Each individual can be totally different as there exists a broad variation of autistic disorders
Highly individual and truly empathetic approach, with well understanding of the background
Initial assessment of general behaviour. Pre-questionnaire can be sent to patient/parents via post with questions regarding patients preferences, fears, phobias, impairments, communication, etc.
Long acclimatization. Being very patient and listen to patient. Lots of reassurance all the way
Empathetic attitude, respect, knowledge and practical competences.
Quiet voice, keep movements to minimum
Use of simple short phrases, repetitions and reassurance,
Clear explanations about findings and proposed treatment
Variations of different types and manifestations
Young patients often focus obsessively on certain subjects, eg. games, movies, cards, dinosaurs, etc.
Non-verbal communication vitally important ! body language much more essential than words. The reason, why autistic patients do not respond well to inhalation sedation – they just to not listen verbal instructions.
Patient may ask a bit unusual questions, eg. “how old are a dentist?” or the opposite – may answer in a repetitive way while asking about eg. brushing: ” I do not know”.
Patients usually less talkative and quiet, allow a longer time for an answer
Short attention span, likely to be distracted, keep appointment time short and simple
Non-verbal communication vitally important !, do not rely on verbal communication ! Some ASD patients do not listen at all.
Good and enhanced ‘peripheral vision’ (“sideways looking”), it means patients can be a very good observers and constantly monitor what is going on around them
Difficulties with maintaining of eye contact but not always.
Some autistic patients can be very chatty (‘chatta box’) and clever.
Dental chair has to be reclined slowly , with pre-warning, some patients do not like ‘flat position’, prefer sitting upright. Dental chair movements demo and gradual familiarization
Little distractions always helpful for young patients, eg. blowing out baloon made of dental glove, pt can draw a smiling face on it.
There is no a single ‘golden advice’ how to manage autistic pt.
Clear explanations regarding aetiology of caries/periodontal diseases (adult patients)
Non-pharmacologic bahaviour management techniques: tell-show-do, positive reinforcement, voice control, humour, protective stabilization.
Way of communication is paramount: discussion with the caregiver/parents about techniques they have found to be effective in managing the patient’s behavior. Share your ideas with them, and find out what motivates the patient. It may be that a new toothbrush at the end of each appointment is all it takes to ensure cooperation.
Patient should be scheduled early in the day if possible. Early appointments can help ensure that everyone is alert and attentive and that waiting time is reduced.
Successful visit needs to by involve the entire dental team from the receptionist’s friendly greeting to the caring attitude of the dental assistant in the operatory.
Repetetive bahaviour can be nicely adjusted in dental settings by using also stereotypical behaviours in our favour.
Oral care provision in an environment with few distractions. Try to reduce unnecessary sights, sounds, or other stimuli that might make it difficult for your patient to cooperate. Some patients, however, enjoy music and may be comforted by hearing it in the dental office during treatment.
Step-by-step evaluation plan, starting with seating the patient in the dental chair. If this is successful, perform an oral examination using only your fingers. If this, too, goes well, begin using dental instruments. Prophylaxis is the next step, followed by dental radiographs. Several visits may be needed to accomplish these tasks.
Consistent in all aspects of providing oral health care. Use the same staff, dental operatory, appointment times, and other details to help sustain familiarity. The more consistency you provide for your patients, the more likely that they will be cooperative. Comfort people who resist oral care and reward cooperative behavior with compliments throughout the appointment.
Unfamiliar environment in the dental office, strong light, suction noice or high speed noice ‘taste’ of dental materials (eg. ZnOE) may trigger autistic behaviours
Unflavoured and non-foaming toothpaste can be better accepted by autistic patients.
Conscious sedation techniques often helpful
General anaesthesia can be the only option to complete more complex dental treatment (extractions, multiple restorations)
The use of Makaton language sometimes halpful as a means of communication to patients who cannot communicate efficiently by speaking
Avoid highly distractive elements in dental surgery (bright light, noise)
Paradoxically, some patient with autistic spectrum disorder seem to be more compliant with dental treatment, than ‘routine’ patient, depending on type, severity, degree of autism.
Do not assume, that ‘quiet’ patient with autism would be fully cooperative.
Conduct disorder – antisocial behaviour, ‘too mature’ way of talking
Some meds for ADHD , with extended release (Quillivant XR) couse side effects such as: decreased appetite/weight loss and sleep problems. Patients may act in a strange way: no food intake during the day and obsessive eatign at night, risk of rampant caries
Reactions can be unpredictable: screeming, tears, agitation
Dental procedures may trigger autistic behaviour: sucction, injection, etc.
‘Dental Passport’ can be be useful, with pt’s photo and details: what pt likes, what sort of fears pt is having
Highly individual (customised) treatment plan – ideally sent via letter to parents following dental exam – is a very good option! Clear statement point by point re: oral hygiene regime, diet, adjuvant technique and aids
Step-wise technique should be used, with the use of ZnOE, GIC or Biodentine to acclimatise patient with more invasive dental treatment
Bulk composite to accelerate procedural time as short attention span
UV toothbrush sanitiser as a ‘dental gadget’ which may encourage for regular brushing
Give enough time to patient to allow him/her to gradually build up the confidence
Postpone non-urgent procedures if not trully necessary
Leave ‘ready to exfoliate’ teeth to come out in natural way
To monitor eg. retained deciduous teeth/roots if asymptomatic
‘social stories’ using pictures – is extremelly useful way for accliatisation of autistic patient
Colour pictures can be used to make patient familiar with dental offcie
Gentle clinical holding or just head support by: stabilizing patient’s head/mandible between hands preventing from involuntary movements.
Even just a slight touching within temporal/cheek areas may make patient much more calm, relaxed and compliant.
The ipad app. cADET (in French) to teach autistic child proper brushing
Groups of patients – range;
1. extremely quiet, withdrawn, polite, hypoactive
2. interrupted speach, sudden reactions,
3. wants to know everything about dentally-related issues
4. just scarred/anxious
5. talkative, many questions all over
Persons with autistic spectrum disorders can be also successfully manager in general dental practice by using well prepared and structured sessions, including: perparation, maintaining contact, using stereotypical bevaiours in our favour, assimilation and feedback.