May 12, 2020
by Jennifer Grzebien, RDH
It was in March of 2019 that my daughter was diagnosed with autism at a support level 3, just before her 3rd birthday. This means that she requires substantial support in order to get through her day. Since then, I have spent endless hours reading articles, books and anything that would allow me to better help and understand my non-verbal autistic child. As a mother and hygienist, I have learned quite quickly the obstacles facing those who care for those with autism. Autistic individuals can have issues in all aspects of their life from oral hygiene, bathing, dressing, eating, sleeping, self-regulation, communication, behavioural and sensory.
Autism is a spectrum disorder, which means it can present itself in many ways. It is not a cookie-cutter disorder and those affected can learn and move along the spectrum. Over time, they may learn to overcome certain obstacles. Every child is unique and, coupled with autism, this uniqueness is magnified as the child will have a whole new set of obstacles to face.
One of the greatest challenges for autistic individuals is that of communication and the inability to interact with others. Many suffer with the inability to express their thoughts, desires, joys, sadness, pain, frustrations, or feelings of being cold, hot, hurt, hungry, tired, upset or sick. The ability to express ourselves and to connect with the world around us is something that most people take for granted. These individuals have intelligence like you or I; they are simply trapped in their heads and unable to communicate their thoughts to others. Understanding these challenges and finding ways to connect with autistic individuals requires patience and effort.
Those with autism often take in what is going on around them all at once. Over time, they learn to filter this input and focus on the information of value to them. When those with autism feel overwhelmed with input, they may cover their ears. This is to lessen and sometimes to alter the way the input sounds. They may also make humming sounds; this is simply them creating output to block the input.
When treating an individual with autism, having an in-depth talk with the client or client’s caregiver prior to the appointment is crucial to having a successful appointment. Autistic individuals often have sensory issues. Knowing those issues is important in order to not overwhelm the client during the appointment. Here are some questions you could ask:
1. Is the client sensitive to noise? If they are, you may want to try to keep the use of the ultrasonic, suction and hand piece to a minimum, or eliminate them all together. They may not be able to tolerate the noise at all and you will quickly see a reaction from the client if they find these sounds overwhelming. Also keep the music in the room low or turn it off altogether, if possible.
2. Does the client get overwhelmed with too many people in the room? If they do, let the other staff know not to enter your room while you are seeing this client.
3. Do they have any dislikes? They may not be able to tolerate the air/water syringe, the prophy paste or any number of things during a hygiene appointment.
4. Is there something that the client is fond of, such as a TV show? Things like this can be helpful motivators for the client to focus. For example, my daughter loves “Paw Patrol” so I could put “Paw Patrol” on the TV during her appointment.
When seeing an individual with autism, ensure that you have booked enough time for the appointment. Also, make sure the appointment time coincides with the time of day the client finds easiest to manage.
The client may not be able to tolerate items in their mouth for very long so you may have to make several quick trips into and out of their mouth, taking longer than a typical client. Otherwise they may become overwhelmed and can break down and start to cry, or express frustration by slapping your hand away. This is important to know in order to maintain safety when you have instruments in their mouth. Always pay attention to the client’s mood and, as soon as you see them becoming frustrated, stop whatever it is that you are doing. Do not overwhelm the client to the point of a breakdown. They may also not be able to keep their mouth open for long periods or be able to stay still, which may lengthen the appointment. Consider bringing them back for multiple appointments if you are unable to get through treatment in just one.
If the client can tolerate a fluoride varnish, it can be very helpful. Also, if the client is able to tolerate a bite block this can be helpful to help prevent injury to the clinician’s fingers if the client tends to bite down or close their mouth frequently. One of the best ways of achieving positive appointments is simply getting to know the client over time. Autistic individuals love familiarity and routine. So even if your first appointment doesn’t go so well, don’t give up.
Homecare is another aspect where support is needed. For example, find out if the client is swallowing toothpaste. If so, recommend one that is safer for consumption. Also, if they chew on the toothbrush, then a plastic one is safest as a bamboo brush might break and splinter in the mouth. Brushing may also take longer than usual at home due to them being unable to focus or tolerate items in the mouth. So once again, you may have to make several quick trips in with the toothbrush, which will take more time. Finding a toothpaste that they can tolerate is very helpful. You can do this by finding one that has a flavour and texture that the client likes. If they swallow, a mouth wash is not recommended. If they bite whatever is in their mouth, this makes it difficult to implement flossing or interdental aids as you don’t want to place your fingers in their mouth and risk injury.
Caring for those with autism is a lifelong commitment where you build on small achievements over time. Remember: just because they might not look like they are listening or paying attention to you, doesn’t mean that they aren’t. Many autistic individuals find it overwhelming to look at someone’s face. It is as if their brains take a thousand photos at once and it can be too much to process. They are often listening, even when it doesn’t seem that way.
Getting to know and learning to connect with your autistic client can be very rewarding. Working with them and watching them overcome their obstacles is a demonstration of the hidden intelligence, strength and perseverance that these individuals possess. You have the privilege to be just one of many support staff that hopefully can support them in their daily life. The best part is when you get a hug, a smile or a high five!
About the Author
Jennifer Grzebien is an independent RDH who specializes in severe dental phobias and special needs. With over 8 years of experience and over half of that working independently, she provides a very unique personalized experience for her clients, working closely with them in order to overcome their fears, anxieties and barriers to care in order to achieve their oral health goals.