How Dental Visits Can Be Made Less Stressful For Autistic Children

Autistic children tend to struggle with poor oral health a lot more than their neurotypical peers. Everything from accessing dental treatments to tolerating clinical set-ups is an uphill battle because of sensory issues that make autistic children hypersensitive towards harsh fluorescent lights, loud sounds, smells, and physical touch.

But despite the fact that one in 36 children are autistic, there are no clinical dental protocols in place which accommodate their needs. To make matters worse, dentists are not trained to treat autistic children and in many cases, even unwilling to do so. This has resulted in countless autistic children feeling overwhelmed, anxious, and stressed out before, during, and even after visiting the dentist’s clinic. In a new study published in JAMA, researchers found that tweaking the environment of an average dental office that meet autistic children’s sensory needs can significantly reduce the anxiety and behavioral distress they experience while undergoing treatment.

The team enrolled 162 autistic children aged six to 12 years old in their clinical trial. More than 75% of them were white. While 83 children received dental treatments in a regular office, the other 80 went to a dental clinic that had a sensory-adapted environment.

Each one of them participated in two routine dental clean-ups that took place around six months apart. The group of autistic children who went to the sensory-adapted dental clinic had radically different experiences because all overhead fluorescent lights — including the dental operatory lamp — were turned off. Windows were covered with darkening curtains. The pediatric dentist instead used a glass-mounted headlight that specifically directed light into the child’s mouth and avoided their eyes. A projector created slow-moving visual effects chosen by the child that included bubbles or fishes on the ceiling. Classic music with nature sounds was played in the room through a small speaker.

Also, most of the children were given a butterfly wrap that was weighted with a pediatric dental radiograph vest. The butterfly wrap was placed around the dental chair in a way that the wings wrapped around the child’s shoulders and went all the way down to their ankles — mimicking a deep hugging sensation. In the event any of the 80 children felt uncomfortable with either of the sensory stimuli, the dentists discontinued using it. More than 90% used the projector, music, and head lamp, and also preferred having the lights switched off. And at least 74% used the butterfly wrap without complaints.

The researchers video recorded the children during their dental cleanings to observe their behaviors and stress levels. They observed that the children who were treated in the regular dental clinics without any changes made to the set-up experienced severe distress and screamed, whimpered and/or cried during their clean ups. Whereas those who received sensory adaptations were a lot more calm and relaxed and also less anxious while undergoing dental clean ups.

“This finding supports previous studies reporting the efficacy of a sensory-adapted dental environment to decrease a variety of physiological measures of stress and anxiety in smaller sample sizes of autistic children, children with developmental disabilities and adults with intellectual and developmental disabilities,” the researchers wrote in the JAMA study.

They further highlighted that the sensory-adapted dental environment approach is highly scalable. “It requires minimal training to implement, is easily portable, does not involve renovations, requires only 5 to 10 minutes to set up or remove, and incurs a 1-time cost of less than $6000,” they added. “In practice settings, this equipment could remain set up indefinitely, with clinicians able to use (or not use) sensory-adapted dental environment adaptations for any given patient. Due to the simplicity and high scalability of sensory-adapted dental environment, it has outstanding potential to be readily implemented into dental clinics nationwide.”

“In fact, The American Academy of Pediatric Dentistry recently added this approach to their best practices for behavioral guidance as a potential technique for dental patients with anxiety or special health care needs,” the researchers wrote. “This is important because enhancing oral care is critical for autistic children; this intervention may also be beneficial for populations beyond autism.”