Special Care Dentistry
Teeth-brushing has been a skill on Charlie’s IEP for the past three years—-prior to that, I brushed his teeth or, rather, worked on teaching him to open his mouth and to tolerate having a piece of plastic and wiry bristles on his tongue and teeth. I started using an electric toothbrush for Charlie when he was 4 years old, on the advice of a dentist who had two autistic children himself; the electric toothbrush got in some extra brushing, at a slightly faster rate. If it wasn’t a good night, we often skipped the tooth-brushing and sometimes a fairly quick brush of toothpaste to the surfaces of the teeth counted as “brushing teeth.”
Over time, Charlie learned to open his mouth and to let me brush his teeth. (It also helped that he started to like the taste of one particular type of toothpaste.) We keep his toothbrush, toothpaste, and cup in a plastic bin and, as of tonight, when I tell him to brush his teeth, he gets everything out, applies toothpaste to toothbrush, brushes bottom and top left and right and the front teeth (with a reminder from me), rinses off the toothbrush (sort of), and rinses out his mouth. And puts everything away. (Well, I usually have to rinse off the toothbrush again.)
Fortunately, or maybe amazingly, Charlie has yet to have a cavity. We’re not due back at the dentist for his 6-month check-up till July and I need to start practicing with him lying on his bed and holding his mouth open and keeping his hands in his lap. We take Charlie to a pediatric dental practice that (aside from being the nicest dental office I’ve ever seen—-even Nemo might have been happy in its deluxe fish tank, for a little while) specializes in special needs kids. Charlie has seen the same dentist for the past year. He’s been able to have his teeth checked, cleaned, and polished, but not yet to have an x-ray taken.
The April 29th Daily Trojan reports about the Special Patients Clinic at the USC School of Dentistry. The clinic has been open for twenty years and uses what it describes as a “team approach” with the dentist and assistants. All students at the USC dental school “receive one week’s worth of training in the Special Patients Clinic so that all graduating dentistry students are able to provide their services to those with special needs”—this sounds good, but I wonder if one week is enough? Perhaps it would be helpful for dental students to have the opportunity to work with more than a few special needs kids?
The Daily Trojan article indeed notes that many dentistry students continue to volunteer at the clinic after the week of training. Here’s what the Special Needs Clinic does to help make dental visits successful for autistic children:
Patients with autism often need dentists to spend a great deal of time reassuring them that they are safe so they will be cooperative, [Dr. Roseann Mulligan, associate dean for community health programs and professor at the School of Dentistry] said.
“You want to approach [autistic patients] where they can see you, see what you’re doing through your body language, voice and the things you say so they don’t feel threatened or frightened,” she said.
Because patients with autism also have a hard time dealing with unusual sights, smells or sounds, the treatment they receive at the Special Patients Clinic is catered to their needs.
“The Special Patients Clinic is on the first floor. It’s a very private setting. When people come in, their needs are very specialized and we want them to feel comfortable when coming with their family members so we have individual offices for them,” [Angelica Urquijo, director of public relations at the School of Dentistry] said.
Here in New Jersey the UMDNJ Autism Center has a dentist who specializes in autistic patients; hope that more dental schools might follow suit and/or make sure that families know if they have such clinics.
You can also contact the Special Care Dentistry Association for help in locating a dentist with experience with special needs patients.
Tags: asd, asperger, autism, Dentist, Health, pdd-nos, tooth brush, toothpaste, x-ray
17 opinions for Special Care Dentistry
CS
Apr 30, 2008 at 1:05 pm
Kristina, this was a great post and I’ve bookmarked it. Can you please let me know what that toothpaste Charlie liked is?
Leanne
Apr 30, 2008 at 1:12 pm
Wow, good for Charlie. No Cavities!!
Patrick has had one filling. Our dentist is fabulous. I decided to try him with Patrick before seeking a special needs dentist. It went really well. I’m finding lately that luck has a lot to do with this kind of stuff.
Linda
Apr 30, 2008 at 2:50 pm
You are so generous sharing the experience and expertise you have learned with your son. Such a gift for which we thank you.
FXSmom
Apr 30, 2008 at 3:17 pm
how funny. i just blogged about matty’s dentist visit that happened yesterday. the dentist is never a joy. but it is getting better :)
Sarah
Apr 30, 2008 at 3:37 pm
That’s really fantastic. I wish such a thing would have been available when I was a kid, when trips to the dentist were an annual nightmare for both me and the staff. The next step is to get a similar program for opthalmology, which can be just as bad as going to the dentist IMO.
Regan
Apr 30, 2008 at 4:09 pm
Great for Charlie! Cavities are a bummer. If he has made it this far without a cavity, he is practicing great oral hygiene.
Thanks for sharing the programs; I will reinvestigate what we have going in our state.
Sidebar: Did you know that some lucky people who have terrible hygiene never get cavities because their body chemistry does not support the caries-forming bacteria? We did a plating experiment in college to see who did and didn’t. Two guys did not, both had 0 cavities, and one I know was constantly chowing down candy bars and soda. So his overall health might not have been great, but the teeth were immaculate.
Our hygienist told us that chewing xylitol-based gum 2X daily for 3 weeks can help to cut down on the specific bacterial population for 6 months. Just be cautious starting out because too much xylitol gives you the runs.
Beth
Apr 30, 2008 at 4:11 pm
Thank you for highlighting an issue that is often overlooked with special needs patients.
I work for a dental residency program at Tufts University in Boston. They have 8 facilities statewide which specialize in dental care for special needs patients.
There are many obstacles which prevent people with all types of special needs from receiving proper dental care. Sensory issues, motor control, behavioral issues, etc., can make daily care and dental visits extremely difficult. In addition, many patients with limited verbal skills suffer from toothaches and can not tell anyone about their pain. This further escalates their anxiety about letting anyone near their mouths.
Another major obstacle for adults with special needs is that many adults rely on state funded Medicaid which private practitioners often do not accept, even if they can find a dentist trained to work with special needs patients.
I am glad to see the link to Special Care Dentistry for those having trouble accessing dental care. In addition, those who live near teaching hospitals and dental schools, may also check with them to see if they have any services geared toward patients with special needs.
Thanks again for highlighting this important issue!
Kristina Chew, PhD
Apr 30, 2008 at 5:16 pm
@CS,
Charlie likes Crest Baking Soda and Peroxide—Fresh Mint flavor (it’s blue). I tried the other flavor (green) and he did not like it—-since brushing teeth is so important, I just hope Crest keeps making this flavor!
@Beth,
Thank you for pointing out all of those concerns. Good dental care is so essential but has not been easy to teach; it’s taken time and I’ve often felt very discouraged. Charlie actually learned to brush his teeth first at school and then we’ve worked on it at home, slowly.
Loose teeth bother him immensely. I don’t think he has yet had a toothache, but that’s the kind of pain that he cannot express, and that would cause him major difficulty, and that would be compounded because he is not able to tell us about it.
@FXSmom,
Great for Matty—I just try to get us out more or less in one piece……
My dad and me, too, do not seem very prone to cavities and I’m hoping—thinking—-that Charlie has inherited this.
Marla
Apr 30, 2008 at 6:11 pm
We found a fantastic pediatric dentist for M. He gives her special sunglasses since the light is the worst part for M and then the touch. It took three visits for M to even sit in the chair but once she did the doctor gained her trust by not forcing anything. I was very impatient. Thank goodness the doctor knew there would be a pay off if we took it slow.
Bonnie Sayers
Apr 30, 2008 at 7:24 pm
What subject is the goal for toothbrushing on the IEP? Can you share what it says? They work on this at summer camp and other daily living skills. Matt has been to the childrens hospital in los angeles (Hollywood) for a cleaning and check for cavities and he had none. He is due back and it is a nightmare of a visit. I took pics of the chair with the papoose board and they had two dentists and two nurses working on him. I would rather go back there than the USC facility mentioned - plus it is closer and only serves special needs.
Bonnie Sayers
Apr 30, 2008 at 7:26 pm
It is amazing that you find all these articles in LA papers and I live here and have not seen or heard of them. But I was not home all day and have not looked at my alerts.
Mouse
May 1, 2008 at 11:48 am
I wish we had a clinic like that.
We went to a pediatric dentist we’d been told was good with kids with sensitivity issues, but that wasn’t out experience at all. Even after I told them that my son was obviously upset by the drill in the next room, they were impatient with how non-compliant he was. And to brush his teeth, the hygienist had him lean back into her lap, even though it was clear that he felt insecure in that position.
sharon
May 1, 2008 at 2:17 pm
We just got home from the dentist. We go to a Pediatric Dentist but not one specializing in special needs. They schedule the patients with special needs during the slow lunch time so it is quieter and quicker.
Last visit, Andy had 2 small cavities but they were in baby teeth so they are just waiting for them to fall out. One gone, one to go.
Andy did so much better this time letting the dentist and the techs do their thing.
We bring our own toothpaste an they add the pumice to it. The boys won’t allow the spinning toothbrushes nor the xrays. Our dentist seems to think kids with autism have less cavities. Probably just a coincidence.
One thing our dentist always encouraged was Andy’s cheweys (Ark Theraputics Grabbit). Seems the salivia produced while chewing help fight plaque.
I also offer incentives like the book store or toy store if they are good.
Kristina Chew, PhD
May 2, 2008 at 1:30 am
@Bonnie Sayers, This is how the tooth-brushing is written on Charlie’s IEP:
Objective: Completing Self-Care
Operational Definition: Charlie independently completes each step defined in the task analysis within 5 sec of each step such as (teeth brushing and dental hygiene). Data are collected weekly and summarized as the percentage of steps completed correctly. During data collection, no teaching procedures are used.
Criterion for advancement: Independently completing the self-care tasks on 100% of the opportunities for two consecutive sessions.
Hope this is helpful; can explain more about how the steps for teeth-brushing were broken down.
Bonnie Sayers
May 2, 2008 at 9:53 pm
Thanks for sharing this. Sometime this month is Matt’s matriculation/triennial IEP. I would love to learn the breakdown of this so I can incorporate something similar. I mentioned this to his aide this morning.
Does Charlie have an aide?
Kristina Chew, PhD
May 2, 2008 at 10:29 pm
Charlie’s in a 1:1 classroom, with a teacher and aides—he doesn’t have a particular aide assigned to him (they rotate on a regular schedule throughout the day). I can look up the breakdown/task analysis too and will post it—we’ve also started him flossing using those flossing sticks.
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