Child with autism, age 6
An autistic child at the dentist means three sensory sensitivities meeting at once: the shrill noise of the suction and the drill, the white light of the exam lamp in his eyes, the texture of the rubber dam in his mouth. Without preparation, a third of appointments fall apart. A card handed in at reception, a scan before the room: the chair can be prepared with noise-cancelling headphones, dimmed lighting, and a soft silicone dam.
This case concerns autistic children and teenagers (level 1 and 2 ASD) at routine dental or orthodontic appointments, with or without anesthesia.
The moment as it happened
Dental office, 10:30am. A 6 year old sits in the waiting room with his mother. He stares at the goldfish, swings his legs, doesn't speak. The dental assistant opens the door: "Robin? let's go". Robin gets up, follows his mother into the room. When the assistant turns on the exam lamp, Robin squeezes his eyes shut. She waits for him to calm down. He withdraws. The dentist comes closer. He tries to get him to open his mouth. Robin clenches his teeth and his fists.
The mother takes the laminated index card out of her bag. "Wait". She hands the card to the dentist. He scans it. In thirty seconds he reads: noise-cancelling headphones in the car, tilt the exam lamp to the side before entering, soft silicone dam rather than rubber, gradual exposure time in the chair (5 minutes for the first appointment).
He turns off the exam lamp. He suggests Robin just sit in the chair without doing anything. He waits. He suggests counting to ten with his eyes closed, headphones on. By the second session, the dam is placed. Treatment can begin.
- You write it
- The QR is in place
- The reader scans
- Understood, without explaining again
Where to place the QR for this case
A laminated index card (85 x 55 mm), in the parent's health record book or in a folder dedicated to medical appointments. Hand it in at reception when checking in, not in the waiting room: the dental assistant needs time to scan it before preparing the chair.
Duplicate it in the digital patient file if the practice accepts it: a sticker on the child's paper file, in the chair-side folder. At the regular orthodontist's reception desk, a paper sheet with the QR can stay at the front desk, updated every year.
Avoid a card around the child's neck: it gets in the way during setup. Avoid emails sent to the dentist 24 hours in advance: they aren't opened by the practitioner, who only discovers the child once in the room.
For an appointment under general anesthesia (multiple extractions, fitting heavy appliances), the card is also passed on to the anesthesiologist in advance, through the pre-admission file.
Pre-written text templates
The three templates below are written from the parent's side. The vocabulary mixes concrete sensory observations with minimal dental terminology, to help the practitioner prepare his actions.
For the "Overview" section
"Robin is 6 years old. He has level 1 autism spectrum disorder (ASD), diagnosed at age 3. He is hypersensitive to noise and light, but not to taste or light touch. He understands simple verbal instructions if they are prepared in advance. He doesn't talk much during care, he communicates using signs (thumb up means ok, clenched fist means stop)."
For the "How to help" section
"You can: let him keep his noise-cancelling headphones on during the whole procedure, dim the overhead light or turn it to the side before he sits down, use a soft silicone dental dam instead of a rubber one, show him each instrument before using it, plan 30-second breaks every 3 minutes, tell him before each new step."
For the "What to avoid" section
"What to avoid: switching on the overhead light straight in his face, turning on suction without warning him, saying 'open wide' without counting (counting to 3 works), holding him down by force when he clenches his teeth (wait 30 seconds instead), promising a lollipop (he has no interest in that), saying 'it will be fine' (too generic, he stops listening)."
Conditions related to this case
This case is based on level 1 autism spectrum disorder (ASD) with sensory hypersensitivity. It also applies to children with isolated sensory hypersensitivity without ASD, children with Ehlers-Danlos syndrome (fragile mucous membranes), and children with severe anxiety. The sensory preparation overlaps in each case.
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Three texts (introduction, how to help, what to avoid), one shared QR code. When they scan it, the person reads what they need to know, in their own language.