Interdisciplinary Collaboration between Occupational Therapy and Dentistry for Autistic Patients and Sensory Processing Differences

4 Introduction to Capstone Project . 5 Literature Review . 6 Needs Assessment . 17 Objectives Achieved . 21 Implications of Capstone . 30 Conclusion . 32 References . 34 Appendix A . 37 Appendix B . 39 Appendix C . 40 Appendix D . 41 Appendix E . 42 Appendix F . 43 INTERDISCIPLINARY COLLABORATION BETWEEN OT AND DENTISTRY 3 Appendix G . 50 Appendix H . 53 Appendix I . 54 Appendix J . 55 INTERDISCIPLINARY COLLABORATION BETWEEN OT AND DENTISTRY 4 Abstract Dental care is the most frequently cited unmet healthcare need for children with special needs (Cermak et al., 2015). Given the increased research linking oral health to overall health, it is important to ensure that dental care is accessible to all individuals. Oral hygiene and health management are both occupations included in the Occupational Therapy Practice Framework (4th ed). Combined with the unique training of an occupational therapist in sensory processing and environmental adaptations, the profession of occupational therapy has an important role in addressing the availability of dental care for those with disabilities. The aim of my doctoral capstone experience was to explore the benefits of interdisciplinary collaboration between occupational therapy and dentistry to improve dental care for autistic patients and those with sensory processing differences. This included a literature review to explore current evidence-based approaches, meeting with experts on the topic, developing trainings for different audiences, creating visuals, implementing sensory and emotional regulation strategies, providing parent consultations, and exploring reimbursement. The DCE resulted in improved dental provider confidence and increased advocacy for oral health care for autistic individuals. The details of the doctoral capstone experience will be furtherDental care is the most frequently cited unmet healthcare need for children with special needs (Cermak et al., 2015). Given the increased research linking oral health to overall health, it is important to ensure that dental care is accessible to all individuals. Oral hygiene and health management are both occupations included in the Occupational Therapy Practice Framework (4th ed). Combined with the unique training of an occupational therapist in sensory processing and environmental adaptations, the profession of occupational therapy has an important role in addressing the availability of dental care for those with disabilities. The aim of my doctoral capstone experience was to explore the benefits of interdisciplinary collaboration between occupational therapy and dentistry to improve dental care for autistic patients and those with sensory processing differences. This included a literature review to explore current evidence-based approaches, meeting with experts on the topic, developing trainings for different audiences, creating visuals, implementing sensory and emotional regulation strategies, providing parent consultations, and exploring reimbursement. The DCE resulted in improved dental provider confidence and increased advocacy for oral health care for autistic individuals. The details of the doctoral capstone experience will be further outlined in this manuscript. INTERDISCIPLINARY COLLABORATION BETWEEN OT AND DENTISTRY 5 Introduction to Capstone Project There is an increasing push from the neurodivergent community for acceptance of neurodiversity, changes in autism research and practices, and increased accessibility for all. An article from Leadbitter and colleagues (2021) states the neurodiversity movement incorporates the premise that “the disability is not simply a defect in the individual but arises from the interaction between a non-standard individual and an unaccommodating environment”. There is a need to accommodate for neurodiversity in schools, workplaces, and, for the focus of this capstone, medical environments. Occupational therapists have specialized training to modify environments based on unique client factors. Therefore, it is imperative that the profession of occupational therapy fills its role in supporting this movement. Dental appointments are notorious for being a challenging sensory experience for the autistic community, creating a barrier to accessing dental care. In addition, dental practitioners report challenges in providing quality care to autistic patients, describing a lack of training and a lack of cooperation from autistic patients. My capstone project focused on program development to ease this experience for autistic patients, caregivers, and dental practitioners. In order to address this issue, I spent 14 weeks at a pediatric dentist office in Grand Rapids, MI. The owner of the practice is passionate about providing quality care to children with special healthcare needs. Therefore, they see many autistic children as well as children with other disabilities such as down syndrome and cerebral palsy. My site mentor was the director of operations, who was able to assist with arranging trainings, adding materials to the website, working within the electronic medical record system, and coordinating other logistics needed to implement my capstone. My second site mentor was the lead hygienist at the office. She was able to provide the information I needed to create visuals and develop trainings that address the INTERDISCIPLINARY COLLABORATION BETWEEN OT AND DENTISTRY 6 specific problem areas at the office. Although the dentist who owned the practice was not technically one of my site mentors, she was the person I worked most closely with throughout the experience and served as a point person for approval and feedback on my ideas. While most of my time was spent with this specific office, I also met with a variety of other experts in the field and provided trainings for other pediatric dental offices, dental students, and therapy centers. Literature Review Introduction Despite the importance of proper oral care, dental care is the most frequently cited unmet healthcare need for children with special needs (Cermak et al., 2015). With the consistent rise of individuals being diagnosed with autism, it is likely that an increasing number of dental practitioners will encounter autistic patients in their practice (Como et al., 2021). However, 6080% of dentists state they are unwilling to treat patients with developmental disabilities because of their resistive behaviors (Stein et al., 2014). Of all the reasons someone may require dental care in the hospital under general anesthesia, resistive behaviors had the strongest correlation to treatment in the hospital (Stein et al., 2014). Occupational therapists have specialized training in sensory and environmental adaptations. Therefore, they can provide a unique opportunity for interdisciplinary collaboration between occupational therapy and dentistry to decrease anxiety, reduce the use of general anesthesia and restraints, and improve overall oral health for autistic patients. However, very few dental offices in the country currently collaborate with occupational therapy. The purpose of this literature review is to first explore the reasons for difficulties with oral care for autistic individuals and then to address occupational therapy’s role in improving access to oral care in the home and at the dentist. The literature review used ProQuest, Google INTERDISCIPLINARY COLLABORATION BETWEEN OT AND DENTISTRY 7 Scholar, Google Search, and CINHAL with search terms such as “autism spectrum disorder”, “oral hygiene”, “dental care”, and “environmental modifications”. Autism According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, to be diagnosed with autism spectrum disorder (ASD)