Envision Painless Dental Visits:
Using Assistive Technology in Healthcare Settings
by Randi Sargent
Assistive technology can make an enormous difference in helping children prepare for and communicate in healthcare settings. For example, many of our kids (and even some of us adults!) are anxious about visits to the dentist. Glaring lights, strangers in masks and loud buzzing sounds can send kids with sensory issues over the proverbial edge. For our kids with complex health issues and developmental disabilities, anxiety can also be heightened by their lack of experience or understanding and fear of discomfort. If you have one of these kids, this guide should help make your next dental visit as painless as possible. The same techniques can also be applied to other healthcare settings, such as doctor visits and procedures.
Find that Special Dentist
Children with special healthcare needs are often more susceptible to tooth decay, gum disease or oral trauma due to medication, diet or physical difficulty preventing effective dental hygiene at home. Our kids with special needs deserve a special dentist. Ask your pediatrician, local parent support group, or local advocacy agencies for a referral to a dentist who is experienced with working with children with special healthcare needs. Call the office and speak with the dentist about your child's challenges and any concerns you have. When possible, ask that your child see the dentist rather than the hygienist because he or she has probably received training in working with children with special health care and behavioral issues. Ask about the dentist's hospital affiliations if sedation or general anesthesia would be required for procedures. Ask about insurance coverage and if they accept Medicaid if that's required.
Consider the accessibility of the office. If your child travels in a wheelchair, this is essential but also explore options for seating in the office. Can your child sit in his/her wheelchair, or on your lap if that's what it takes to make your child feel comfortable? Finally, when booking an appointment, ask if they have a quiet time of day when they can book a longer visit. Some offices reserve slots at the beginning or end of day for patients who require longer appointments.
Prepare for Your Visit
All kids benefit from knowing what to expect. Pictures and visual schedules can help prepare children for their experiences at the dentist. Prior to your appointment, prepare visual supports to review and bring with you. Download a free visual schedule of a dental appointment (see link below) or make one using pictures or symbols to let your child know what he will see and do during his visit. If necessary, ask if they have photos of their office so you can familiarize your child with the actual office and personnel. If not, bring your camera and take some photos yourself.
Review the Routine
In the days prior to your appointment, review some of the many books, social stories, videos and/or apps about going to the dentist. Visual social stories and pictures are very helpful at showing children what they will see during the visit. See the list below to find some pre-made social stories that show children at the dentist and even some of the equipment that will be used. Review the visual schedule to help them understand what will happen during the appointment.
Teach and Practice
Effective dental visits require good behavior. Kids need to sit still and follow directions, and this can be difficult for some of our kids. Some kids may need to be taught proper behavior in a dentist office. Teach and practice how to wait patiently, sit still with their feet out, open their mouths wide, move their tongues around and spit into a sink. Discuss relaxation techniques they can use if they are nervous such as closing eyes, holding hands, listening to music with headphones, humming a favorite song or wiggling their toes. Let them know that they have some control of the activity by showing them how to communicate wait/stop, need a break and OK.
On the day of the appointment, bring a bag of favorite toys, books or electronic games to help your child wait quietly for her turn. Bring and review the visual schedule she has already seen. Some kids benefit from checking off each activity as it occurs throughout the appointment. Consider using a visual timer if necessary during the appointment to show how much time remains until they go home.
Rewarding a Job Well Done
All kids benefits from receiving praise for their accomplishments, so give it! Reinforce the concept of First-Then by rewarding them for a job well done after a good visit. Your dental office may have stickers and small toys, and your child may enjoy making a selection. If not, use whatever reward motivates your child's good behavior.
When Sedation is Required
For some kids, cleanings and procedures need to be performed under sedation or general anesthesia. Your dentist should be affiliated with a hospital or surgical center where he or she can perform dental procedures that require the use of gas, IV sedation or general anesthesia depending on your child's needs. Preparing your child for hospitalization is another important topic. See the Arthur's Guide to Children's Hospital (link below) for a nice introduction to a child's hospital stay.
Book Your Next Appointment
How did the appointment go? Discuss different strategies for improving the next visit with your dentist. Suggest some of the resources below to your provider and encourage them to make visual supports available for their younger patients and patients with special needs. Book regular visits for preventative care. Good dental hygiene between appointments is good practice and leads to healthy and happy kids (and moms!).
Randi Sargent is a parent of a son with multiple disabilities and good teeth. She is the founder of www.SayitwithSymbols.com, a resource for functional communication supports for children and adults with severe speech limitations. She is a board member at the Federation for Children with Special Needs, Boston and the Massachusetts Rehabilitation Commissions' Assistive Technology Advisory Council.