In this section, you'll find information for dentists about treating patients with an autism spectrum disorder (ASD).
Dental care and autism (PDF) is a leaflet produced by Michelle Golding, Senior Dental Officer, East Elmbridge and Mid Surrey CDS/PDS, to help people with an ASD and dental teams to prepare for a dental visit.
In addition, we have written the following information, Dentists - supporting adults with autism.
Dentists - supporting adults with autism
About autism spectrum disorders
An autism spectrum disorder (ASD) is a lifelong developmental disorder, including autism and Asperger syndrome. People with an ASD experience three main areas of difficulty, known as the 'triad of impairments'.
- Social interaction: difficulty recognising or understanding other people's emotions and feelings, and expressing their own.
- Social communication: difficulty with verbal and non-verbal communication, tone of voice or facial expressions.
- Social imagination: difficulty predicting what will happen next and coping with unfamiliar situations. Difficulty understanding and interpreting other people's thoughts, feelings and actions.
Each person will have different levels of ability and areas of difficulty. Levels of independence will also vary. Some people with an ASD have severe learning disabilities, and some may never speak. People with Asperger syndrome usually have an average or above average IQ, and be better able to mask some of the difficulties they experience. As well as the triad of impairments, people may:
- have sensory issues: a person may be hyper- or hypo-sensitive to stimuli such as sound, touch, pain and lights. Check with your patient or their carer.
- be resistant to change in routine, and therefore find it difficult to cope with new or unfamiliar situations, environments and people
- exhibit repetitive behaviour, which can be a way of coping with stress or sensory issues
- experience sensory overload: this is when a person reacts in 'fight or flight' mode to an environment or situation. It is possible that they could go into meltdown. Other people may become unable to communicate; this is known as ‘shutdown’
- have co-morbid conditions: for example, many people with an ASD experience anxiety. This can affect both the mind and the body, and produce a range of symptoms, often including depression. People with an ASD can vary in their ability to cope with anxiety. A higher than average percentage of people with an ASD have epilepsy. Check medication before prescribing. People with an ASD may also have dyspraxia, which can include a strong gag reflex.
Before and during treatment
- Try to minimise waiting time, as this can lead to increased anxiety.
- Always explain what is happening (for example, 'I will be checking your teeth to make sure they are in good condition') and what you are about to do ('I am going to put a small mirror inside your mouth to check your teeth. The mirror might touch the edges of your mouth'). People with an ASD often need extra time to process information, and some may prefer information to be presented visually. Easyhealth produces a selection of free leaflets for patients.
- Some people with an ASD do not like to be touched. If you need to touch them during the course of your treatment, give them plenty of warning. Clearly explain what you will be doing.
- Some people with an ASD have heightened sensitivity to light and noise. See if you can find out about potential issues before your appointment, and adapt the environment. For example, turn the radio off if a person with an ASD finds it hard to deal with this kind of 'background' noise. You may not be able to alter lighting or the noise made by equipment so if this is an issue, stress balls or visual distractions may be useful. Be aware that some people with an ASD may find equipment and the noise it makes frightening or fascinating.
- Rinses and chemicals may smell or taste more intense to people with autism. Where possible, can you offer alternatives? For example, offer a very mild mouthwash, or none at all.
- Be aware that injections and drilling, especially if accompanied by noise or other sensations such as cold water, may be particularly painful.
- Some patients with an ASD are hypo-sensitive to pain - so may not respond if you are testing for pain.
- If your patient is accompanied, it is usually best to allow their companion to be present during treatment, assuming the patient is happy with this. A companion may make communication easier for you and for the patient.
- It may help to book a double appointment, or spread treatment over several visits. This means you can take things one step at a time, and possibly help to manage a person's anxiety.
- People with autism can take things literally, so make sure you say what you mean. Avoid metaphors. Check that the person has understood you, but avoid being patronising.
- Do not rely on gestures or body language to convey information. Humour may also be misunderstood.
- With some patients, you may notice unusual body language and eye contact (some people find it easier to avoid eye contact; others may find it difficult to know how much eye contact to make, and perhaps misjudge things slightly).
- When anxious, people with an ASD may make sounds or use repetitive movements. This may be a way of coping and should be respected.
- If a person’s behaviour becomes challenging, consider why this might be in the light of their ASD. This might help you to intervene more appropriately.
You may also be interested in reading items written for parents:
British Society for Disability and Oral Health