Overcoming Sensory Barriers for Better Dental Care

Authored By: Eden Park Art By: Kain Wang

The whirring of the spinning machinery that enters your mouth. The sterile smell that cuts the room as soon as you step foot into the door. The bright, overhead lights that make you squint as you lay down on the office chair. The dental office is full of sensory stimuli that impacts a patient’s experience,  creating comfort or potentially triggering anxiety. Young children are especially impacted by the busy environment of a dentist’s office. Specifically, children with autism spectrum disorder (ASD) fear dental appointments due to the overstimulation of sensory stimuli, leading to life-long  consequences from the lack of proper oral habits. To raise awareness about ASD and to promote a satisfactory experience for all, researchers have explored ways to overcome these concerns and create united harmony between pediatric patients and the dental team. 

To better understand this challenge, it is necessary to understand why children with ASD experience sensory processing differences. Individuals with these differences may be hypersensitive (over-reactive) or hyposensitive (under-reactive) to sensory input processing. They are usually triggered by environmental factors, which are transmitted to the brain and processed into perception [1] (Patil & Kaple, 2023). Due to altered neural connectivity, atypical sensory modulation, and an imbalance in sensory excitation and inhibition, it leads to changes in sensitivity to various stimuli. For example, sensory gating has both the ability to reduce response to irrelevant incoming stimuli and the ability to respond to novel stimuli when a new stimulus is introduced. This altered sensory gating can lead to sensory overload. The underlying mechanisms of SPDs affect how children with ASD act and behave in every life. 

Children with ASD often struggle and become overwhelmed by unfamiliar settings, particularly those with intense sensory input. Overwhelming sensory stimuli, such as the sound of dental drills, sensation of tools grinding against their teeth, and strong antiseptic smell can trigger children with ASD to become highly stressed and present physical withdrawal, aggressive behaviors, and vocal outbursts [2] (Thomas et al., 2018). Research indicates that children with autism had significantly higher decayed, missing, or filled teeth than unaffected patients. These issues often get worse with age, further aggravating oral health disparities. Additionally, many children with ASD prefer soft and sweetened food, which they may hold inside their mouths due to poor tongue coordination [3] (Jaber, 2011). This behavior increases the susceptibility to dental caries and highlights the urgency for dental programs to recognize and address challenges faced by children with ASD.

Strengthening oral health initiatives for children with ASD consists of various strategies. First, collaboration with caregivers must be prioritized to improve communication. Parents and caregivers play a crucial role in their children’s oral health, and for children with ASD, as they are the experts and advocates for their children. Dentists should discuss with caregivers to determine the patient’s needs, reinforce good oral hygiene practices, and provide guidance before dental visits. Second, dental providers need to incorporate behavioral intervention and visual tools in their practice. Studies have shown that using visual tools, such as videos and photographs, prepares children for their first dental examination and cleaning [4] (Pastore et al., 2023). Allowing children to touch and familiarize them with the process and machinery both reduces anxiety, and improves cooperation. Finally, pre-visit preparations must be completed at home. This initiative is an experience for children to prepare for appointments at home by interacting with behavior programs to teach sitting skills and familiarization with dental environments [5] (Delli et al., 2013). Emphasizing these aspects promotes a more inclusive dental approach for each individual, ensuring a personalized and supportive experience for each child.

The collaboration between children with ASD, their caregivers, and the dental office is pivotal in improving the dental experience and long-term oral health. More research and practical solutions are needed to reduce anxiety and enhance accessibility to ensure that all children receive the equitable dental care they deserve. Dentists must foster understanding and commit to creating an environment where children with ASD feel safe, supported, and included in the dental community.

References

1. Delli, K., Reichart, Pa., Bornstein, Mm., & Livas, C. (2013). Management of children with autism spectrum disorder in the dental setting: Concerns, behavioural approaches and recommendations. Medicina Oral Patología Oral y Cirugia Bucal, e862–e868. https://doi.org/10.4317/medoral.19084

2. Jaber, M. A. (2011). Dental caries experience, oral health status and treatment needs of dental patients with autism. Journal of Applied Oral Science, 19(3), 212–217. https://doi.org/10.1590/S1678-77572011000300006

3. Pastore, I., Bedin, E., Marzari, G., Bassi, F., Gallo, C., & Mucignat-Caretta, C. (2023). Behavioral guidance for improving dental care in autistic spectrum disorders. Frontiers in Psychiatry, 14, 1272638. https://doi.org/10.3389/fpsyt.2023.1272638

4. Patil, O., & Kaple, M. (2023). Sensory Processing Differences in Individuals With Autism Spectrum Disorder: A Narrative Review of Underlying Mechanisms and Sensory-Based Interventions. Cureus. https://doi.org/10.7759/cureus.48020

5. Thomas, N., Blake, S., Morris, C., & Moles, D. R. (2018). Autism and primary care dentistry: Parents’ experiences of taking children with autism or working diagnosis of autism for dental examinations. International Journal of Paediatric Dentistry, 28(2), 226–238. https://doi.org/10.1111/ipd.12345