Does your son or daughter have orthodontia or need braces? Sensitivities around the mouth combined with atypical sensory processing can make any sort of dental or orthodontic procedure difficult or problematic for the child or adolescent with sensory processing issues. Anxiety is a big factor, too.
First and foremost, decide whether braces are necessary at this point. For example, orthodontists say that if a child has to have her palate widened, making that happen while the bone is still soft and the plates on the roof of the mouth haven’t completely knit together yet may prevent the need for surgery down the road. Malocclusion, which is when the teeth don’t line up properly, can cause tooth and jaw issues that involve more expensive and invasive procedures in the future. Talk to an orthodontist about whether you can wait until your son or daughter is more mature and better able to handle the demands of orthodontia.
Second, be sure you work with a sensory smart orthodontist—and a sensory smart dentist. Pediatric dentists, as well as orthodontists and dentists who specialize in treating children and teens with special needs such as kids with autism, know many tricks for making procedures more tolerable and devices more manageable. However, any dentist or orthodontist who is respectful of sensory differences and knows what to do about them, or is willing to learn, can be a good choice. The professional also needs to be willing to take extra time with your son or daughter.
Your dentist should alert you to the need for orthodontia for your child, so be sure your dentist is up for supporting a sensory child’s challenges with dentistry and orthodontia. Your child will need extra attention from a dentist during the years when the braces are on or a retainer, palate jack, or night brace is being used. Good dental hygiene is especially important and challenging when a young person has braces and sensory issues complicate matters.
Be realistic about how much effort will be involved in getting your child to cooperate with orthodontic practices. If your child is highly unlikely to tolerate regular tooth brushing and flossing (which can be done with braces on), wearing a night brace or retainer, and so on, be honest with your dentist and orthodontist. Your child may not be ready to tolerate all that’s involved in orthodontia or may need a modified plan. Some kids won’t wear the rubber bands or night brace as often as needed, or at all, but may still benefit from braces. Talk frankly with your dental professionals and your son or daughter before making the commitment to orthodontia.
Once you find the right orthodontist and dentist, take advantage of the following sensory smart tips for orthodontia.
Give your child plenty of information. As with any dental procedure, when it comes to orthodontia, take time to let your child know exactly what the procedure will involve. You may have to spell out exactly how long sensations will last and what the order of procedures will be. For example, your teen may need to know and even feel what it’s like to have impression trays in her mouth. She may be need to know which tray, top or bottom, will be inserted first, how many seconds they will be in her mouth, and so on. Be honest if you don’t know what’s involved. Offer to call the orthodontist ahead of time if need be to get the information. Don’t assume every orthodontist does every procedure the same way, so let your child know if you’re not sure what is involved. If you guess, and the orthodontist has a different plan, you may trigger an anxious reaction in your child.
Make appointments first thing in the morning if possible to allow extra time and less waiting. Know that your child may not be able to go back to school that day if the sensations are too upsetting for her. Plan accordingly.
Desensitize and distract. Desensitize the area in and around the mouth with gentle massage or vibration depending on your child’s unique sensory needs. Doing so will prepare her mouth, gums, lips, and tongue for unfamiliar and/or unpleasant sensations.
Be sensitive to your child’s unique level of pain tolerance. Children and teens with sensory issues have unusual levels of pain tolerance. They can be overly sensitive or undersensitive or even both at the same time. The sensory processing centers of their brains may process sensations very differently, so that, for example, the sensation of numbing from an injected painkiller such as Novacain may actually be more distressing for your teen than the sensation of drilling a cavity or putting metal bands on her teeth.
Communicate with your child every step of the way during a procedure. Be right next to your sensory child at appointments if possible. Acknowledging his or her need for information will ease anxiety.
Use distraction as a key tool for managing anxiety, pain, and distress. Kids can distract themselves from the discomfort of procedures by wiggling their fingers and toes when a procedure is being performed. They can also create a vision or “mini movie” in their head of something pleasant, whether it’s playing a video game or imagining themselves drawing a cartoon or swimming—whatever makes them feel happy and safe. You can also sit with them and talk to them about a topic they enjoy, keeping a running monologue.
Instruct your child or teen to use hand signals when she needs a break during a procedure. It’s anxiety-provoking not to be able to speak when a procedure is being performed, so respect your child’s need to interrupt and communicate.
Plan a reward. Something pleasant to look forward to after a procedure can motivate a child to do her best to use her sensory smart techniques to tolerate the procedure and her anxiety about the appointment and the sensations she’ll be feeling. Give your child or teen the reward regardless of how anxious or uncooperative she was. Talk through what she did and what might make the appointment easier next time. Build her confidence rather than punish her for failing at managing her anxiety and pain.
Prepare for the visit with strategies, techniques, supplements, or medications for pain or anxiety. To reduce anxiety, distress, and pain, you may want to give your child a painkiller, antianxiety medication, or a supplement for anxiety. For example, your pediatrician and nutritionist might suggest GABA and 5-HTP. Always talk to your pediatrician and orthodontist beforehand to be sure that the medication or supplement won’t be a problem. Don’t try out a new medication or supplement the day of a procedure, however. Unfamiliar sensations such as feeling very relaxed or “woozy” can be deeply distressing to a child or teen with sensory issues.
Be patient. It takes a lot of extra time and soothing to help sensory kids practice good dental hygiene and tolerate dental and orthodontic procedures. Model patience and cooperation and your child will be reassured that he, too, can develop these qualities despite the challenges and orthodontia.
You might be very surprised by what your child or teen is able to tolerate if you use these sensory smart tips. Maybe what seems to you an incredibly painful procedure, or a distressing new oral routine, will simply irritate your child mildly for a couple of days. Whatever decision you make, know that patience, good communication, and sensory smart strategies for managing sensations and anxiety are always important.
Learn more about oral sensory seeking and sensitivities, and pick up even more practical tips for helping your child with dental and oral issues, in Raising a Sensory Smart Child, the award-winning book by Lindsey Biel, OTR/L, and Nancy Peske.