Although some dentistry professionals are making strides to change the industry, many parents and autistic patients still feel frustrated. So why is dentistry such a tough thing for neurodivergent people, and how can you help your kiddo maintain a sparkling smile? Let’s drill into the tooth of the matter! (See what we did there?!)

Why are visits to the dentist difficult for autistic kids?

Think bright lights, sitting still for a long time, scary new noises in an unfamiliar place, strangers touching your mouth, and disruption to your daily routine — it’s all very overwhelming! As parents, we may fear our child’s dentist appointments just as much as they do. We fear they may have a meltdown, that the staff won’t accommodate them, or take our concerns seriously. And of course, a bad experience means the possibility you can’t get your child to return next time. All of these barriers can delay parents or autistic adults from seeking dental care.

Why are children with autism more likely to have dental problems?

Kids on the spectrum, and those with other developmental differences (like Down Syndrome) are at greater risk for cavities and other oral health problems. This is due to sensory sensitivities and coordination challenges (like difficulty brushing teeth) and dry mouth (caused by medication or eating habits). Because finding accommodating dental care is so hard, autistic people often go longer periods of time without the care they need. This creates a vicious cycle.

Why is finding good dental care for autistic kids so hard?

A lot of people with developmental differences have unique barriers to dental care — things like sensory sensitivities, heart concerns, and communication challenges. Many dentists simply aren’t equipped for working with patients who have special needs. To most dentists, teeth are just teeth. Adults with developmental differences are often forced to see pediatric dentists because they have more experience working with disabled patients.

Prevention is better than intervention

Preventing dental issues before they happen will save your child (and you!) a lot of distress in the future. Most kids don’t like brushing their teeth, but autistic kids can have sensitivity to taste, texture, and other sensory experiences that make regular brushing difficult. Establishing a healthy oral hygiene routine can minimize the amount of dentist visits your child has to make.

Here are some tips for keeping your child’s teeth healthy:

Make brushing a part of their everyday routine. Many autistic people thrive on routine. Knowing exactly what to expect can take out some of the anxiety associated with teeth brushing.
Make a picture schedule or try using the Goally app. Breaking down your child’s oral hygiene routine using pictures and simple steps can make it easier for them to follow, and encourage independence.
Find the right toothpaste. It may take some trial and error to find a toothpaste your child likes. If all else fails, you can dip your child’s toothbrush in a fluoride rinse (like ACT) and brush with that.
Use the right brush. Some kids may prefer using a two or three-sided toothbrush because it covers more teeth in less time. A toothbrush with your child’s favorite characters on it, or one that plays music or lights up, can make brushing more fun. Some parents swear by whole-mouth brushes like the AutoBrush. Your child may like a manual brush because it’s quieter, while some kids may like the vibration of an electric toothbrush.
Do what you can. A little bit of brushing is better than nothing! Start off small, even if that means just touching the brush to your child’s mouth at first. A little bit of brushing morning and night can make a difference. If your child likes to eat things that stick to the teeth (like gummy candy or crackers), brush after they eat. This prevents sugar or debris from sitting on their teeth for too long.
Help them brush. A good rule of thumb is to supervise/help your child with teeth brushing until they are able to tie their own shoes. After that, they should be ready to brush on their own. Our kiddos may take a bit longer to get the hang of things like shoe-tying, so use your best judgment.
Begin flossing as soon as possible. Dentists recommend starting your child’s flossing as soon as they have two teeth that touch. Beginning a flossing routine when your child is little will get them used to it and establish it as part of their routine. It might be hard to introduce flossing later on. Flossing picks may be easier for some kids than traditional floss.
Check your child’s teeth. If you can, lift up your child’s gums and look for any brown or white spots that could indicate cavities. If you find any, set up an appointment with your child’s dentist before things get too bad.
Start dentist appointments young. Dentists recommend your child has their first visit by age 1. You want to get your child used to the dentist and make it a regular part of their lives. Building a trusting relationship with their dentist can make your child’s appointments easier in the future. This will come in handy as they get older or need more complex dental work.
Keep dental appointments regular. We tend to avoid the stress of dentist’s appointments as much as possible, but this can actually backfire and create more issues. Making a dental appointment part of your child’s regular routine can help ease your child’s anxiety. Aim for an appointment every 6 months. Circle their dental appointment on the calendar, and play them videos of a previous visit to show them what to expect. Regular visits can nip problems in the bud before they require more serious dental procedures. You also want your child to have the opportunity to build a relationship with their dentist.
Provide healthy snack options. Low fat cheese, veggies, and fruit are good ones to keep around.
Only give your child water in their cup. It’s best to only offer your child water in between meals. If your child is going to walk around with their sippy cup or bottle, dentists recommend only filling it with water.
Don’t share food or drink. Sharing utensils, food, and beverages with your child can spread cavity-causing bacteria from your mouth to theirs. Don’t allow them to share with friends, either!

What you should know about sleep dentistry

Sleep dentistry (aka sedation dentistry) is when your child is put to sleep so the dentist can work on their teeth. There are different levels of sedation dentistry, ranging from “laughy gas” to being put fully asleep (which usually happens at a hospital). Sometimes sedation dentistry seems like the only option for autistic kids.

Children with autism often become distressed during dental appointments, which may lead to dysregulation like aggressive behaviors or flailing around. Restraining your child at the dentist can be really traumatic and upsetting, even if it’s well-intentioned. Autistic adults highly discourage restraint, as they share how traumatic it was for them. Sleep dentistry can be seen as a “more humane” way of stabilizing a patient’s body during dental work.

If possible, try to avoid sleep dentistry for your child. Here’s why:

It carries unknown risk. Sedation dentistry is generally accepted as being pretty safe. But like any medical procedure, it carries certain risks and can have icky side effects (like nausea, vomiting, and difficulty breathing). Besides the risks we do know about, there are also risks we don’t know about. For example, we don’t know what interactions may occur in neurodivergent brains when put under anesthesia. Almost all the research done on sedation dentistry used non-disabled adult subjects. What little we do know about anesthesia for autistic kids is that the risks are higher than for the general population. This is especially true if the child has a history of seizures or other medical concerns.
It takes away the opportunity to learn. You want your child to get used to the dentist and feel comfortable going, so that they can maintain their oral health long into the future. Sometimes dentists will suggest sleep dentistry for routine appointments to avoid making accommodations for “difficult” patients. Keep hunting for a quality dentist who will work with your child until they’re comfortable with routine dental work.
It prevents self-advocacy. Learning to advocate for themselves during medical appointments is an important part of becoming independent as your child grows older. If your child is under sedation, they can’t advocate for themselves.

Keep in mind, it’s still okay to use sedation for the same procedures non-autistic people use it for! Or for procedures your child just can’t tolerate for their own unique reasons. Sedation dentistry shouldn’t be an excuse for impatient providers who just don’t want to take time to build a relationship with your kiddo. For some kids, even the most understanding dentist won’t do — a sedated cleaning once a year is all they can tolerate. With enough time, understanding, and patience, the right dentist can help you figure out what works best for your child.

Conclusion

Dentistry and autism have a complicated relationship. Autistic and other people with developmental differences are more likely to have cavities and malocclusions. Obstacles, such as a lack of understanding dental providers, can discourage parents from seeking care, which creates a vicious cycle. You can prevent additional dental appointments by helping your child establish a healthy routine at home. Check out our full guide to prepare your child for their next dentist appointment.

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