How do neurological disorders affect dental and oral health

Neurological disorders, such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD), not only affect children’s cognitive and behavioural aspects but also have a significant impact on their overall health, including dental well-being.

In this post, we will delve into how these disorders can influence children’s dental health. We will also explore strategies to address their unique dental care needs.

Autism Spectrum Disorder (ASD) and Dental Health:

Children with ASD may face specific challenges in maintaining optimal dental health. Here’s how ASD can impact dental care:

Sensory Overload:

Individuals with ASD often have sensory issues. Therefore this can often make dental experiences overwhelming or uncomfortable. Lets be honest the dental clinic can offend almost all of our senses, even for those that are not neuro-diverse themselves!

The sounds, lights, smells, and physical sensations associated with dental visits can trigger anxiety and sensory overload.

Possible Solution:

We often advise parents with kids with ASD to call and let us know in advance. That way we can discuss their specific sensory issues, and develop a plan to make it as easy as possible. Often this includes:

• Finding a quiet time in the clinic. First thing in the morning, Lunchtime, after hours and Saturdays tend to be quieter in the clinic
• Making sure the lighting isn’t too bright in the clinic. So just using the light on the chair and lowering the other lights can work
• Noise cancelling headphones can be a great option to remove the noises of the clinic

Oral Hygiene Difficulties:

People with ASD may have difficulties with fine motor skills, coordination, and sensory issues. Therefore, individuals with ASD may struggle with brushing and flossing properly. This can then lead to plaque buildup, tooth decay, and gum disease.

Possible Solution:

There are a number of oral hygiene products that are specifically designed for people with ASD.

This includes:

• Toothbrushes – Regular toothbrushes may not be easy to use for some with ASD or might cause sensory issues. Therefore opt for a brush with extra soft or silicone bristles.  
• Non-foaming or non-mint flavoured toothpaste – Many children with autism can find mint flavoured or foaming toothpastes trigger sensory issues. Therefore we tend to find that special non-foaming toothpaste and flavours other than mint, such as fruit punch, bubblegum or non-flavoured, work well.  
• Flavoured floss – Like with toothpaste, often mint flavoured floss can often be an issue. Try alternative flavours to see what works. If doesn’t help, a water flosser might work better.

We have listed a number of our favourites below:

• For non-mint toothpaste Tom’s of Maine Natural Children’s Fluoride Toothpaste
• If you need a non-foaming toothpaste option then we would recommend GC Tooth Mousse Plus
• Surround Toothbrush

Always discuss with your dentist if the above is appropriate for your kid.

Restricted Diet and Oral Habits:

Some individuals with ASD have limited food preferences or engage in repetitive oral habits, such as chewing on non-food objects or thumb sucking. Therefore, these behaviors can contribute to dental problems, including tooth erosion and misalignment.

Possible Solution:

This is important to discuss with your dentist or OT, as each kids situation is going to be unique. Obviously eliminating as much sugar as possible will be important. As to will be finding alternatives to thumb sucking.

What resources are available to help?

The Autism Association of Western Australia have developed some great resources to help. You can find these by clicking here. Many of these will help prepare your child for their visit to the dentist.

Attention Deficit Hyperactivity Disorder (ADHD) and Dental Health:

Difficulty with Focus and Attention:

Children with ADHD often struggle with maintaining focus and following instructions. Therefore this can make it challenging to adopt and adhere to proper oral hygiene routines.

Possible Solution:

With kids with ADHD we would strongly recommend the parent to supervise brushing for an extended period of time. Typically this would be 2 to 3 years longer than kids who are not neuro-diverse. The reasons behind this are:

• Executive functioning can be up to 40% behind in developing in kids with ADHD than their peers
• It helps to reinforce the importance of oral health
• You have a chance to see and pick up on any dental issues
• Feedback can be given on how effectively they are brushing
• You know they are meeting the required 2 minutes of brushing

Also following the steps below can certainly be beneficial:

• Lead by example: Show them how it is done step by step. Showing how you brush each surface of the tooth in a circular motion. Then perform it on them, if they can see this in a mirror it is often helpful
• Let them take over: When you feel they are ready let them try it themselves. This should obviously be under supervision and be prepared to help if necessary
• Follow a routine: Routine is so important. So make sure that teeth are brushed at the same time and in the same place each day.
• Reward their efforts: As discussed in the next section a reward process is important to reinforce the positive behaviour

Impulsivity and Hyperactivity:

Impulsive behaviour and hyperactivity can make it difficult for children with ADHD to brush their teeth thoroughly and for long enough. They may rush through the process or struggle to sit still for regular dental check-ups.

Possible Solution:

Creating a routine can be really helpful here! So an expectation that teeth will be brushed at the same time each day is important. Also don’t forget to make it fun! We find there are some great brushing videos on YouTube that go for the right amount of time they need to brush. Some links to these are below:

• Super Simple Songs – Brush Your Teeth
• Hey Duggee – The Toothbrushing Song
• The Wiggles – Brush Your Teeth

Rewards, reward charts or jars can also work really well. Just make sure that the reward doesn’t take too long to reach. Small simple things such as 10 minutes of iPad time after brushing is a simple reward. Or filling a jar with marbles and a bigger reward when it is full.

Medication Side Effects:

Some medications used to manage ADHD symptoms can cause dry mouth or reduce saliva production. This can therefore increase the risk of tooth decay and gum disease. There are some oral health products that can assist with this.

Possible Solution:

Below is a list of oral health products that can help to reduce dry mouth:

• GC Dry Mouth Gel (not for kids under 6 years of age, and follow the directions for use)
• Biotene Oral Rinse for Dry Mouth (not for kids under 12 years of age, and follow the directions for use)

What resources are available to help?

The ADHD Foundation have some resources on their website. However your kids Developmental Paediatrician or Psychiatrist will also be able to help develop some strategies to assist.

Furthermore there are some great resources online. How to Parent ADHD is a great resource on Facebook, Merriam is a parent of 3 with ADHD and also has ADHD herself. She is also a licensed family therapist (she is based in the US)

So how do you prepare for your kids dental appointment

1. Sensory-Friendly Dental Environment:

Find a dentist experienced in treating children with special needs. They can create a sensory-friendly environment, adjust lighting and noise levels, and use calming techniques to alleviate anxiety. Consider letting the clinic know in advance, so they can find a quiet time to book them in.

2. Visual Supports and Social Stories:

Use visual schedules, social stories, and visual aids to help children with ASD understand and prepare for dental visits. This can therefore reduce uncertainty and facilitate cooperation.

Click here to find a link to some great resources for this

3. Distraction Techniques:

Many dental clinics now have TV’s on the ceiling, we have them in all of our rooms. These are usually connected to a streaming service or can connect to YouTube. We then encourage the child to let us know what they want to watch. This gives them some control and choice when they come to the dentist, and will make them more comfortable.

You are also welcome to bring an iPad or wireless headphones to help as well.

4. Positive Reinforcement and Rewards:

Implement positive reinforcement strategies, such as praise, tokens, or rewards, to encourage and reinforce proper oral care routines. At our clinic we have a prize box, which is used as a reward to encourage kids to return for check ups. It doesn’t need to be anything big, kids typically respond well to positive reinforcement.

For kids with ASD and ADHD this isn’t a bribe, it is a perfectly good strategy to help them.

5. Collaboration with Dental Professionals:

Work closely with dentists who have experience in treating children with neurological disorders. They can then provide tailored recommendations, strategies, and regular monitoring of dental health.

6. What about if my kid needs extensive work, or they can’t have treatment in the chair?

There are certainly different options available for those who either have extensive treatment or who wouldn’t be able to have treatment done in the chair.

Most of these options would include some form of sedation, either laughing gas, IV Sedation or a general anaesthetic in hospital.

We do offer all three options, however there are also a number of other clinics that can facilitate this type of treatment, if Midland isn’t close to you.

There is also the Special Needs Dental Clinic, which is run by the WA Department of Health (Dental Health Services). They are located in North Perth.

For more information on our sleep dentistry options please click here or give us a call to discuss further, as there are some limitations on IV Sedation for kids.

Neurological disorders like ASD and ADHD can have a profound impact on children’s dental health. Understanding the specific challenges associated with these conditions and putting strategies in place can help support optimal dental care.

By creating a supportive environment and the right advice we can ensure that children with these disorders receive the dental care they need for a healthy and confident smile.

We have extensive experience working with kids with neurological disorders, so please don’t hesitate to give us a call if you have any questions at all on 08 9250 8844