Nik Sisodia discusses the special needs of patients.
One in 100 people are thought to be on the autism spectrum, meaning you are likely to come across autistic patients in practice on a day-to-day basis. World Autism Awareness Week not only shines a spotlight on the lives of autistic people, but also provides us with the opportunity to improve our understanding and appreciation of the condition, enabling us to enhance the standard of care we provide to autistic people. This is extremely important given that those with autism often face various challenges in accessing essential dental treatment.
What is autism?
Autism – otherwise known as autism spectrum disorder (ASD) – is generally understood to be a complex and lifelong developmental condition that can impact an individual’s ability to communicate and relate to others, and how they experience the world around them. It is categorised by a specific set of behaviours and affects individuals differently and to varying degrees. This means some autistic people need little or no support, whilst others may require help from a parent or carer every day in order to maintain a good quality of life.
Typical signs of autism include:
- Difficulties interpreting verbal and non-verbal communication
- Difficulties expressing their own emotions, in addition to recognising and understanding others’ feelings and intentions
- Repetitive or restrictive behaviours
- Over- or under-sensitivity to light, sound, taste or touch
- Highly focused interests or hobbies
- Extreme anxiety, particularly in social situations or when facing change
- Becoming overwhelmed, leading to meltdowns and shutdowns
It is important to make the distinction that autism is not an illness with treatments or a ‘cure’, but relates to how an individual’s brain works differently to others. Although there is much that we have already learned about the condition, the causes of autism are still being explored. There is evidence to suggest that autism develops from a combination of genetic and environmental factors that lead to a child’s brain developing differently and resulting in autistic behaviours. For instance, children of older parents are known to have an increased autism risk and boys are four times more likely to be diagnosed with ASD than girls.
Environmental risk factors for autism are primarily associated with exposures to harmful chemicals during fetal growth. Research has linked exposure to air pollution and/or pesticides during pregnancy with a higher risk of the child developing autism. Decades ago, children whose mothers took thalidomide or valproic acid were also reported to have autistic behaviours. Fortunately, these drugs are no longer in use, but research on their effects has informed our understanding that autism risk may begin as early as in the womb.
Dental treatment considerations
The nature of autism can undoubtedly make a visit to the dentist extremely stressful for autistic people, who may not understand that regular dental check-ups are important to overall health, as is maintaining teeth and gums through daily oral care. Dental treatment requires you to invade patients’ personal space, which can be very distressing for those with autism. These patients may also become overwhelmed by the sights, sounds and scents associated with being in the practice (such as bulky dental equipment, noisy handpieces and strange-smelling disinfectants), as well as the sensation of having instruments in their mouth.
Therefore, dental teams should make every effort to adapt their workflow to accommodate treatment for autistic patients. You can start by including useful information online about the practice and the procedures you follow, providing autistic patients with an idea of what to expect from their appointment in advance. If you know one of your patients is autistic, it is worthwhile speaking to them or their family/carer prior to the appointment to find out if there are any issues you can address in order to make their visit more comfortable.
During the patient’s appointment, it is important that you clearly explain and demonstrate what will happen and what you will do without being patronising. Make sure you allocate plenty of time to the appointment, as this will enable you to better manage any of the patient’s fears or worries. Additionally, some autistic patients can take longer than others to process information provided, so it might be useful to present this information visually to ensure the patient understands their treatment before you proceed.
Should the patient become distressed, give them plenty of space and allow their parent or carer, if present, to take control of the situation, as they will know the best way to support the patient. Sometimes, the oral healthcare needs of an autistic patient can be complex, necessitating the referral to a trusted clinic like Ten Dental+Facial. Ultimately, treatment for any autistic patient should always be guided by their specific circumstances.
In the UK, there are approximately 700,000 autistic adults and children, all of whom deserve to receive the highest quality care in dental practice. Dentists and their teams can make a significant difference to an autistic patient’s overall quality of life simply by taking a compassionate and considered approach, with treatment tailored to the patient’s individual needs and preferences.
References available on request.