April is Autism Awareness Month, and while we celebrate advances made in understanding this complex condition, families and individuals with autism spectrum disorder (ASD) continue to face obstacles in accessing quality dental care. 

According to the CDC, about 1 in 36 children in the United States has been diagnosed with ASD. This is an increase from 2018 studies that showed an incidence of 1 in 44 children with an ASD diagnosis, which means that dental providers need to be equipped and prepared to provide appropriate care for this growing population. It also means patients, their families and caregivers will need to find the appropriate dentist and health care team to safely and humanely facilitate care for ASD patients.

One of the biggest challenges for patients with ASD is sensory issues. Many patients with ASD are hypersensitive to touch, sound and light, which can make dental exams and cleanings uncomfortable or overwhelming. 

“The key part in tailoring a treatment approach for a patient with autism is to work closely with the caregivers to determine which methods may work best for their child,” said Dr. Michelle Harmon, a pediatric dentist in Watkinsville. “Some patients may have difficulty with noises and could benefit from wearing headphones during their appointment, or avoiding a loud suction and using gauze instead to wipe off the teeth after a cleaning. The taste and texture of toothpaste can also be a challenge, and we encourage some patients to bring their own toothpaste from home or to choose one of our no-flavor options.”

For children and adolescents where the sound and sensation of the handpiece is stressful, Harmon said there are many minimally invasive cavity treatment options that can allow her office to avoid a “drill and fill” approach. “Working in collaboration with the parent as a team allows is paramount,” she said. 

Many families find that patients with ASD have difficulty with oral hygiene at home, and seek out a dentist once it is apparent the patient has cavities.

“Patients with autism spectrum disorder may have heightened sensitivity to sensory stimuli, which can make routine dental procedures challenging,” said Dr. Jayni Bradley, a pediatric dentist based in Watkinsville with years of experience treating patients with ASD. “I enjoy the challenges. It seems to come naturally to me since I grew up observing how my mom interacted with her special needs brother.”

“Every person is so different and their care needs to be customized for them,” said Bradley. “Many times, extra time and patience are all that’s needed. Our goal is to take care of the disease in a calm, compassionate manner. There are times when the use of a dental anesthesiologist is needed to allow the child to tolerate multiple procedures without being traumatized.”

Communication difficulties are another major challenge for patients with ASD. Patients with ASD may have difficulty communicating their needs and understanding instructions from dental staff. This can make it hard for dental providers to determine what treatments are needed or to explain procedures to patients. 

“Communication is key when working with patients with autism spectrum disorder,” remarked Dr. Alyson White, a general dentist in Athens who treats patients with ASD. “Our patients with mild/moderate ASD do very well with repeated instruction and sometimes shorter appointments. We try to be patient and never push them to anything that is uncomfortable.”

For patients that cannot tolerate dentistry while conscious, there are options for anesthesia, White explained, whether that means staying with the dental home or being referred to a dentist with anesthesia resources.

Anxiety and fear are also common issues for patients with ASD when seeking dental care. Patients with ASD may feel anxious or fearful about dental procedures, especially if they have had negative experiences in the past. This can make it difficult for dental providers to build trust and establish a positive relationship with patients.

“Dental visits can understandably be very intimidating for parents and difficult for children with ASD. Successful visits are possible through early intervention and repetition, so parents should try to schedule their first appointment at an early age and return to their dental home often,” added Dr. Ben Popple, a Newnan-based pediatric dentist. “We may need to use techniques such as positive reinforcement, distraction, desensitization visits or sedation to help patients stay calm and cooperative during dental procedures.”

Behavioral issues can also be a challenge for patients with ASD seeking dental care. Patients with ASD may have difficulty sitting still, following directions or cooperating with dental staff. This can make it hard to maintain safety and provide care effectively.

“We need to work with patients and families to create a  calm and reassuring environment. With the patient’s input, we will schedule consistently at their preferred time, with their preferred staff and tailor the experience to their individual needs as best we can”, said Dr. Trudy-Ann Frazer, a pediatric dentist based in Smyrna and Douglasville who worked extensively with patients with ASD in her pediatric specialty residency. 

Limited access to care is another significant challenge that families and patients with ASD may face when seeking dental care. Many dental providers may not have the training or resources needed to provide appropriate care for patients with ASD. This can make it difficult for families to find dental providers who are equipped to meet their needs.

“Access to care for patients with any condition that prevents them from tolerating dentistry with local anesthesia or mild sedation and local anesthesia is a problem that can be likened to being on a life raft in the ocean, You’re thirsty, you’re surrounded by water, but you can’t drink any of it,” said Dr. John Hansford Jr, a pediatric dentist and dental anesthesiologist who works with patients with ASD. “Historically, there have been anesthesia providers and dental providers, but they’ve had limited access to being able to work together for financial, legal or myriad other external factors.” 

Northeast Georgia has several avenues for compassionate care. A few dentists have anesthesiologists come to their office, and a couple of dentists have surgery center or hospital privileges to take their patients in for anesthesia services, explained Hansford.

Overall, patients with ASD and their families face a range of challenges when seeking dental care. Dental providers who work with patients with ASD need to be equipped and prepared to address these challenges, from sensory issues to communication difficulties. By working together, dental providers, other healthcare providers, patients and families can ensure that patients with ASD receive the dental care they need in a safe and supportive environment.

Nearby dentists may be experienced with caring for patients with ASD. Give your local dentist a call about the insurance and services they offer. 

Dr. John T. Hansford Jr. is a double board certified specialist in pediatric dentistry and dental anesthesiology. He practices in Watkinsville, Athens, Lilburn and Newnan. 

(0) comments

Welcome to the discussion.

Keep it Clean. Please avoid obscene, vulgar, lewd, racist or sexually-oriented language.
Don't Threaten. Threats of harming another person will not be tolerated.
Be Truthful. Don't knowingly lie about anyone or anything.
Be Nice. No racism, sexism or any sort of -ism that is degrading to another person.
Be Proactive. Use the 'Report' link on each comment to let us know of abusive posts.
Share with Us. We'd love to hear eyewitness accounts, the history behind an article.