Patient care barriers Breaking down the
Many people with autism find visits to the dentist disorientating. But with a few basic adjustments, dentists can make a real, positive difference to the lives of people with the condition, argues Dr Robert Moffat
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magine that, to the outside world, you appear to be coping well. But, on the inside it’s a very different story because the prospect of every social
interaction presents insurmount- able obstacles. You can’t read facial expressions,
so it’s hard to differentiate the well- intentioned from those who may wish you harm. Run-of-the-mill behaviour others take for granted – humour, sarcasm, irritation, even flirting – are unlockable, disturbing mysteries to you. The world is a confusing, anxiety-inducing, threatening place. As you struggle to understand it, people see you as difficult, odd, challenging and even obsessive. You rely heavily on routines
to make sense of the world, and become distressed and disorien- tated by unpredictability. Your senses can be acutely sensitive. Noise, bright lights and smells that go virtually unnoticed by many people can be unbearably over- whelming and disorientating. At present, 50,000 Scots – that’s
one in every 100 – live on what is known as the autism spectrum, and have undergone many of these expe- riences. If your patient register is 2,000, you can realistically expect up to 20 will have autism or Asperger
ABOUT THE AUTHOR
Dr Robert Moffat is the national director of the National Autistic Society (NAS) Scotland. Following his son’s diagnosis with a
syndrome, which is a form of autism. Individuals who are considered to
be on what is known as the ‘autism spectrum’ are in many ways very different from each other. The range of intellectual ability
extends from the severely learning disabled right up to normal or even superior levels of intellect. Similarly, linguistic skills range from those who are mute to those who display complex, grammatically correct speech. All such individuals have difficulties in communication, social situations and understanding the world around them. A surgery visit can be stressful
for any patient, however, it can be dramatically so for someone with this recognised developmental disa- bility. Crying, lashing out, screaming and sometimes even fainting can
be typical reactions, particularly in children with the condition who have not been prepared for their appointment. Practitioner, parent or carer can be left with the choice between undesirable, physical intervention or giving up the appointment entirely. There are a range of reasons
developmental condition, Robert gave up a career in engineering to become his full-time carer. Robert studied psychology and completed a PhD in language impairment in children. Since joining NAS in 2004, Robert developed a hands-on approach,
working directly with families, professionals and people on the autism spectrum, as well as
managing NAS Scotland’s
extensive autism support services. He became the organisation’s national director in 2010.
“I have always had an interest in this patient group and felt we could make
our service more accessible for them” Lyndsay Ovenstone
30 Scottish Dental magazine
why many children and adults with autism can find a visit to the dentist acutely distressing. Some people with autism, particularly children, do not understand the purpose of going to see a man or woman in a white coat who looks into their mouth and uses strange equipment, while they are expected to lie on a chair with a large light positioned on their face. It can sometimes be helpful to establish with the patient the importance of having healthy teeth and gums and the consequences of not having regular appointments. Dentists are one of the few profes-
sionals who we permit to enter our personal space. Most people find this uncomfortable, but under- stand that the dentist needs to be so close in order to examine teeth. For individuals with autism, this close proximity can be extremely distressing. Finally, sensory issues are one
of the main anxiety triggers at the dentist for individuals with autism. The obvious areas of difficulty will be touch and noise. Mouths are extremely sensitive places and for a person with autism, the sensa- tion of a cold instrument entering their mouth can be very painful. The noise of the drills and cleaning
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