Successful Trips to the Dentist for Children with Disabilities

Say “Aah” Successful Trips to the Dentist

It is estimated that approximately 20% of adults fear dental treatment to the point that they put off necessary visits. Children with disabilities may be even more prone to experience dental anxiety due to strangeness of environment and discomfort of the procedures.

If appropriate oral hygiene is neglected, children may experience ongoing pain, lasting damage to their teeth and gums, and poor diet as their food options are restricted.

This may escalate the children’s behavior problems and produce significant stress for their parents. Because of the severity of children’s resistance to treatment, parents frequently resort to sedation for simple

procedures (e.g., cleanings), posing additional health risks and increased cost for treatment.

Without successful strategies, these patterns can escalate over time. We offer the following suggestions for making dental visits more positive and increasing children’s cooperation.

Know What to Expect

Before making an appointment, visit the office and talk to the dentist or staff about your child’s needs.

Note the characteristics of the waiting and examination rooms and learn about routines and procedures your child may undergo.

If possible, observe these. Specific questions you might consider include:

• With what items or objects might your child interact?
• With whom your child might interact (e.g., the receptionist, the oral hygienist, the dentist)?
• What procedures are likely (e.g., will the visit include just a physical exam and cleaning or will x-rays, fluoride or other procedures be performed?

Inform the dentist of your child’s anticipated reactions given his/her history with dental or medical situations or related experiences and discuss any modifications the dental staff might be willing to make (e.g., a few five minute visits to the office to sit in the chair or allowing your child to watch you during a dental exam, items you would be allowed to bring) to make your child more comfortable.

Ask if any of the tools that are typically used (e.g., dental bib, clips, bite blocks) are available for practice at home. Recognize other ways you might prepare your child for the experience (e.g., using an electric toothbrush at home or playing dentist with a dental mirror).

Prepare for the Visit

Many challenges associated with going to the dentist can be avoided or minimized through careful planning and advanced preparation.

If possible, you should take your child to the office prior to their scheduled appointment to see the environment, meet the staff, and possibly observe procedures (e.g., while you or a sibling are undergoing them).

During that visit, you may be able to identify additional triggers and strategies that could help. If that cannot occur, you can use the information you obtained from the dentist’s office to prepare your child in other ways.

If your child is experiencing pain or going to undergo an uncomfortable experience, talk with your dentist in advance about possible adaptations to procedures (e.g., smaller bite blocks) and/or pain management.

Help your child understand the value of oral hygiene and problems associated with neglect by sharing stories and pictures.

Make brushing and flossing teeth part of your normal routine so your child becomes accustomed to these activities. Limit foods that may cause additional dental problems (e.g., sodas, candy).

Prepare your child for the visit using social stories, communicating with your child at a level he/she understands.

Your story can include every step that will occur during the appointment, what your child will be expected to do, what help you and the dental staff will offer, and what will occur if the visit is successful. Bring enjoyable items and activities that can serve as a distraction such as electronic devices, headphones, toys, a blanket, bubbles, and other items allowed by the dentist.

Steps such as these may make the dental experience more positive.

Teach and Practice Skills

When faced with uncomfortable or awkward treatments, we don’t want to just tell our children what not to do (e.g. don’t move), we need to teach them what to do.

Using the following basic steps of teaching, we can help our children get oriented with procedures and practice new behaviors in a calm environment while demystifying dentist tools:

1) Clarify expectations

2) Specify expected behaviors (explaining why they are necessary)

3) Model skills

4) Provide practice opportunities

5) Reward effort.

A fun way to teach is to ‘play dentist’ at home. While playing dentist, guide your child to ask for breaks or communicate in other ways when talking isn’t possible (e.g., squeezing Mom’s hand).

Use a timer to increase the length of time your child is able to lie down with his/her mouth open.

Allow your child to manipulate the tools that will be used. Teach slow deep breathing, thought distraction, and appropriate ways to move (e.g. wiggling feet) to help your child tolerate the actual procedures.

Reward Cooperation

There are strategies that can be used to further increase and maintain your child’s cooperation with the procedures during the dental visit.

Praise your child when he/she sits still, follows instructions and does other things that are expected.

Provide your child with favorite little items (e.g., stickers, pencils, cars) following each procedure or stage of the visit. If the procedures are awkward or uncomfortable, provide brief breaks following periods of cooperation and/or when your child requests them (i.e., not following challenging behavior).

Let your child know what has been accomplished and what still needs to occur as the visit progresses.

Once your child completes the visit, provide the “jackpot.” Following successful appointments, give your child a special treat (e.g., new toy, special activity).

Depending on your child, you may choose to tell them that these positive consequences will be available (i.e., “if you do __, we will __) or wait until after the appointment to avoid repeated requests.

Clearly, it is important to work closely and collaboratively with the dentist and his/her staff to help your child have successful experiences at the dentist.

They may be able to offer additional suggestions and you may share ideas they can use with other patients.

Given this relationship, it may be necessary to hand-pick dental providers who are willing to be flexible and supportive, showing your appreciation for adjustments they are willing to make for your child (e.g., waiving cancellation fees if your child has difficulty).

Dental visits may be stressful for you. When you celebrate your children’s successes, make sure you reward yourself as well.

Here are a few social story PDF’s and videos about going to the dentist to help you prepare for your child’s next dental appointment.

Social Story PDF’s:

• A Trip to the Dentist by Ability Path
• Today’s Visit to the Dentist Office by Say It With Symbols

Social Story Videos:

• Going to the Dentist
• A Child’s visit to the Dentist – An educational video for kids
• Going to the Dentist – Great for children with Autism and Down syndrome

Meme Hieneman, has a Ph.D. in Special Education and is nationally certified as a behavior analyst. She has published a variety of articles, chapters, and books including “Parenting with Positive Behavior Support: A Practical Guide to Resolving Your Child’s Difficult Behavior.” In her professional career, Meme has worked with children with severe behavior problems for more than 20 years.

Helpful Articles

• Say “Aah” Successful Trips to the Dentist
• Ask Special Parents: Brushing Teeth
• Helping Kids Keep Healthy Teeth {Tip 4 of 31}

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This post originally appeared on our March/April 2016 Magazine