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Going to the Dentist - July 17, 2009

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Going to the Dentist

By: Heather Miller-Kuhaneck, MS OTR/L BCP


Reprinted with the express permission of SPD, Sensory Processing Disorders Foundation as originally published on their website.

NB: This article is written for dentists treating children with SPD and related problems. It is also useful for the parents of these children. We publish it here because we know that therapists like to give their client's caregivers as much information as possible. This article would be particularly useful before taking a child with SPD to the dentist.

Introduction

Sensory defensiveness, one type of Sensory Processing Disorder, occurs in children with a variety of diagnoses and disabilities. Therefore, in a dental practice that serves children with special needs, this disorder may likely affect some portion of your clientele. A thorough understanding of sensory defensiveness and strategies to alleviate difficulties caused by this disorder would be beneficial for dental professionals, in order to make the dental visit more pleasant for all involved. Therefore, this paper will present information allowing dental professionals to recognize the signs and symptoms of over sensitivity. In addition, helpful techniques to reduce the discomfort and anxiety of their patients with sensory defensiveness and increase compliance with dental procedures will be provided.

What is Sensory Defensiveness?

Sensory defensiveness has been defined as the behavioral indications of over-reactivity to common sensory experiences (Lane, Miller, & Hanft, 2000; Wilbarger & Wilbarger, 1991). Sensory defensiveness can occur in any of the sensory systems, of which there are really eight, rather than five. They are as follows:
  • Tactile system (touch)
  • Vestibular system (sense of movement in relation to gravity)
  • Auditory system (sound)
  • Visual system (sight)
  • Proprioceptive system (position of our body parts, joints, and muscles, as well as the amount of force being used with movement)
  • Gustatory system (taste)
  • Olfactory system (smell)
  • Inner senses (hunger, elimination, etc.)

Typical over-reactions to sensations that others might not find noxious range from mild to severe, depending on the stimuli received and the overall amount of stimuli the child is being exposed to. The range of behaviors includes gaze aversion, physical withdrawal, blocking of the stimuli, vocal outbursts, aggressive behaviors, and tantrums.

A child with sensory defensiveness may exhibit the following during a dental visit:
  • Tendency to pull away from or over-react to unanticipated touch, particularly touch to the face
  • Over sensitivity to teeth cleaning by the hygienist
  • Fear responses to moving backwards in the dental chair
  • Difficulty tolerating the bright light above their head
  • Fear responses to the noises of the dental equipment, including the polishing brush
  • Fear responses to unexpected office noises, such as intercoms, door alarms, or beeps
  • Extreme dislike of the polishing paste due, to the texture
  • Over-reactive gag responses to dental tools or x-ray materials
  • Responses to the smell or feel of the glove materials

Fear responses may escalate to physical responses if the fear is not respected. Typically a child will demonstrate "flight or fight" behaviors. First, they will try to escape from the stimuli that are distressing, but if that cannot occur, they will become more and more physically reactive in any attempt to remove themselves from the situation. A child may be able to tolerate one type of stimuli but become more and more agitated if multiple stimuli are added.

Intervention Strategies for Sensory Defensiveness

Sensory defensiveness is often treated with two types of sensory input: deep touch pressure and heavy work. Deep touch pressure is firm touch provided to the skin by way of massage, vibration, brushing, lycra clothing, ace wraps, sandwiching between pillows, heavy weighted clothing, or lying under something heavy. Heavy work includes any activity that provides resistance to the muscles and joints of the body. Activities such as pushing or pulling something heavy, hanging from a trapeze bar, jumping, lifting or carrying heavy items, or squeezing something against resistance can all be considered heavy work. Using deep touch pressure and/or heavy work before and during distressing events can help calm a child with sensory defensiveness. See the box below for specific ways to use these techniques before or during a dental visit. Lastly, a child with sensory defensiveness will best be able to handle discomforting inputs when they are not unexpected. Using verbal preparation can be very helpful. Before doing anything that involves distressing sensory input, warn the child that it is about to occur so they can be prepared and not startled. Also, giving a set time limit that the input will occur may also be helpful (i.e., "we are going to do this until the count of 20," or "we’ll be done when the clock says X," etc.).


Suggestions for Reducing Sensitivity During Dental Visits
  • Have the child wear the X-ray vest during the entire appointment to provide extra weight and deep pressure.
  • Have the parent do oral deep pressure or vibration in the form of electric toothbrush, mini massager, or rubbing with toothette prior to appointment.
  • Have the child eat something very chewy prior to the appointment.
  • Allow the child to have a fidget toy that provides "heavy work" during the session.
  • Have the child wear a heavy or tight hat before and during the appointment.
  • Use firm touch whenever touching the child.
  • Verbally warn the child before each thing you do.
  • Allow child to wear something that blocks the bright lights if he/she is sensitive to this.
  • Allow the child to listen to calming music over headphones if the office noises or equipment noises are distressing.


Conclusion

It is difficult for individuals with sensory defensiveness to cope with the fact others do not share their discomfort and others actually may enjoy situations that they find so upsetting. For a child with sensory defensiveness who may not be able to verbalize or even recognize the problem, the accompanying feelings of anxiety and frustration can be overwhelming. Therefore the impact on functional behavior can be significant. Having a dental professional who is understanding and attempts to make the experience as comfortable as possible by respecting their fears and reducing the level of stimuli that is distressing may make the difference between a visit that is successful and one that is not.

References

Lane, S., Miller, L. & Hanft, B. (2000). Towards a consensus in terminology in sensory integration practice: Part 2: Sensory integrations patterns of function and dysfunction. American Occupational Therapy Association’s Sensory Integration Special Interest Section Quarterly, 23(2), 1-4.

Wilbarger, P. & Wilbarger, J. (1991). Sensory Defensiveness in Children Aged 2- 12. Denver, CO. Avanti Education Programs.

Featured Organization: Sensory Processing Disorder Foundation

The SPD Foundation is a world leader in research, education, and advocacy for Sensory Processing Disorder, a neurological condition that disrupts the daily lives of an estimated 1 in 20 children and adults. Originally called the KID Foundation, SPDF has been providing hope and help to individuals and families living with SPD since 1979.

About the author:

Heather Miller-Kuhaneck currently teaches in the graduate occupational therapy program at Sacred Heart University in Fairfield, Connecticut. She has practiced in pediatrics for years, and has specialized in school-based practice and outpatient occupational therapy using Ayres’ sensory integrative approach. She has edited a book on occupational therapy for children with autism, and has been the quarterly editor for AOTA’s School System Special Interest Section. She is currently developing an assessment tool to examine behaviors indicative of sensory integration dysfunction in the school setting. She can be reached at [email protected] or [email protected].

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Tags: OT Sensory Processing Disorder July 2009 Newsletter Article