Tips for Managing Dental Patients With Autism

What Is Autism? 

ASD is a group of conditions related to the development of the brain — also known as a neurodevelopmental disorder.²  

People with autism may have differences in communication and how they interact with others. They may also exhibit behaviours and interests that may seem unusual to some people. Autism is a spectrum of disorders, and each individual will experience symptoms differently. Some people may need little to no support, while others may require help from a caretaker every day.  

Symptoms of ASD may include:³ 

• Avoiding eye contact 
• Lack of facial expressions 
• Difficulty expressing desires 
• Difficulty following directions 
• Difficulty understanding how others feel 
• Anxiety in unfamiliar situations or locations 
• Difficulty understanding new information 
• Repetitive behaviours (such as hand flapping or rocking) 

Autism can be diagnosed in children as young as 18 months, but most children are not diagnosed until after the age of 3.^4,5  

The goal of autism treatment is to reduce the symptoms that interfere with quality of life. Currently available treatments include behavioural, developmental, educational, and social-relational approaches.²  

Challenges in Managing Patients With Autism 

Providing quality care for patients with autism can be challenging.  

Oral Health 

Several dental problems are common in patients with autism, including:⁶ 

• Anterior open bite 
• Dental crowding 
• Bruxism 
• Tongue thrusting 
• Lip biting 

 However, several studies have found that children with autism have fewer caries related to healthy siblings or other developmentally disabled children. The reason for this is unclear. It could be related to eating habits. Children with autism usually have very regular dietary habits with low carbohydrate intake and rarely snack in between meals. It may also be related to high rates of caregiver oversight of dental hygiene routines.⁶  

Difficulty With Change and Unfamiliar Environments 

Many people with autism may prefer to have a routine they stick to every day. Any deviation from the normal routine can be difficult to deal with.⁷  

A visit to the dentist represents a major change to the daily routine and can be a source of anxiety for people with autism.  

Difficulties Communicating and Understanding 

People with autism may have difficulty communicating their own needs or feelings, leading to expressions of frustration and anger. Similarly, a person with autism may get frustrated if they do not understand what is expected of them.⁸  

Sensory Overload and Overstimulation 

Up to 90% of children with autism experience an unusual response to sensory information. A visit to the dentist involves all five senses — sight, hearing, touch, smell, and taste. When too much sensory information floods the senses, sensory overload can result.⁹  

If a person with autism is overstimulated as a result of sensory overload, it may manifest as anxiety, irritability, difficulty focusing, or physical pain. Some people may exhibit self-stimulatory behaviours (also known as stimming) as a way of regulating their emotions.¹⁰  

3 Tips for Overcoming Challenges 

The following tips can help dental providers overcome challenges when caring for patients with autism. 

1. Develop a Relationship With the Patient and Caregiver 

A good relationship with the patient and caregivers can help facilitate a successful visit and improve outcomes. A pre-visit meeting with the patient’s family or caregivers without the patient with autism present can help set expectations for the visit^.6  

It may also be helpful to start the relationship with short visits so the patient can become familiar with the dental office and procedures. Showing the patient all of the instruments that will be used during the visit may also help decrease anxiety.^6,11  

Additional staff training may be necessary to make sure that everyone in the dental office understands how to communicate with the patient and family. The caregivers or therapists may use social stories to help prepare the patient for a dental visit.^6,11  

 Ending each visit on a positive note can help build a strong relationship.¹¹  

2. Communicate Clearly

Patients with autism may have difficulty understanding instructions. Dental providers may have to use different strategies to make sure they are understood, such as:^6,11 

• Speak in a calm, soothing voice 
• Come down to the patient’s level 
• Let the patient know what will happen next  

People with autism may have different ways of learning new information. Other ways to communicate that may be helpful include:^6,11 

• Use pictures or diagrams whenever possible 
• Use assistive communication devices  
• Use tell-show-do when teaching a new skill  

3. Prepare the Office

If a patient becomes overstimulated with sensory information, a few changes to the office can make the visit more comfortable for them. Examples of ways to reduce sensory stimuli include:11 

• Dimming the lights 
• Turning down loud noises (such as phones, televisions, or music) 
• Removing clutter  

References: 

1. Autism Europe. Prevalence rate of autism. Accessed November 22, 2023. https://www.autismeurope.org/about-autism/prevalence-rate-of-autism/  
2. Cleveland Clinic. Autism spectrum disorder. Updated February 26, 2023. Accessed November 22, 2023. https://my.clevelandclinic.org/health/diseases/8855-autism 
3. NHS. What is autism? Updated September 7, 2022. Accessed November 22, 2023. https://www.nhs.uk/conditions/autism/what-is-autism/ 
4. Centers for Disease Control and Prevention. Screening and diagnosis of autism spectrum disorder. Updated March 31, 2023. Accessed November 22, 2023. https://www.cdc.gov/ncbddd/autism/screening.html 
5. National Institute of Child Health and Human Development. When do children usually show symptoms of autism? Updated January 31, 2017. Accessed November 22, 2023. https://www.nichd.nih.gov/health/topics/autism/conditioninfo/symptoms-appear#: 
6. Delli K, Reichart PA, Bornstein MM, Livas C. Management of children with autism spectrum disorder in the dental setting: concerns, behavioural approaches and recommendations. Med Oral Patol Oral Cir Bucal. 2013 Nov 1;18(6):e862-8. doi: 10.4317/medoral.19084. PMID: 23986012; PMCID: PMC3854078.
7. National Autistic Society. Dealing with change. Updated August 14, 2020. Accessed November 22, 2023. https://www.autism.org.uk/advice-and-guidance/topics/behaviour/dealing-with-change/all-audiences 
8. National Autistic Society. Autism and anger management - a guide for parents and carers. Updated August 14, 2020. Accessed November 22, 2023. https://www.autism.org.uk/advice-and-guidance/topics/behaviour/anger-management/parents 
9. Suarez MA. Sensory processing in children with autism spectrum disorders and impact on functioning. Pediatr Clin North Am. 2012 Feb;59(1):203-214, xii-xiii. doi: 10.1016/j.pcl.2011.10.012. PMID: 22284803.
10. National Autistic Society. Sensory differences - a guide for all audiences. Updated September 20, 2020. Accessed November 22, 2023. https://autism.org.uk/advice-and-guidance/topics/sensory-differences/sensory-differences/all-audiences 
11. Autism Speaks. Successful dental visits for children with autism. Accessed November 22, 2023. https://www.autismspeaks.org/sites/default/files/2018-08/Dental%20Guide.pdf