Most of parents and those with AS (or NLD) know that a trip to the dentist can be a non-preferred experience to put it mildly, or to put it another way, they can be dead set against it. This blog is to briefly explore why a visit causes so much anxiety, and then to get practical advice, 9 tips about working with the dentist’s office to make the experience better.
Why is the dentist’s office such as challenge? We all know doctor’s offices have needles. Dentists have needles and more. There’s a long list. Many dentists don’t explain exactly what’s going to happen in a procedure. Or, if they explain, it’s a general overview and not the step-by-step detail needed by many with AS. Dealing with unexpected situations is always problematic.
Many with AS and NLD have sensory hypersensitivities, and the dentist visit provides many sensory challenges. The experience of being in the dentist’s chair can be novel and discomforting for someone unused to have his or her body tilted in space. Then a bright light shines right in the patient’s face, a challenge for the visually sensitive. The whizzing and grinding sounds of dentist’s instruments can be frightening to neurotypicals; for someone with auditory sensitivity, they can be very hard to tolerate. There’s also that needle for anesthetizing the gum, which can trigger immediate anxiety. And last, but not least, there’s the tactile sensations of water being squirted in the mouth, having to hold the mouth open, and having someone’s hands touching the mouth.
Parents of children near pediatric dentists can choose to go to them; these dentists have training in ASD challenges. However, dentists with this specialty aren’t available everywhere, and as people with AS continually remind me, adults don’t necessarily grow out of finding these experiences difficult.
I had a 12-year-old boy who would start crying days before a dentist’s visit. On the big day, he would be dragged there, only to bolt out the door as soon as possible. After a chase, he’d be caught and held while the dentist tried to work, but this does take some degree of cooperation from the patient.
What to do to improve the situation? Here are some tangible ideas. They won’t make the experience wonderful, but they might help.
- Have someone explain in age-appropriate detail what’s going to happen. For older children – adults, this might be a verbal explanation, perhaps even written down. For young children, there could be a storyboard with cartoon figures showing a step-by-step process.
- Be aware of the issue of the chair. It’s possible to find reclining chairs at home or at stores, and for the prospective patient to have the experience of lying in one out of a triggering context. If not, the patient could be allowed to sit in the dentist chair and have a chance to get used to the feeling.
- The bright light is necessary for the dentist. A patient or parent might bring something to cover the eyes without covering much of the face, and try this out ahead of time.
- The dentist should demonstrate the sounds of the instruments before starting the work. While it’s not going to drown out the noise, it could be possible to bring ear bud (or other small) headphones and favorite music on a phone, so something more soothing is available as a focus.
- The feeling of holding the mouth open can be practiced before if it’s uncomfortable, and the dentist can allow the patient to feel the instruments in his or her mouth before the work begins.
- The water is necessary for the process. Dentists use suction to keep the water under control; being allowed to spit out water more frequently can help. Again, allowing a patient to experience the water squirting (and spitting it out) before anything else is done is a helpful preview.
- The attitude of the dentist is critical. If the dentist is respectful, sensitive to the issues of the patient, shows patience with demonstrating and gives the patient time to get used to an experience, this can improve things significantly. Even younger patients with AS can be exquisitely sensitive to disrespect and condescension.
- Understanding is probably unusual for adults who are expected to have “gotten over it.” Adults still dealing with sensory issues need respect.
- It can be important to have strategies for getting fatigued or upset. The dentist might have a signal for needing a break from holding the mouth open. Whether and when it’s possible to take a self-calming break is a good question to ask in advance. Some with AS and NLD benefit from calming sensory tools, such as a weighted vest or some other source of sensory stimulation.
The experience of going to the dentist is difficult, but it can be improved. Having a positive relationship with the dentist, previewing the experience and creating sensory accommodations will certainly make a visit much more tolerable.