Autism and oral health

Maintaining oral health hygiene can be challenging for people with autism.  This lifelong spectrum disorder affects how someone communicates and interacts with the world, but every individual with autism is different and symptoms can vary.  Some autistic people share certain characteristics which can have an affect on their oral health care:

Over or under sensitivity to light, sound, taste, touch and pain
Sensory issues can be triggered by brushing teeth – the person may not like the feel of a toothbrush in their mouth or the taste or texture of the toothpaste. Using unflavoured and non-foaming toothpaste can be helpful.

Attending the dentist can also be challenging as the person may find for example that background music is distracting and intolerably loud.

Lack of understanding and communication
Some people with autism may not understand why it is important to care for their mouth and teeth, and the consequences of not doing so. It’s important to explain this in simple language. Use ‘tell, show, do’ to demonstrate toothbrushing on yourself first so they can see exactly what to expect.

If someone is severely autistic and non-verbal, it’s important to note any changes in behaviour. For example, if they have been touching or hitting one side of their cheek, this could be their way of communicating that they have toothache.

Extreme anxiety
Visiting the dentist can trigger anxiety in many people, but as mentioned above, sensory overload can mean the the dental environment is particularly challenging for autistic people.  The Community Dental team can work with autistic people and their families to help reduce anxiety.

Repetitive behaviour
Routine is important for people with autism so it’s important to develop a good oral health care routine from the onset. Start a good toothbrushing routine as soon a child gets their first tooth and try to ensure children eat healthily.

It is more difficult and takes longer for autistic people to make changes once behaviours have been established – for example, reducing sugary snacks.  People with autism may also for example prefer the same colour foods and/or specific brands of food. This can be challenging when making necessary dietary changes to prevent tooth decay.  All changes should be introduced slowly into their routine.

Meltdown and shutdowns
If an autistic person becomes completely overwhelmed by a situation, they can experience a temporary loss of control.  Physical lashing out or verbal screaming or crying is known as a meltdown. Or when someone becomes very quiet and appears to have ‘switched off’, this is known as a shutdown.

Additional medical conditions
Some autistic patients have additional medical conditions such as epilepsy, ADHD, and learning disabilities to name a few. These additional conditions present their own challenges too.

Medications
Some prescribed medications for autism can affect a person’s mouth resulting in conditions such as xerostomia (dry mouth), gingivitis, overgrown gums, prolonged bleeding, glossitis (enlarged tongue), discoloration of tongue and difficulty swallowing. There are other possible side effects dependent on which medications have been prescribed.

Tongue thrusting
This occurs when the tongue presses too far forward in the mouth during speech, swallowing, and at rest. This can affect the dental development of some people with autism, resulting in crooked teeth and bite issues.

Oral health tips for people with autism

Many people with autism find dental treatment challenging, so prevention is the key to maintaining good oral health. The British Society of Paediatric Dentistry has this helpful advice for parents of children with autism. Our Community Dental service recommends:

Brushing teeth twice a day

Brush once in the morning and once at night before bed using a fluoride toothpaste. As toothbrushing can be challenging for autistic people it doesn’t have to be done in the bathroom. Different toothbrushing positions and oral health aids (page coming soon) can also be beneficial, such as:

• a triple headed toothbrush to clean three surfaces of the tooth in one action
• an Open mouth rest or a Bedi shield useful to prop one side of the mouth open whilst brushing the other side
• unflavoured, non-foaming toothpaste rather than regular mint toothpastes
• an electric rather than manual toothbrush.

It may be a case of trial and error to see what toothpaste and type of toothbrush the person prefers.

Using distractions
When brushing teeth at home or having treatment at the dentist, distractions such as listening to music, watching a favourite TV show may help.

Being aware of changes in behaviour
People with autism may have difficulty communicating to others when they are in pain. It is important to keep an eye out for unexplained changes in behaviour, such as changes in eating habits, hitting or touching their face, self-harm, disturbed sleep or emotional outbursts which may indicate the person is experiencing pain.

Some autistic patients who are sensory seeking might put their fingers or other objects in their mouth which is known as stimming. This can be a false indication of toothache, but it is still important to visit the dentist to double check as these habits can sometimes damage the gums or cause mouth ulcers.

 

Considering a person’s individual sensory reactions
It may be necessary to increase or reduce exposure to some stimuli, for example by using a soft-headed toothbrush or offering the sensory stimuli of the vibrations of an electric toothbrush.

Using positive reinforcement
Verbal praise, encouragement, and smiles are always important!

Regular visits to the dentist
The earlier in life a visit to the dentist becomes part of an autistic person’s routine the better as they will become more familiar and comfortable with the environment.

Preparing before a dental visit

Preparation can help to avoid an autistic person becoming very overwhelmed by a new environment, like a visit to the dental surgery. Consider taking a tour of the surgery before any dental work is carried out. Visual aids can also be very beneficial especially for children – show them pictures and videos of going to the dentist and read books together – such as ‘Peppa Pig goes to the dentist’.

Ahead of the actual visit to the dentist, parents or carers should inform the dentist if there are any triggers that may stress the person with autism as well as suggesting things that make them feel good.