Dental care for very sensitive children

dentistMost children with additional needs can learn to look after their teeth or let someone do it for them, and can attend a regular dentist. How well that goes depends partly upon personalities and the atmosphere at the surgery. Other parents may be able to recommend a dentist who is successful with children who have additional needs and/or are particularly nervous, and who also gives helpful ongoing advice.

Brushing teeth at home, and teaching the child to do it, can be a particular challenge with the autistic spectrum. Helpful hints from another parent (also about cutting of hair and nails) can be found at Autism help for you. Related advice on teaching self-help skills is available from the National Autistic Society. The charity Scope publishes a factsheet with suggestions for helping children with additional dental issues at/from home. These include adapting toothbrushes to make them easier to use; help with the costs of dental treatment; how and where to find an accessible dental surgery; and what information the dentist will need to know. (Scope, Cerebral Palsy section 6: dental care).

Strategies for children who do not understand what is going on at the dentist and/or are hypersensitive to touch around their mouths, might include some preparation in advance for both child and dentist. For example, it might be useful to get dental records to take to any new dentist. Some children may benefit from play activities to rehearse aspects of the visit in advance, or to go through a book such as “Topsy and Tim go to the dentist” by Jean Adamson (available from Cerebra’s postal lending library, no.C0036).

If it is very difficult or impossible to take a child to the dentist, Community dental services may help, and/or special dentistry could be the answer.

Special dentistry

Special dentistry owes its existence in the UK to Dr Janice Fiske (Fiske, 2003) and others who have worked since the 1980s to raise awareness of particular dental care needs and to build services for people with them. They recognised that in addition to fears and difficulties with actually being at the dentist, children with cerebral palsy, seizures and other conditions encounter issues such as less control of the jaw and mouth, greater difficulty with cleaning their teeth, greater risk for tooth decay, extra gum growth, upper and lower teeth that do not meet (“malocclusion”), tooth protrusion, swallowing difficulties, reflux, strong gag reflexes and a shortage of enamel and dentin in their teeth (Stanford, 2000).

In view of this kind of issue, Special Care Dentistry is a further qualification that dentists can take. Their additional studies include:

  • the nature and effects of different disabilities, conditions and states of health;
  • behavioural issues and management, and dealing with extreme fear;
  • quality of life issues;
  • communication and treatment planning;
  • further study of pain elimination; and
  • medical emergencies.

As well as among individual dentists working in the community, there will be someone qualified in this way in a hospital where there is a dental service. Referrals can be from a doctor or another dentist, but are not always needed. More details: British Dental Health Foundation, tel: 0845 063 1188.

Getting to see a specialist dentist is not necessarily straightforward. This account by a parent illustrates the heartache and complications that can be caused by “gatekeeping” systems that do not work well:

“X. hated having his teeth brushed, and going to the dentist. He needed a specialist dentist. The social worker who did the assessment seemed not to understand this. The Early Bird centre (National Autistic Society) that he attended found a specialist dentist who said that a GP referral was needed, but the GP refused and said try the paediatrician. A lady at the dental service suggested a local hospital, where he got an appointment. He had 5 teeth removed and 3 crowns. His teeth are now good.”

The Healthcare Travel Costs Scheme (HTCS) covers some services that regular dentists, as well as doctors can refer patients on to for more specialist attention. More details: Healthcare Travel Costs Scheme: instructions and guidance for the NHS, (Dept of Health). Some dentists can make home visits.

If a child may need sedation in hospital to access dental care, PALS (Patient Advice and Liaison Service) will have more information if the hospital has one, or Action for Sick Children.

References and further resources

The British Dental Health Foundation provides independent advice on all aspects of dental health including information on fear management, treatment options and preventative care.

The British Society for Disability and Oral Health publishes information about finding a primary care / community dental service, including special care dentistry, and about accessing dental care where this is difficult.

Fiske J. et al. 2003. A Case of Need: proposal for a specialty in special care dentistry. Oxford. Joint Advisory Committee for Special Care Dentistry.

The National Autistic Society publishes factsheets about dental care and autism.

Stanford T.W. 2000. Cerebral palsy and dentistry: a brief review. Texas, Baylor College of Dentistry. (See Caring for cerebral palsy: dental care).