and Temple had been procrastinating going to the dentist. Ever since childhood going to the dentist had been a painful experience for her. She just could not stand the fluorescent lights starring at her from the ceiling, the smell of the dentist’s office, and the sound of the drill.

Temple was experiencing dental anxiety. The experience is somewhat akin to a postraumatic stress disorder (PTSD) derived from both her initial visits to the dentist and her hypersensitivity as an autistic individual. In addition, it is also possible that all of the different stimuli that she made reference to (e.g., sound of the drill) were automatically causing anxiety and fear by classical conditioning. Neuroscience has discovered neural mechanisms underlying anxiety disorders: in one pathway, the limbic system (primarily the amygdala) contributes to the development of a phobia, while on another pathway the frontal lobes influence the maintenance of both specific fears and generalized anxiety. I guess that once Temple’s expectations were set she was a slave to her way of thinking. Many autistic individuals build sets of rigid predictions and expectations and it is very difficult to break free from them.

I must confess that I share the same anxiety as Temple about going to the dentist, but in her case, it was higher by several orders of magnitude. My executive functions allow me to overcome my fears as I understand that, generally speaking, pain is a protective mechanism. As for tooth pain in particular, nerves inside the pulp tell you about the possibility of decay, a loose filling, a cracked tooth or even an abscess. Although, I do understand that in many cases toothache needs dental care, I do not see this as forcing me into taking a decision; rather, I sell this to myself as a way of avoiding bigger problems down the road.

I have visited a large number of clinics that take care of health related issues for autistic individuals. In regards to needs assessments, dental care usually comes within the top five of their list. When establishing a dental clinic for autistic patients I have learned that implementing a few things may help both staff and patients:

1) Always establish good communication. Explain the procedure with drawings, if possible, in advance. I find it convenient to have a dry erase board or dental models as props available for the dentist to visually explain the procedure.
2) Do not rush the procedure. Slow down the pace, as in #1 always explain what you are doing.
3) I found an innovation by a dentist, the mother of an autistic child, quite useful. It was a body pillow that fitted the length of the dentist’s chair. The pillow gave some amount of pressure around the body of the patient and served to relieve anxiety. The pillow acted as a pressure vest or a squeeze machine.
4) Have a whole body swing outside of the office. In cases of tantrums or if one is already taking place, the whole body swing may help the patient to calm down. Also, if he/she is accompanied by a caregiver/parent, both of them can go in the swing.
5) Be cognizant of the needs of a child with autism. Have a trained staff. Get referrals to service from parents at your local layman support organization.

Some additional information may be found from a dental kit for autistic individuals at http://www.autismspeaks.org/family-services/tool-kits/dental-tool-kit
A useful article from the New York times is: http://well.blogs.nytimes.com/2014/10/20/for-children-with-autism-opening-a-door-to-dental-care/?_r=0

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