Caring for Dental Patients on the Spectrum: I Get It.

Dr. Krysta Manning

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In (and outside of) dentistry, it can take some people a long time to find their passion. For me, it happened early, but the reasons why I chose my particular path wouldn’t become apparent until much later.

Special needs dental patients need specialized care
The first year after completing dental school, I entered a fellowship program in Developmental Dentistry at the Lee Specialty Clinic. The focus was on treating adult patients with neurodevelopmental disabilities. During that time, I had the chance to learn about working with patients who have various levels of autism spectrum disorder (ASD) and sensory processing disorders (SPDs).

As a clinician, the experience had a huge impact on me. However, it wasn’t until much later that I would come to appreciate the true value of the kind of treatment we were able to provide, care that was tailored specifically to patients with ASD and SPD. That moment came when my son, who had just turned three, was diagnosed with ASD level one. It was also then that I began to truly understand what it meant to care for these patients.

Personalizing my practice for ASD and SPD patients
As a mom of a child with autism, I learned, first-hand, how challenging seemingly routine things can be, and knew all too well the struggles that other parents of children with these issues experienced as well. And as I’ve watched the autism community grow, I’ve seen how the support for this population has also grown. Yet, I’m well aware that the need for caring, compassionate, and knowledgeable healthcare providers is still great.

It was in seeking help for my son that I discovered how I might be of help to others like him. Shortly after his diagnosis, my son began to receive applied behavioral analysis (ABA) therapy. This type of approach is well regarded as the most predictable method for assisting children on the autism spectrum with developing skills for adapting to the world around them. After countless visits with therapists and specialists for my son, I began asking questions and considering how I might take the successful elements from this type of therapy and put them to use in my own practice.

A typical visit for an atypical circumstance
Calling on the information and experience I had gained in Developmental Dentistry, plus the expert assistance from a trained ABA therapist, I was able to develop a protocol that is now used in my office to effectively treat this specialized patient population. Here’s a look at what patients with ASD or other SPDs can expect when they book a desensitization appointment at my office:

We usually start with providing the patient’s caregivers with a clinic-specific social story – a step-by-step explanatory narrative that can be reviewed daily with the patient to help them set expectations and prepare for the visit at hand. We also call in advance to discover any aversions or preferences the patient may have so we can better accommodate them during their first visit.

First visit:
The goal for this visit is to get to know the patient, and to determine if he or she is a likely candidate for desensitization. We let our patients’ caregivers know that although they should be prepared for treatment at this appointment, it may not actually happen during this visit. Our real goal at this time is to help the child feel comfortable with the environment and providers. And we will end this appointment, by sharing with the parents a list of objectives and goals for future appointments.

Subsequent visits:
If possible, future visits are scheduled one week apart on the same day at the same time to establish a routine. During appointments, we reinforce positive behaviors, redirect negative behaviors, and halt dangerous or destructive behaviors. And we also set aside time after each appointment to debrief parents and assess our progress.

When all the work that needs to be done has been completed, I recommend bi-monthly consult visits so that the patient will remain familiar with the office environment and be comfortable with any subsequent treatment that may be required.

I also want to let my patients’ caregivers to know that not all patients are likely candidates for desensitization. I’ve discovered that in many situations, a patient’s verbal acuity can be used to predict success. That’s to say, when patients are verbal, we’ve seen an 80-90% success rate of being able to provide treatment without the use of sedation.

Of course, I’ve learned quite a bit since that fellowship I completed years ago – about dentistry, the ASD and SPD communities, and so much more. But I also understand that there are so many discoveries being made every day. And it’s my goal to continue incorporating that information into my practice so that the patients who need it most, can receive the best care possible.


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