Dental care for neurodivergent children

A/Prof Mihiri Silva, Associate Professor in Paediatric Dentistry, Melbourne Dental School, The University of Melbourne

Neurodivergent children often experience the world differently to others and a trip to the dentist may present a whole other level of anxiety and fear. 

 ‘Neurodivergent’ is a term commonly used to describe autistic children, though autistic behaviours vary considerably in their severity and type. 

“It’s important to know how we can support neurodivergent children, or those with sensory challenges, to have good oral health, and this involves working to suit individual preferences as much as possible,” said A/Prof Silva, a paediatric dentist from Melbourne Dental School.

Establishing good oral health habits like twice-daily toothbrushing, limiting sugary foods and drinks, and regular dental visits are important throughout childhood, and particularly for children with developmental concerns or disability. 

“One of the most common concerns relates to the taste and texture of toothpaste which can make toothbrushing a really stressful event and almost like a battle at times,” said A/Prof Silva. “But there are now non-foaming and flavour-free fluoride toothpastes in the supermarket which have really changed this for some children.”  

In addition, parents can remind, encourage and assist with toothbrushing. Mindful that children love to copy adult behaviours, modelling good oral hygiene habits at home is helpful with parents leading the way by heading to the basin twice a day themselves for brushing and flossing. Using visual schedules and rewards may also help establish positive routines. 

Neurodivergent children may also have restricted diets. Changing dietary patterns according to their needs and wishes can be challenging for parents and carers. But this is where the dentist and dental teams can be so helpful in this scenario as they can partner with allied health professionals like dieticians to provide holistic support to reduce sugar intake.

In addition to these challenges at home, families with neurodivergent children worry about dental care because bright lights, loud noises, and smells in the dental clinic can be distressing. So some simple pre-visit planning and open communication with the dental team can often avoid unnecessary distress, such as parents providing the dentist with information about their child’s specific sensory needs and preferences before the appointment.

“Dentists are trained to support children, irrespective of developmental stage or disability, and have a range of ways to make the dental visit more comfortable and less challenging for the neurodivergent child,” said A/Prof Silva.

This can range from simple things such as reducing bright lights and loud noises in clinic and providing comforting weighted blankets, sunglasses or noise-cancelling headphones. 

Practicing opening the mouth at home, reading books together about visiting the dentist and talking through simple step-by-step instructions at home may also be helpful to prepare the child for the dental visit. Social stories which explain the details about an event such as this, and the behaviours expected at the visit, can also be helpful in the preparation process. 

While Australian Dental Association survey data suggests that many parents put off taking their child to the dentist until a problem arises, seeing a dentist both early (when the first tooth emerges) and regularly, keeps the focus on prevention. This is especially important for neurodivergent children and those with a disability because it means that children can be introduced to the sights, sounds and sensations of the dental environment at their own pace, without the urgency of treating an issue. Sometimes this may mean just visiting the practice without any examination or treatment.

When necessary, the dentist may refer to a Specialist Paediatric Dentist, who has additional training in providing care to children with special needs. Options such as sedation and use of anaesthesia may also be considered, especially when more complex treatment is needed.

While families with neurodivergent children may face unique challenges when it comes to their oral health, new approaches to care, focusing on personalising to individual needs can make a huge difference, and a conversation with your dentist will get this process off to a great start.

4-10 August is Dental Health Week. www.ada.org.au