5

Stress the importance of conscientious 

oral hygiene and frequent prophylaxis.

TOOTH ERUPTION may be delayed due 

to phenytoin-induced gingival hyperplasia. 

Phenytoin is commonly prescribed for 

people with autism.

TRAUMA and INJURY to the mouth 

from falls or accidents occur in people 

with seizure disorders. Suggest a toothsaving kit for group homes. Emphasize to 

caregivers that traumas require immediate 

professional attention and explain the 

procedures to follow if a permanent tooth 

is knocked out. Also, instruct caregivers 

to locate any missing pieces of a fractured 

tooth, and explain that radiographs of 

the patient’s chest may be necessary to 

determine whether any fragments have 

been aspirated.

Physical abuse often presents as oral 

trauma. Abuse is reported more frequently 

in people with developmental disabilities 

than in the general population. If you 

suspect that a child is being abused or 

neglected, State laws require that you call 

your Child Protective Services agency. 

Assistance is also available from the 

Childhelp® National Child Abuse Hotline 

at (800) 422–4453 or the Child 

Welfare Information Gateway 

(www.childwelfare.gov).

Making a difference in the oral health 

of a person with autism may go 

slowly at first, but determination can 

bring positive results—and invaluable 

rewards. By adopting the strategies 

discussed in this booklet, you can 

have a significant impact not only on 

your patients’ oral health, but on their 

quality of life as well.

Additional Readings

Hyman SL, Towbin K. Autism Spectrum 

Disorders. In Batshaw ML, Pellegrino L, 

Roizen NJ (eds.). Children With Disabilities

(6th ed.). Baltimore, MD: Paul H. Brookes 

Publishing Co., 2007.

National Institute of Child Health and 

Human Development, National Institutes of 

Health (NIH). Autism Questions and Answers 

for Health Professionals. Retrieved July 9, 

2009, from http://www.nichd.nih.gov/publi- cations/pubs/autism/QA/index.cfm.

National Institute of Child Health and 

Human Development, National Institutes of 

Health (NIH). Autism Spectrum Disorders. Retrieved July 9, 2009, from http://www.

nichd.nih.gov/health/topics/asd.cfm.

NLM Family Foundation. D-Termined 

program of repetitive tasking and 

familiarization in dentistry: a behavior 

management approach. View at 

http://www.nlmfoundation.org/media.htm.

For more information about autism, contact

National Institute of Child Health and Human 

Development Information Resource Center

P.O. Box 3006 

Rockville, MD 20847 

(800) 370–2943 

www.nichd.nih.gov 

NICHDIRC@mail.nih.gov
2 

Health Challenges in Autism 

and Strategies for Care

People with 

autism need 

consistency and 

can be especially 

sensitive to 

changes in their 

environment.

Before the appointment, obtain and review 

the patient’s medical history. Consultation 

with physicians, family, and caregivers is 

essential to assembling an accurate medical 

history. Also, determine who can legally 

provide informed consent for treatment.

Communication problems and

mental capabilities are central 

concerns when treating people with autism.

 Talk with the parent or caregiver to 

determine your patient’s intellectual 

and functional abilities, and then 

communicate with the patient at a 

level he or she can understand.

Use a “tell-show-do” approach to 

pro viding care. Start by explaining 

each procedure before it occurs. 

Take the time to show what you have 

explained, such as the instruments 

you will use and how they work. 

Demonstrations can encourage some 

patients to be more cooperative.

Behavior problems—which 

may include hyperactivity and quick 

frustration—can complicate oral health 

care for patients with autism. The invasive 

nature of oral care may trigger violent 

and self-injurious behavior such as temper 

tantrums or head banging.

Plan a desensitization appointment to 

help the patient become familiar with 

the office, staff, and equipment through 

a step-by-step process. These steps may 

take several visits to accomplish.

• Have the patient sit alone in the 

dental chair to become familiar 

with the treatment setting. Some 

patients may refuse to sit in the 

chair and choose instead to sit on 

the operator’s stool. 

• Once your patient is seated, 

begin a cursory examination 

using your fingers.

• Next, use a toothbrush to brush the 

teeth and gain additional access to 

the patient’s mouth. The familiarity 

of a toothbrush will help your patient 

feel comfortable and provide you with 

an opportunity to further examine 

the mouth.

When the patient is prepared for 

treatment, make the appointment 

short and positive.

Pay special attention to the treatment 

setting. Keep dental instruments out of 

sight and light out of your patient’s eyes.

Praise and reinforce good behavior after 

each step of a procedure. Ignore inappropriate behavior as much as you can.

Try to gain cooperation in the least 

restrictive manner. Some patients’ 

behavior may improve if they bring 

comfort items such as a stuffed animal 

or a blanket. Asking the caregiver to sit 

nearby or hold the patient’s hand may 

be helpful as well. 

Use immobilization techniques only 

when absolutely necessary to protect 

the patient and staff during dental 

treatment—not as a convenience. 

There are no universal guidelines 

on immobilization that apply to all 

treatment settings. Before employing 

any kind of immobilization, it may 

help to consult available guidelines 

on federally funded care, your State 

department of mental health/disabilities, 

and your State Dental Practice Act. 

Guidelines on behavior management 

published by the American Academy of 

Pediatric Dentistry (www.aapd.org) may 

also be useful. Obtain consent from 

your patient’s legal guardian and choose 

the least restrictive technique that will 
2

Before the appointment, obtain and review 

the patient’s medical history. Consultation 

with physicians, family, and caregivers is 

essential to assembling an accurate medical 

history. Also, determine who can legally 

provide informed consent for treatment.

CommuniCation problems and

mental Capabilities are central 

concerns when treating people with autism.

Talk with the parent or caregiver to 

determine your patient’s intellectual 

and functional abilities, and then 

communicate with the patient at a 

level he or she can understand.

Use a “tell-show-do” approach to 

providing care. Start by explaining 

each procedure before it occurs. 

Take the time to show what you have 

explained, such as the instruments 

you will use and how they work. 

Demonstrations can encourage some 

patients to be more cooperative.

behavior problems—which 

may include hyperactivity and quick 

frustration—can complicate oral health 

care for patients with autism. The invasive 

nature of oral care may trigger violent 

and self-injurious behavior such as temper 

tantrums or head banging.

Plan a desensitization appointment to 

help the patient become familiar with 

the office, staff, and equipment through 

a step-by-step process. These steps may 

take several visits to accomplish.

• Have the patient sit alone in the 

dental chair to become familiar 

with the treatment setting. Some 

patients may refuse to sit in the 

chair and choose instead to sit on 

the operator’s stool. 

Health Challenges in Autism 

and Strategies for Care

People with 

autism need 

consistency and 

can be especially 

sensitive to 

changes in their 

environment.

• Once your patient is seated, 

begin a cursory examination 

using your fingers.

• Next, use a toothbrush to brush the 

teeth and gain additional access to 

the patient’s mouth. The familiarity 

of a toothbrush will help your patient 

feel comfortable and provide you with 

an opportunity to further examine 

the mouth.

When the patient is prepared for 

treatment, make the appointment 

short and positive.

Pay special attention to the treatment 

setting. Keep dental instruments out of 

sight and light out of your patient’s eyes.

Praise and reinforce good behavior after 

each step of a procedure. Ignore inappropriate behavior as much as you can.

Try to gain cooperation in the least 

restrictive manner. Some patients’ 

behavior may improve if they bring 

comfort items such as a stuffed animal 

or a blanket. Asking the caregiver to sit 

nearby or hold the patient’s hand may 

be helpful as well. 

Use immobilization techniques only 

when absolutely necessary to protect 

the patient and staff during dental 

treatment—not as a convenience. 

There are no universal guidelines 

on immobilization that apply to all 

treatment settings. Before employing 

any kind of immobilization, it may 

help to consult available guidelines 

on federally funded care, your State 

department of mental health/disabilities, 

and your State Dental Practice Act. 

Guidelines on behavior management 

published by the American Academy of 

Pediatric Dentistry (www.aapd.org) may 

also be useful. Obtain consent from 

your patient’s legal guardian and choose 

the least restrictive technique that will 
2

Before the appointment, obtain and review 

the patient’s medical history. Consultation 

with physicians, family, and caregivers is 

essential to assembling an accurate medical 

history. Also, determine who can legally 

provide informed consent for treatment.

CommuniCation problems and

mental Capabilities are central 

concerns when treating people with autism.

Talk with the parent or caregiver to 

determine your patient’s intellectual 

and functional abilities, and then 

communicate with the patient at a 

level he or she can understand.

Use a “tell-show-do” approach to 

providing care. Start by explaining 

each procedure before it occurs. 

Take the time to show what you have 

explained, such as the instruments 

you will use and how they work. 

Demonstrations can encourage some 

patients to be more cooperative.

behavior problems—which 

may include hyperactivity and quick 

frustration—can complicate oral health 

care for patients with autism. The invasive 

nature of oral care may trigger violent 

and self-injurious behavior such as temper 

tantrums or head banging.

Plan a desensitization appointment to 

help the patient become familiar with 

the office, staff, and equipment through 

a step-by-step process. These steps may 

take several visits to accomplish.

• Have the patient sit alone in the 

dental chair to become familiar 

with the treatment setting. Some 

patients may refuse to sit in the 

chair and choose instead to sit on 

the operator’s stool. 

• Once your patient is seated, 

begin a cursory examination 

using your fingers.

• Next, use a toothbrush to brush the 

teeth and gain additional access to 

the patient’s mouth. The familiarity 

of a toothbrush will help your patient 

feel comfortable and provide you with 

an opportunity to further examine 

the mouth.

When the patient is prepared for 

treatment, make the appointment 

short and positive.

Pay special attention to the treatment 

setting. Keep dental instruments out of 

sight and light out of your patient’s eyes.

Praise and reinforce good behavior after 

each step of a procedure. Ignore inappropriate behavior as much as you can.

Try to gain cooperation in the least 

restrictive manner. Some patients’ 

behavior may improve if they bring 

comfort items such as a stuffed animal 

or a blanket. Asking the caregiver to sit 

nearby or hold the patient’s hand may 

be helpful as well. 

Use immobilization techniques only 

when absolutely necessary to protect 

the patient and staff during dental 

treatment—not as a convenience. 

There are no universal guidelines 

on immobilization that apply to all 

treatment settings. Before employing 

any kind of immobilization, it may 

help to consult available guidelines 

on federally funded care, your State 

department of mental health/disabilities, 

and your State Dental Practice Act. 

Guidelines on behavior management 

published by the American Academy of 

Pediatric Dentistry (www.aapd.org) may 

also be useful. Obtain consent from 

your patient’s legal guardian and choose 

the least restrictive technique that will 

Health Challenges in Autism 

and Strategies for Care

People with 

autism need 

consistency and 

can be especially 

sensitive to 

changes in their 

environment.
5

Stress the importance of conscientious 

oral hygiene and frequent prophylaxis.

TOOTH ERUPTION may be delayed due 

to phenytoin-induced gingival hyperplasia. 

Phenytoin is commonly prescribed for 

people with autism.

TRAUMA and INJURY to the mouth 

from falls or accidents occur in people 

with seizure disorders. Suggest a toothsaving kit for group homes. Emphasize to 

caregivers that traumas require immediate 

professional attention and explain the 

procedures to follow if a permanent tooth 

is knocked out. Also, instruct caregivers 

to locate any missing pieces of a fractured 

tooth, and explain that radiographs of 

the patient’s chest may be necessary to 

determine whether any fragments have 

been aspirated.

Physical abuse often presents as oral 

trauma. Abuse is reported more frequently 

in people with developmental disabilities 

than in the general population. If you 

suspect that a child is being abused or 

neglected, State laws require that you call 

your Child Protective Services agency. 

Assistance is also available from the 

Childhelp® National Child Abuse Hotline 

at (800) 422–4453 or the Child 

Welfare Information Gateway 

(http://www.childwelfare.gov).

Making a difference in the oral health 

of a person with autism may go 

slowly at first, but determination can 

bring positive results—and invaluable 

rewards. By adopting the strategies 

discussed in this booklet, you can 

have a significant impact not only on 

your patients’ oral health, but on their 

quality of life as well.

Additional Readings

Hyman SL, Towbin K. Autism Spectrum 

Disorders. In Batshaw ML, Pellegrino L, 

Roizen NJ (eds.). Children With Disabilities

(6th ed.). Baltimore, MD: Paul H. Brookes 

Publishing Co., 2007.

NLM Family Foundation. D-Termined 

program of repetitive tasking and 

familiarization in dentistry: a behavior 

management approach. View at 

http://www.nlmfoundation.org/media.htm.

For more information about autism, contact

National Institute of Child Health and Human 

Development Information Resource Center

P.O. Box 3006

Rockville, MD 20847

(800) 370–2943

http://www.nichd.nih.gov 

NICHDIRC@mail.nih.gov
5

Stress the importance of conscientious 

oral hygiene and frequent prophylaxis.

TOOTH ERUPTION may be delayed due 

to phenytoin-induced gingival hyperplasia. 

Phenytoin is commonly prescribed for 

people with autism.

TRAUMA and INJURY to the mouth 

from falls or accidents occur in people 

with seizure disorders. Suggest a toothsaving kit for group homes. Emphasize to 

caregivers that traumas require immediate 

professional attention and explain the 

procedures to follow if a permanent tooth 

is knocked out. Also, instruct caregivers 

to locate any missing pieces of a fractured 

tooth, and explain that radiographs of 

the patient’s chest may be necessary to 

determine whether any fragments have 

been aspirated.

Physical abuse often presents as oral 

trauma. Abuse is reported more frequently 

in people with developmental disabilities 

than in the general population. If you 

suspect that a child is being abused or 

neglected, State laws require that you call 

your Child Protective Services agency. 

Assistance is also available from the 

Childhelp® National Child Abuse Hotline 

at (800) 422–4453 or the Child 

Welfare Information Gateway 

(www.childwelfare.gov).

For more information about autism, contact

National Institute of Child Health and Human 

Development Information Resource Center

P.O. Box 3006 

Rockville, MD 20847 

(800) 370–2943 

www.nichd.nih.gov 

NICHDIRC@mail.nih.gov

Making a difference in the oral health 

of a person with autism may go 

slowly at first, but determination can 

bring positive results—and invaluable 

rewards. By adopting the strategies 

discussed in this booklet, you can 

have a significant impact not only on 

your patients’ oral health, but on their 

quality of life as well.

Additional Readings

Hyman SL, Towbin K. Autism Spectrum 

Disorders. In Batshaw ML, Pellegrino L, 

Roizen NJ (eds.). Children With Disabilities

(6th ed.). Baltimore, MD: Paul H. Brookes 

Publishing Co., 2007.

National Institute of Child Health and 

Human Development, National Institutes of 

Health (NIH). Autism Questions and Answers 

for Health Professionals. Retrieved July 9, 

2009, from http://www.nichd.nih.gov/publi- cations/pubs/autism/QA/index.cfm.

National Institute of Child Health and 

Human Development, National Institutes of 

Health (NIH). Autism Spectrum Disorders. Retrieved July 9, 2009, from http://www.

nichd.nih.gov/health/topics/asd.cfm.

NLM Family Foundation. D-Termined 

program of repetitive tasking and 

familiarization in dentistry: a behavior 

management approach. View at 

http://www.nlmfoundation.org/media.htm.