Autistic at the Dentist – Part 1

Like many autistic people, I HATE going to the dentist.  Also like many autistic people, I have really bad teeth.  I won’t speculate on which came first – my baby teeth were pretty bad to start and I had some issues learning to brush my teeth – but I do know that the current state of my mouth has much to do with the fact that by the time I had any adult teeth, I was terrified of my family dentist and would do almost anything to avoid going.  I don’t have some of the sensory issues that other autistic people have to deal with surrounding oral care, but since I’ve recently been through some dental work and realized I’ve made some progress in my phobia, I thought I’d talk about it here a little.  There’s a lot more to cover, so this is just Part 1 – tips for autistic adults at the dentist.

Why Do People Hate Dentists So Much?

I can’t speak for other people, but much of my dental trauma comes from large, loud men looming over me and telling me it was all my fault – “why can’t you do better?” and “all your teeth are going to fall out!” were frequent refrains.  One dentist walked in calling my name as if I were about to be grounded or beaten.  When I told him, around age 7, that I had worked really hard on taking care of my teeth and I really believed I had no cavities, the man laughed at me and said “Oh, you’ve got some” before he ever looked in my mouth.

You aren’t made to feel like that when you go to your doctor (unless they’re all about your weight or your blood pressure, which is also not ok).  If you get sick and call your doctor, you’re going to a professional to be taken care of.  But the way I grew up, needing to go to the dentist was an admission of guilt – that I had screwed up and had to come in for punishment.  That’s not right!  Your dentist should be just like your doctor – someone who takes care of you when your teeth are sick, just as your doctor takes care of you when other parts of your body are sick or injured.

So Look for a Good Office Culture

When you’re looking for a dentist (I know, it’s a terrible thought, but stay with me), look for a practice with a good office culture.  You want to find a place where they do what I just talked about – they believe they’re there to help patients, not berate them.  A good way to find places like this is to ask for personal recommendations from people – especially anyone you know who has a lot of dental work!  Ask everybody you know if they like their dentist and how they feel when they go in vs when they come out.

Look at places that advertise with mentions of dental phobia; they tend to be understanding.  Usually they’ll talk about their anesthesia options and how they can help people relax.  Other good signs are advertisements with lines like “Bad teeth?  We’ll make it right.”  That kind of language can indicate a caring and understanding office culture instead of an attitude of “we’ll fix what you screwed up”.

What is Your Specific Issue?

The more specific you can be about what bothers you about dentistry, the better accommodations an office can make for you.  So take a little time and try to think it through (when you’re calm). 

Is it just a general fear of dentists from being badly treated before?  Is it the shots that freak you out?  Do you walk in expecting pain?  Do you have a history of not being fully numb during dental work?  Are you afraid of getting yelled at or shamed? 

Is a dental office sensory hell for you?  It is for me.  The smell alone can send me into panic arracks.  And I absolutely cannot stand the feeling of metal against my teeth!  For other people, it’s the sound of the drill, or the overall noise level of all the instruments.  Maybe being numbed for a procedure is sensory hell for you, or maybe you just can’t handle things touching your teeth or having stuff in your mouth. 

In my most recent dental experience, I realized a few things.  First, I don’t mind the shots – they’re not fun and I do close my eyes during them, but they don’t scare me and they don’t hurt that much.  Second, I don’t even mind the sound of the drills so much, except the last one that’s extra high-speed or something.  That one resonates through my sinuses and hurts my ears terribly.  Third, I realized that I’m more afraid of getting an exam than of having work done – even major work like getting a crown.  I hate all the putty and stuff they use to get a mold for a crown, but at least I never feel any metal against my teeth. A cleaning and exam is much worse because I have to feel all the metal scraping and poking around and there will definitely be pain when they find the places that need work – and they do it twice, first the hygienist and then the dentist!  Plus, exams were always when I got yelled at and shamed for how bad my teeth were, so I associate them with humiliation as well.  That’s all good information I can share with my dentist to make things better for me.

Be Upfront About Your Issues!

Tell your dental office, from the hygienist to the assistants to your dentist, about your specific problems and what accommodations you need.  I gave the entire office a quick speech that boiled down to “I’m autistic and everything about a dental office is sensory hell for me, and the absolute worst feeling in the world is metal on my teeth”.  I had them put notes in my chart to that effect so I didn’t have to go through it every time, and included a note that I will always wear the heavy x-ray apron any time I’m in the chair because it helps with the anxiety.

The first time I met my dentist, I made sure I was standing up when I told her all that so that I wasn’t intimidated by being laid down in the chair.  Imagine my amazement when her response was “Thank you for telling me” and then she made every effort to not touch my teeth with anything metal if she could help it, even using just a mirror where possible.  I haven’t had a cleaning there yet (still very scared of that), but I intend to ask if she’ll make a note for the hygienist to *not* do a preliminary exam so I only have to go through the poking and picking once instead of twice.  I think she’ll do it, it’s not a huge accommodation to make.

There are lots of small accommodations you can ask for that can make a dentist visit easier on you.  If you enjoy a weighted blanket, I highly recommend asking for the x-ray apron.  It doesn’t cover your whole body, but it’s heavy and it helps.  You could also bring your own weighted blanket if the office only has one or two aprons to go around (the office I go to has an apron in each room, so it’s no problem).  Something I never thought to ask for until I noticed my dentist didn’t do it is ask them if they would use a headlamp instead of the overhead alien abduction-type light.  It’s much less overwhelming that way, but not all dentists are comfortable using just a headlamp, so you can really only ask.  Either way, you can always wear sunglasses to block out some light.  Some offices will dim the lights as well.  Earplugs can be useful for blocking out noise and some of the drill sounds.  Many offices now have cleaning instruments that work more like a sonic toothbrush instead of scaling your teeth (I’m totally asking for that).  They sound like a drill, but they don’t scrape, so they’re great for me, but maybe not for others.  Some offices will offer numbing or gas for a cleaning – if that’s an option for you, there’s no shame in that.  

You Deserve Accommodations

Asking for accommodations does not make you a difficult patient.  I know lots of us are conditioned to be afraid of being “too much trouble”, but there’s nothing wrong with trying to make your dental care accessible.  A good dental office will work with you because doing so means you’ll be more able to take care of your oral health and that’s what they care about.  A bad dental office will make you feel bad about it or act exasperated with you for asking because you’re making them take extra steps.  That’s really what it comes down to – a good practice is focused on giving you the best care, while a bad office is focused on making it easy for themselves.

There will be more parts to this series – there’s a lot to cover regarding autistic people and dentistry.  I’m hoping to get my dentist to answer some questions about alternatives to minty products, the automatic full-mouth toothbrush I’ve seen online, minimum care for those who can’t do a full brush and floss twice a day, and how to ask for accommodations in ways that dental professionals will best understand.  I will be SO excited if I get to do an interview with her!

A male dentist in a white shirt pointing at an xray above a dark-haired woman in the patient chair. White and blue text on a purple background reads "Autistic at the Dentist Part 1"

What are your best tips for getting through a dentist visit? Do you have a dentist that you actually want to hug when you leave?  How did you find them?  What are your biggest issues surrounding dental care and how do you deal with them?  What accommodations have made the biggest difference for you?

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  1. Laura Hill

    June 24, 2021 at 8:18 am

    My current dentist has notes in my file that I need way more anesthetic than normal, and that I need Xanax before a procedure, because pain from not being numb is a massive trigger for me, since my childhood dentist never believed me. They also include sunglasses for the alien-abduction light and encourage wearing headphones to listen to music if you want to. The dentists there, and the hygenists all want patients to *not* be scared and work hard to help that be real.

    1. Cali

      June 25, 2021 at 6:06 pm

      After going through several nightmarish dental experiences, I have finally found a dentist office where everyone is kind, thoughtful, and considerate. The dentist himself is very gentle, and has honored my request not to give Lidocaine with Epinephrine because it has an adverse side effect. He will often pause while working and ask if I am okay. I am sure that he would accommodate most requests if asked. I only wish other Autists could visit him! BTW, that is awesome advice about asking to keep the X-Ray apron on. I always hate when they take it off!

      1. Grace

        June 25, 2021 at 6:20 pm

        Oh that makes me so happy to know you’ve found a good dental office! My dentist frequently checks in with me, and if my right hand so much as moves, not only does she stop working, but everything immediately comes out of my mouth. I should ask about using anesthetic without epinephrine because my blood pressure is always high at the dentist (wonder why) and I run thru that stuff so quickly in the first place.

    2. Grace

      June 25, 2021 at 6:25 pm

      That makes my heart very happy to know there are dental practices that really care. I didn’t think that was real for the longest time. With the last work I got done, I told her that I was burning thru the anesthetic extra fast before she got started on the second tooth, and she didn’t hesitate to give me an extra shot. It was amazing to feel so heard!

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