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Paediatric Dentist

What is the role of a Paediatric Dentist?

Paediatric Dental specialists are dentists who have received training in the discipline of dental care for children. This includes comprehensive training in treating those children with individualized, special needs. A Paediatric Dentist can act as a primary care dentist, such that they will see a returning base of patients and take care of their oral health on an ongoing basis. This means seeing patients at specific intervals for teeth cleaning and check-ups. Alternatively, they may act as a referral base for general dentists. In these referral-base situations, they may treat a child only once when specific care is required beyond the ability or comfort level of the general dentist.

For some children and youth with Autism Spectrum Disorder (ASD), a trip to the dentist can be a very anxiety-provoking experience. Paediatric Dentists are aware a trip to the dentist can be frightening and are equipped to meet the special needs of their young patients.

Sedation is an Option. Many Paediatric Dentists offer conscious sedation services in their practices. These sedation services can include light sedation, while other dentists offer patients a sedation option but have visiting dental or medical anaesthesia specialists administer deeper levels of sedation. Some Paediatric Dentists have access to hospital operating rooms and are able to bring their patients to these facilities for treatment. Finally, some sedation services are provided by dental anaesthesiologists and although they are not specialists in Paediatric Dentistry, they are highly trained in the field of anaesthesia for dentistry.

How does a Paediatric Dentist help a child with ASD?

Because Paediatric Dentists might see more children with ASD, they may be more familiar with the special needs children or youth with ASD might have. This is helpful when it comes to developing an effective course of treatment that can meet the needs of the patient sitting in the dental chair. In addition, Paediatric Dentists typically have reinforcing activities available to those waiting or undergoing procedures in their offices that might be of interest to those with ASD. Toys, video games and other sensory items can help to make their visit more enjoyable.

Children with ASD often experience sensory challenges. How will a dentist mitigate these difficulties in their practice?

This is one of the biggest challenges that dentists face treating children and youth with ASD. The mouth is a very sensitive place for anyone. Add a sensory sensitivity, and this makes for a huge challenge.

After slow and steady ‘systematic desensitization,’ a child with ASD and adults alike, may learn to accept the stimuli that come with visiting the dental office for regular check-ups.

A Gradual Introduction. One method of reducing the impact of multiple new sights, sounds, smells, tastes and feelings is to introduce the patient to them very slowly. The first few visits can be structured in such a way that the person with ASD is allowed to simply walk around the office and get used to the environment, see the room and touch the dental chair. The next few visits, more time can be spent sitting in the dental chair, turning on the over-head light and sitting in the dental chair. The next few visits can involve the dentist or hygienist using a toothbrush and dental mirror to look inside the mouth. These visits could happen more frequently than the usual 6 – 9 month intervals, or even monthly to help reinforce the memories of the new situations.

After slow and steady ‘systematic desensitization’, a child with ASD and adults alike, may learn to accept the stimuli that come with visiting the dental office for regular check-ups. If the treatment required provides too much stimuli, an anaesthesiologist can assist with sedation, to alleviate some of the sensory impacts a dental procedure can have on a child or youth with ASD.

‘Some people with ASD require an anaesthesiologist’

Unfortunately, some people with ASD, children and adults alike, are unable to allow invasive dental care. This is when the need for anesthesia becomes necessary. There are different levels of anaesthesia from light sedation to general anaesthesia.

Sometimes giving people with ASD lighter forms of sedation does not help. With lighter forms of sedation, the patient is still awake and is able to respond to what they are feeling. Because the feeling of light sedation can be disorienting, the patient may have difficulties understanding what is happening to them. As a result, the patient may become more agitated. In many cases, general anaesthesia is the best method of ensuring the best possible dental care is provided without causing undue stress to the patient. There are some dentists in Ontario who are trained and licensed to provide general anaesthesia services in their dental offices.

How can a family locate a dental anaesthesiologist?

Families can go online to find these dentists, or they can ask their family dentist to refer them to such clinics. As well, a family can contact the Royal College of Dental Surgeons of Ontario to find out if a particular dentist is licensed in Ontario to provide general anesthesia services. Some Paediatric Dentists have operating room privileges in a hospital; this is another method of accessing general anaesthesia for dental treatment.

In larger cities in Ontario, there are likely to be both Paediatric Dentists and dental anaesthesiologists. Unfortunately, smaller cities have fewer specialists available and possibly longer waiting times for treatment. Many families with members who have special needs end up traveling to more populated areas to access specialized services. If you live in a smaller city, you can ask a local dentist to help you find the nearest paediatric or anaesthesia specialist if local dentists are unable to provide the necessary treatment.

‘In many cases, general anaesthesia is the best method of ensuring the best possible dental care is provided without causing undue stress to the patient.’

How will a dental office accommodate families with children diagnosed with ASD?

A caring and compassionate attitude towards an individual affected by ASD and their family is paramount. Understanding the approaches that best serve the unique needs of each patient is important. With patience, many patients with ASD can successfully tolerate dental treatment.

A general dentist who treats patients with ASD should have patience and understanding. As well, the knowledge of how and when to access supportive services like a Paediatric Dentists or dental anaesthesiologists are necessary if the general dentist and the family feel that these services are required.

Will a dentist recommend solutions/practice for improving oral hygiene a home?

Dental offices have oral hygiene programs that they recommend to people based on their needs and abilities. Both the dentist and the dental hygienist should suggest different ways to help those with ASD maintain their oral hygiene. There are aids like mechanical toothbrushes and special flossing devices, to name a few, that can be recommended. In addition, families should be counseled about which foods and drinks increase the risk of tooth decay and methods to reduce this risk, such as, eating cheese and drinking lots of water.

What else do I need to be aware of when looking for a dentist who is knowledgeable about supporting children with ASD and other challenges?

Similar to searching out any professional service, families should find a level of comfort with both the dentist and the staff members within the office. All members should be welcoming and open to answer any questions or concerns that are presented. If you do not have that level of comfort, simply look for someone else. Smaller communities in Ontario, of course, are more limited with the choices available.

Please describe the training and experience of those who would be working with my child.

A general dentist has four years of dental school training. The training of Paediatric Dental specialists and dental anaesthesiology specialists includes an additional two or three year program after dental school training. A family can contact the Royal College of Dental Surgeons of Ontario to find out if a particular dentist is licensed in Ontario to provide general anaesthesia services. Many of the dental anaesthesiologists are experienced in supporting children with ASD symptoms.

Dental Hygienists and Dental Assistants complete a one year program in their disciplines. After that, there are various continuing education programs that dentists, hygienists and assistants must complete to keep their license valid. Continuing education programs are numerous and cover all of the different aspects of providing dental care, including how to provide service to people with special needs and issues around different syndromes. When it comes to treating children or adults with ASD, some dentists might have never seen a patient who falls within the Spectrum; however, others may be more experienced.

It is important to ask your dentist if they are comfortable and have experience treating patients with ASD.



The interviewee: David A. Isen, Bsc, DDS.

David Isen of Sleep for Dentistry in Toronto, enjoys helping patients of all ages overcome dental anxiety. He has practiced in Toronto since graduating from his dental training in 1991, and remains an active member of his community. David was born in Toronto, Ontario and attended the University of Toronto to study neuroscience as a young adult, he then enrolled at the University of Western Ontario to study dentistry. In addition to general dental training, David received advanced training in intravenous sedation at the Montefiore Medical Centre in New York. He has been featured in the TV shows Marketplace and The Right Fit in episodes about dental phobia and anxiety. In addition, he is President of the Ontario Dental Society of Anaesthesiology.

Disclaimer: This document reflects the views of the author. It is Autism Ontario’s intent to inform and educate. Every situation is unique and while we hope this information is useful, it should be used in the context of broader considerations for each person. Please contact Autism Ontario at info@autismontario.com or 416-246-9592 for permission to reproduce this material for any purpose other than personal use. © 2012 Autism Ontario  416.246.9592  www.autismontario.com.