Parenting, Resources

Orthodontic Treatment and Children with Autism Spectrum Disorder: Q & A

There are many rites of childhood that may be more tricky for kids with autism, and the wearing of braces is one of them. Parents of youngsters who have trouble getting through a dental visit or even a tooth-brushing may wonder if straight teeth are really worth the trouble. But as with so many of those other milestones, careful planning that takes your child's needs into account may make orthodontic treatment a possibility. We asked James M. Crouse, DDS, PA, to share some information on how orthodontists can work with patients on the autism spectrum and what parents need to know.

Q: Are there things you do differently when you work with patients with autism?

A: Appointments with the orthodontist may take longer than with the typical orthodontic patient, and they may be best treated during a quiet part of the day or in a private room. Having the same doctor and same assistant work with the patient helps build a sense of familiarity for the child with autism. The usual method of behavior management called “tell-show-do” has limited effectiveness with autistic children. They respond better to visual forms of learning rather than verbal instructions. One technique is using the Picture Activity Schedule, where photos are used to show the steps of the procedures rather than trying to verbally describe what is to be done. These photos of the steps of the orthodontic procedures are shown to the patient on a daily basis in the week or two prior to the appointment. The pictures can be shown by the parent or the child’s teacher. A wide variety of orthodontic procedures have been accomplished successfully using this technique.

Q: What questions should parents ask when selecting an orthodontist for a child with autism?

A: Find out if they have worked with other children with autism. Determine if they can make accommodations for your child. Can they take the extra time needed for procedures, and can they assign an assistant who has the good demeanor required to work with autistic patients? Long procedures may need to be divided up into shorter easier appointments. If you feel your child would respond well with the Picture Activity Schedule, you should ask the orthodontist if they are familiar with using that technique.

Q: How can parents prepare their kids with autism for getting braces?

A: Showing the child images of the procedures, cleaning the teeth, and the appliances to be used can be helpful. If you don’t already help with brushing their teeth, then it’s a good idea to work on this with them. Maintaining adequate oral hygiene will be important to prevent adverse conditions such has gum problems, “white marks,” and cavities.

Q: What are the challenges for kids with autism in living with braces and maintaining them properly?

A: Traditional braces that are attached to the teeth can be used with children with autism; however, it can take time for them to adjust to the feel of the appliances. The braces will feel large and foreign and can cause sores in the mouth. The braces may need to be placed in phases so that they can adjust to the feel. The parents will also have to be vigilant to make sure the braces are kept clean to avoid cavities and gum problems. Foods that are hard and crunchy and sticky tend to break the braces and therefore should be avoided. Also, foods and beverages that are high in refined carbohydrates (sugar) should be kept to a minimum or eliminated if possible. The worst offenders are sodas; however, you need to be careful with fruit juices, too, as they have a high amount of sugar and tend to be acidic, both of which can lead to white marks left on teeth when the braces are removed, as well as cavities.

Q: Are there cases where parents should wait or choose not to get braces for their kids with autism? Are there other options to consider?

A: If the child cannot tolerate the appliances or cannot keep them clean, then no treatment may be better than attempting treatment and risking damage to the teeth. An alternative is the use of removable clear aligners, such as Invisalign, instead of traditional braces. The aligners are removed to brush and eat; therefore there are few issues with keeping the teeth clean and eating restrictions. They are more comfortable than traditional braces. There are no mouth sores, and the teeth have little or no soreness that is typical with traditional braces. Again, there is a period of adjustment getting used to the feel of the aligners in the mouth.