A New Dental Program to Mirror

A New Dental Program to Mirror



pediatric dentistryAre you nervous about your child’s next Dental visit?  Does your child resist changes in plans?  Do you feel your child needs more protection, compared to other children, in new environments?  Do you notice that your child reacts in unusual ways to sights, sounds, touch & textures?  Does your child become hyper when in noisy environments?

If so, your child may need extra support when visiting the dentist.

A New Dental Program to Mirror

Travis Nelson DDS, MSD, MPH at the University of Washington (UW) Center for Pediatric Dentistry, has been developing a new program to support a positive experience for children with Autism while they receive dental care. His program includes:

Collecting information on an extensive parent questionnaire, identifying factors may interfere and may support a child’s comfort and participation in the dental visit.  Below is an overview of what the questionnaire covers:

  • Medical Background: Diagnosis and Allergies
  • Communication style
  • Triggers (noise, touch, bright lights)
  • Activity level
  • Preferred activities, rewarding & calming activities
  • Oral sensitivities
  • Participation in hygiene habits

Providing a social story specific to the UW Center for Pediatric Dentistry describing a child’s first trip to the dentist. Families can read this story prior to visiting the Center.  This social story includes actual photographs of both inside and outside of clinic; dental tools; and the dental staff.  Build your very own social story with this template.

Adjusting the pace of introducing the dental clinic and procedures to match the child’s pacing and comfort level; staying flexible in order to meet the child’s needs. The child may only tour the office or sit in the dentist’ chair, before showing sings of distress. This pacing allows each child to gradually habituate to the dental clinic over series of visits before completing the routine dental exam, for a small fee. The dental staff is always ready to complete the exam, when the child is ready.

Sensory Adaptations: At the UW Center, the child has the option of using a private room, holding a calming fidget item, or sitting in parents lap during dental procedures. Additional sensory adaptations include:

  • Providing social story for the routine of a dental visit
  • Providing optional private room to limit random sights and sounds
  • Lowering lighting
  • Allowing child to hold a comfort or fidget item
  • Allowing for child to sit on parent’s lap or Knee to Knee with dentist
  • Adjusting pace of intervention in response to signs of stress
  • Displaying name tags of staff members with identifying pictures to child
  • Showing children dental instruments before using them

Environmental Adaptations: The UW Center for Pediatric Dentistry has smaller furniture for smaller bodies! Environmental adaptations include:

  • Smaller dental chairs for child’s examination
  • Sinks and garbage cans and reception desk at lower heights
  • Parents are expected to stay with child during the examination!
  • Couches within dental area for parents to sit and be ready to support child’s participation.

Supports to Overcome Barriers: Social worker, Heather Marks, MSW, works at the U.W. Center for Pediatric Dentistry to help families connect to resources to overcome barriers to receiving dental care.

“The primary barriers to families are those of finances and transportation,” she explained, “her department connects families to resources.” The Social Work Department at the UW Center of Pediatric Dentistry is funded both by the Washington State program for Accessing Baby and Child Dentistry (ABCD), and the Floyd and Delores Jones Foundation. According to Marks, founder and philanthropist Floyd U. Jones has donated about $150,000 to date, to support social work in the Department of Pediatric Dentistry. Thanks to the donations of the the Floyd and Delores Foundation and the support by the State of Washington, her department continues supporting families with limited resources, to improve their dental health. Dr. Nelson and his staff extend the vision of improving children’s access to dental health services by educating families in homeless shelters, community health fairs and school districts.

So far, Dr. Nelson and his patients have enjoyed success with the program he has developed. Thanks to Dr. Nelson, more children now have improved oral health, that would otherwise be too afraid, or have too many poor behaviors, to complete a dental visit. Dr. Nelson’s program at the UW Center for Pediatric Dentistry is the leading regional trainer for dentists wishing to specialize in pediatrics!

Latest Trends for Creating Sensory Adapted Dental Environments

Internationally, the phrase “Sensory Adapted Dental Environment, (SDE)” is gaining more prominence. Initial trials, with the Snoezelen MultiSensory Environment for dentists offices, note decreased signs and symptoms of anxiety of typically developing children while undergoing dental procedures (3). Sensory adaptations included:

Lighting for the dentist provided by a narrow beamed, LED, headlight;

Visual distraction for the child provided by a ROMPA ® solar projector, which projected a series of rotating colors against white netting just in the child’s field of vision;

Rhythmic music with bass amplifier hooked to dental chair, and

Layering of an Xray vest over child during exam.

Initial results were hopeful, however, further research needs to be completed, as this study used a small, readily available sample size; and the children experienced relatively non-invasive dental procedures.

Reducing Anxiety

At the University of Southern California (USC), the National Institute of Dental and Craniofacial Research has funded lead researcher and professor Sharon Cermark to take the next step. Her research, which is being conducted at the USC Division of Occupational Science and Occupational Therapy with the Herman Ostrow School of Dentistry, is trying to define which sensory adaptations should be included in a more extensive pilot study. So far, results indicate that adaptations of “swapping fluorescent light bulbs for softer colored ones, playing relaxing music and utilizing butterfly wraps” may help ease anxiety (2).

An OT and Dentist Brainstorm Solutions

Occupational Therapist, Heather M. Kuhanjeck and Elizabeth Cipes Chisholm, DMD (1), have developed an extensive list of sensory accommodations that may be incorporated into dental routines for children with autism and sensory processing difficulties. The article may be downloaded, free of charge. Overview of Kuhanjeck and Chisholm Suggestions include:

  • Prepare child for visit: Use words and pictures to label sensory input
  • Provide visual and verbal time limits (such as visual timer or counting) to show when stimulus will end
  • Decrease intensity of possible adverse sensory input
    • Smells: Decrease odors from gloves, paste, perfumes
    • Touch: Use firm touch (not light)
    • Avoid gritty paste
    • Allow more rinsing
  • Visual
    • Use transparent face shields instead of masks
    • Allow child to wear sunglasses
  • Movement: Have chair fully reclined before child arrives.
  • Auditory: Provide headphones with music or white-noise machine to mask background noises.
  • Dentists to collaborate with parents on calming strategies for visit. For example, child may
    • Hold mini massager against jaw
    • Wear Xray vest
    • Do “heavy work” exercises during session
    • Wear tight hat, for “deep pressure.”

Hopefully, more children will access effective, successful dental care, as evidence builds to support the effectiveness of:

• Incorporating sensory adaptations into dental visits
• Having the dentist follow at the child’s pace
• Providing visual structure, such as social stories, to children’s dental visits.

To find a dentist for your child, connect to your social network, or refer to the brochure readily available online, for more steps:

Healthy Smiles for Autism: Oral Hygiene Tips for Children with Autism Disorder.

Good luck!  May your Child’s Oral Hygiene be Healthy!

Editorial comment: This is a great resource to share with your dental office.  Please feel free to send your dentist the link to this article or print it out.  Help to raise awareness of sensory adapted dental environments.

References

1) H. M. Kuhaneck & E. C. Chisholm, DMD. (2012). “Improving Dental Visits for Individuals with Autism Spectrum Disorders through an Understanding of Sensory Processing” Occupational Therapy Faculty Publications. Downloaded 02.13.2014

2) D. Pritchard (2014). “Study: Sensory Adapted Dental Environments.” Daily Digest. Downloaded 02.18.2015

3) Shapiro M, Melmed RN, Sgan-Cohen HD, Eli I, & Parush S. (2007). “Behavioral and physiological effect of dental environment sensory adaptation on children’s dental anxiety.” Eur J Oral Sci: 115: 479–483. Downloaded 02.13.2014