Creating Autism-Friendly Dental Spaces

Autism spectrum disorder (ASD) is a complex developmental condition characterized by challenges in communication, behavior, social interaction across multiple contexts, and engaging in repetitive patterns of behaviors.¹ These characteristics can cause significant impairment in social situations, impacting various aspects of health and well-being.² However, ASD is more than a collection of challenging behaviors; there are different levels of ASD that vary from individual to individual. ASD is best understood as a neurological difference that affects how autistic individuals processes their environment.

Autistic individuals face multifaceted challenges in accessing dental care, including heightened sensitivity to sensory stimuli, anxiety in unfamiliar environments, and difficulties adapting to modifications in their daily routines. These factors can hinder the autistic individual’s ability to maintain regular dental visits and proper oral hygiene practices. For dental professionals, these sensory sensitivities can make providing care more complex. Key challenges include difficulty in cooperation, communication barriers, and stress and anxiety management. To mitigate these challenges, oral health professionals need to understand these multifaceted obstacles so they may develop personalized strategies to support success.

Challenges to Receiving Dental Healthcare

Instead of emphasizing the challenging behaviors of autistic individuals, it is more productive to focus on the environments that contribute to these behaviors. Bogdan and Taylor³ suggest abandoning the term “challenging behavior” in favor of addressing problematic environments, while Hillman⁴ advocates for designing environments that help reduce difficult behaviors rather than forcing autistic individuals to cope with environments that may exacerbate their challenges. Hence, dental professionals are encouraged to modify their offices to support the unique needs of autistic individuals.

Collaborating with individuals on the autism spectrum is important.^5,6 Oral health professionals, when modifying their offices, are encouraged to seek input from autistic individuals to generate ideas that are meaningful to them and their families.

Sensory experiences — such as vision, hearing, smell, taste, and touch — impact every aspect of our lives. Many autistic individuals are more affected by external sensory experiences and may be sensitive to stimuli that neurotypical people might not notice. Approximately 94% of autistic individuals experience some level of sensory processing issues.^8,9 Those with hypersensitivities are profoundly impacted by their sensory environment, making navigating public spaces uniquely challenging for them. Even though sensory processing experiences are not uniform across autistic individuals, they have a powerful impact on how autistic individuals navigate healthcare settings such as dental offices, which are saturated with sensory stimuli.¹⁰

Auditory sensitivity in which the sounds of dental instruments, such as drills and suction devices, can be overwhelming and cause significant anxiety.Tactile sensitivity involves the physical sensations of dental procedures, such as the feeling of dental tools in the mouth or the texture and taste of toothpaste, which can also cause considerable discomfort. Visual sensitivity, such as the bright lights used during dental examinations, can be distressing for autistic individuals. Assessing how these environments may increase the stress of autistic individuals is essential.

This heightened auditory, tactile, and visual sensitivity can make dental visits distressing for autistic individuals and create complex and potentially frustrating situations for dental professionals. The increased stress experienced by autistic individuals can lead to extended appointment times, the possible need for additional staff assistance, behavioral outbursts, or refusal to participate in treatments. Additionally, difficulty comprehending verbal instructions necessitates that dental professionals rely on alternative communication strategies.

Many autistic individuals experience heightened sensitivity, leading to hypervigilance in their environments.¹¹ This combination of hyperarousal and hypersensitivity can lead to increased levels of anxiety and difficulty coping with everyday stressors,¹¹ often deterring autistic individuals from seeking dental care. Factors contributing to this anxiety include the dental office’s unfamiliar environment, the anticipation of pain during dental procedures, and previous negative experiences with dental care.

Communication can be tough for many autistic individuals and dental care relies heavily on verbal communication.^12,13 The combination of verbal communication demands and sensory overload in a dental office is one of the primary reasons why autistic individuals may not regularly visit the dentist. Communication challenges can hinder their ability to express discomfort, ask questions, or understand instructions from dental professionals — leading to increased anxiety and a negative experience.

Autistic individuals often rely heavily on routines and predictability to make sense of what they view as a chaotic world. Changes to routines, such as dental visits, can be a significant source of stress and resistance.¹⁴ This reliance on routine means that sudden changes can be particularly disruptive. The inherent unpredictability of dental visits, including potential delays and unforeseen procedures, can further exacerbate anxiety and resistance. Accommodating these needs by incorporating elements of predictability and familiarity into dental visits can help mitigate stress and create a more supportive experience.

Tailored Approaches to Dental Care for Autistic Individuals

Many resources explain the importance of designing sensory-friendly dental offices, but few explain why sensory-friendly environments are effective. Sensory-friendly dental offices help reduce anxiety, which is a reaction mediated by the amygdala, the brain’s fight-or-flight center. The amygdala — one of the brain regions that mediates stress responses — activates when it perceives a threatening event, real or imagined, in our surroundings. Overactivation of the amygdala is widely accepted as a fundamental process causing anxiety.¹⁵

Hypervigilance, when an autistic individual’s amygdala overprocesses sensory stimuli, can lead to the generalization of environments as being dangerous. For example, too many stimuli in an autistic individual’s environment, such as sounds, lights, strong smells, or too many people, can trigger the amygdala to activate, resulting in heightened anxiety and sensory overload. When this occurs, the individual’s stress response part of the brain hijacks his or her thinking part of the brain and the individual finds it challenging to think or act rationally.

To calm the amygdala, other physiological responses must be soothed (such as heart rate or breathing). When individuals are calm, the amygdala decreases the stress response. Hence, sensory-friendly environments are all built around minimizing sensory overload, calming the amygdala, and reducing anxiety. Following are some effective strategies to create a more sensory-friendly environment in the dental setting.

Design a calming waiting room. One effective approach is to divide the waiting room into different areas: a quiet zone featuring a fish tank, rocking chairs, and stability boards and a separate area with an interactive floor game to engage those who seek more stimulation. If a television is in the waiting room, turn a show on but mute the sound.

Install comfortable lighting. Using low lights in the waiting room, dimmable lights in the examination rooms, and headlamps with LED lights worn by dental hygienists and dentists instead of ceiling-mounted dental lights can reduce visual discomfort.

Minimize noise and address taste sensitivities. Using quieter dental tools and providing noise-canceling headphones can help reduce auditory sensitivity, while sunglasses can help manage visual sensitivity. For tactile comfort, incorporating an ultrasonic scaler alongside manual scalers whenever necessary along with warm water for rinsing reduces or eliminates the scraping sound commonly associated with hand instruments. The reduction in noise can contribute to a more comfortable experience for many autistic patients. Additionally, offering a variety of prophy paste flavors when brushing or polishing the teeth can accommodate different tactile preferences, recognizing that many autistic individuals may find regular mint paste too intense.

Anxiety Management Techniques

Dental professionals can effectively manage patients’ anxiety during dental visits through various strategies such as gradual desensitization, positive reinforcement, and relaxation techniques. Gradual desensitization is when the individual is slowly introduced to the dental environment and procedures, allowing him or her to acclimate. Positive reinforcement techniques, such as offering rewards and praise, can encourage successful dental visits and the completion of dental procedures. Teaching relaxation techniques, such as deep breathing exercises, equips autistic individuals with strategies to reduce anxiety during dental appointments, promoting a more manageable and positive experience. By utilizing these anxiety management techniques, dental professionals can create a more manageable and positive experience for autistic patients.

Technology and assistive devices can play a significant role in improving dental care for autistic individuals. For example, using visual scheduling apps or social stories apps can help prepare autistic individuals for dental visits by providing a clear and predictable sequence of events. Additionally, incorporating virtual reality or augmented reality experiences can help familiarize individuals with the dental environment and procedures. These tools can enhance communication, reduce sensory overload, and create a more positive and manageable dental experience for autistic individuals.

Oral health professionals can improve communication with autistic individuals by using visual aids, such as pictures and social stories, to explain dental procedures and what to expect during the visit. Using clear and simple language helps avoid confusion and ensures comprehension of the information conveyed. Dental professionals should also pay close attention to nonverbal cues and be open to alternative communication methods, such as picture boards or communication devices, to facilitate the autistic individual’s understanding and enhance the overall dental experience.

Incorporating elements of routine and predictability into dental visits can help reduce stress among autistic individuals. Scheduling appointments at the same time of day — preferably during less busy times, such as later mornings — and with the same oral health professionals provides a sense of familiarity, reducing anxiety for autistic individuals. Additionally, allowing autistic individuals to visit the dental office beforehand to become familiar with the environment can help reduce anxiety. Providing a clear step-by-step schedule of what will happen during the dental visit and following the same order of events (eg, dental examination, removing plaque and tartar, polishing) will reduce dental anxiety experienced by autistic individuals.

Comprehensive training and education are essential to ensure success for autistic individuals in the dental practice. Oral health professionals should be educated about ASD and the specific needs and challenges faced by autistic individuals. This training should include information on sensory processing issues, effective communication strategies, and techniques for managing anxiety. By equipping dental professionals with the necessary knowledge and skills, they will feel more confident providing dental care to autistic individuals.

Collaboration with caregivers and families is crucial in providing effective dental care for autistic individuals. Caregivers and families can provide valuable insights into the specific needs and preferences of the autistic individual, helping dental professionals tailor their approach. Open communication between oral health professionals and caregivers can also ensure that the individual’s needs are consistently met and that any concerns or challenges are promptly addressed. This collaborative approach fosters a supportive environment and enhances the overall dental experience for autistic individuals.

To ensure that dental practices remain responsive to the needs of autistic individuals, continuous improvement and feedback mechanisms should be implemented. Dental practices should also stay informed about the latest research and best practices in providing care for autistic individuals, ensuring that their approaches are evidence-based and current. This commitment to continuous improvement fosters a culture of inclusivity .

Conclusion

Ensuring better oral health outcomes for autistic individuals requires a comprehensive understanding of the unique barriers they face in accessing dental care. By creating a sensory-friendly environment, managing anxiety, adopting effective communication strategies, incorporating elements of routine and predictability, and utilizing technology and assistive devices, dental professionals can make dental visits more accessible and less stressful for autistic individuals.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, Virginia: American Psychiatric Association; 2013.
2. Lai MC, Lombardo MV, Baron-Cohen S. Autism. Lancet. 2014; 383:896-910.
3. Bogdan R, Taylor SJ. The Social Meaning of Mental Retardation: Two Life Stories. New York: Teachers College Press: 1994.
4. Hillman H. Designing environments to reduce challenging behaviors. Autism Spectrum News. 2021; 14(2):1-2.
5. Poulsen R, Brownlow C, Lawson W, Pellicano E. Meaningful research for autistic people? Ask autistics! Autism. 2022;26:3-5.
6. Vincent LB, Helbig KA, McKenney EL. Consultation and collaboration to support meaningful and socially valid outcomes for autistic people . J Educ Psychol Consult. 2023;34:1-13.
7. Ryan,M. I proudly call myself autistic: Here is why. Available at sbs.co/​.au/​voices/​article/​i-proudly-call-myself-autistic-heres-why/​hgi7yl6zz. Accessed March 31, 2025.
8. Elwin M, Schröder A, Ek L, Wallsten T, Kjellin L. Sensory clusters of adults with and without autism spectrum conditions. J Autism Dev Disord. 2017;47:579-589.
9. Crane L, Goddard L, Pring L. Sensory processing in adults with autism spectrum disorders. Autism. 2009;13:215-228.
10. Sibeoni J, Massoutier L, Valette M, et al. The sensory experiences of autistic people: a meta synthesis. Autism. 2002;26:1032-1045.
11. Gillott A, Standen PJ. Levels of anxiety and sources of stress in adults with autism. J Intellect Disabil. 2007; 11:359-370.
12. Loo CY, Graham RM, Hughes CV. The caries experience and behavior of dental patients with autism spectrum disorder. J Am Dent Assoc. 2008; 139:1518-1524.
13. Weil TN, Inglehart MR. Three to 21-year-old patients with autism spectrum disorders: Parents’ perceptions of severity of symptoms, oral health, and oral health-related behavior. Pediatr Dent. 2012; 34:473-479.
14. Hillman H. What do change in schedules, virtual meetings, and face masks have in common? Autism Spectrum News. 2020; 13(1):26-27.
15. van den Bulk,BG, Meens PH, van Lang ND, et al. Amygdala activation during emotional face processing in adolescents with affective disorders: The role of underlying depression and anxiety symptoms. Front Hum Neurosci. 2014;8:393.

From Dimensions of Dental Hygiene. May/June 2025; 23(3):36-39.