Preparing a Child With Sensory or Additional Needs for a Dental Visit

Preparing a child with sensory or additional needs for a dental visit works best when most of the preparation happens at home, before the day, and when the practice is told in advance what helps and what does not. A dental surgery is an unusual sensory environment. Most of what makes it difficult is predictable, and predictable things can be planned around.

If a dental visit has been difficult before, the next one can be planned differently.
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What makes a dental surgery difficult sensorially?

Very little of a treatment room is designed with sensory difference in mind.

• The overhead light is bright and points at the face.
• The handpiece is high-pitched, and it vibrates as well as makes noise.
• The suction is loud, wet and starts and stops without warning.
• The chair reclines, which removes the sense of where the floor is.
• The smell of gloves, disinfectant and dental materials is distinctive and strong.
• Almost everything involves being touched close to the face and mouth.
• The order of events is unfamiliar, so it is hard to know when it will end.

For a child who processes sensory information differently, any one of these can be enough on its own. Several at once, in a room they have never been in, is a great deal to ask.

Naming which of them affects a particular child is the single most useful piece of information a parent can bring.

What can be done at home before the visit?

Make the sequence predictable

Social stories and picture sequences work because they turn an unknown into a list. A short set of photographs — the front door, the waiting area, the chair, the mirror, going home — gives a child something to rehearse in advance.

Practise the physical parts

Lying back on the couch with the head on a cushion, for a few seconds at a time, makes a reclined chair less startling. Counting teeth with a toothbrush handle rehearses the feeling of something entering the mouth without any pressure attached to it.

Let the room be seen first

Watching a sibling's or a parent's appointment is often more useful than any explanation. Some children need to visit the practice once with nothing happening at all, and that is a reasonable thing to ask for.

Choose the timing deliberately

A quieter appointment time, away from after-school hours, changes how busy and loud the waiting area is. Appointments placed before a nap, before a meal, or at the end of a long school day are harder for reasons that have nothing to do with dentistry.

What should the practice be told in advance?

All of the following is useful, and none of it needs to be discovered on the day:

• known triggers — noise, light, smell, touch, being reclined, unfamiliar people;
• how the child communicates, including whether they use a device or AAC;
• what has gone wrong at previous appointments, and what happened immediately before it went wrong;
• whether they need to keep headphones, sunglasses or a hood on, and whether a comfort object comes in with them;
• what settles them once they are distressed, and what makes it worse;
• relevant medical history, medications and any diagnosis the family wishes to share.

This can be given by phone before the appointment, so the visit is planned around it rather than adjusted halfway through.

Telling the practice what helps, before the day, is the part that changes the appointment most.
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How is the first appointment run?

The first appointment is never treatment

It exists so the child can meet the room, the chair and the clinician with nothing being done to them. If it goes well, what follows is going home — not a procedure added on because there was time.

Show, tell, do

Each instrument is shown, then explained, then used, in that order and at the child's pace. The mirror comes first because it is small, silent and does nothing.

Language that removes the threat

The suction becomes the funny straw. The polishing brush becomes the tickle brush. Plaque becomes sugar bugs. A toy is offered at the start or the end, and sometimes at both.

Several short visits rather than one long one

Desensitising means adding one new step per visit — sitting in the chair, then the mirror, then counting teeth, then a polish — and stopping while it is still going well. It looks slower written down and is usually faster in practice than forcing a single long appointment.

More on how this is approached is on the special needs dentistry page, and there is a related article on anxious children and first dental visits.

Where does happy gas fit?

Nitrous oxide, usually called happy gas, is available at the practice where the clinical team judges it appropriate. It is breathed through a small nosepiece, and it reduces anxiety while the child stays awake and able to respond.

It is discussed and assessed first, never assumed. It suits some children and not others, and a child who will not tolerate the nosepiece will not tolerate it here either.

Happy gas is $120. That figure assumes no health-fund contribution; a fund may contribute depending on the policy, and a written quotation is provided before anything begins. There is more detail on the sedation page and the fees page.

What if it still does not work?

Some children need more visits than anyone expected. Some need care delivered in a facility that can provide a general anaesthetic, and a referral is made where that is the right answer. That is a normal clinical outcome, not a failure by the child or the parent.

No practice can promise a calm visit, and this one does not. What can be planned is the preparation, the pace, and how many steps are attempted in one sitting.

Berala Dental is a general dental practice with no specialist on site. Children's preventive care is delivered by the oral health therapists, and referral is made where a case genuinely needs a specialist setting. General background on dental care is available from healthdirect.

Quick answers

Can my child keep headphones or sunglasses on?

Generally yes. Ear defenders, sunglasses and a comfort object are usually easy to work around, and it helps to say beforehand that they are coming in so nobody asks the child to remove them mid-appointment.

Should I explain what is going to happen, or will that make it worse?

Most children cope better with an accurate, short and repeatable description than with a surprise. What tends to backfire is promising that nothing will be done and then doing something, so it is worth only describing what is actually planned.

Will anything be done at the first visit?

The first appointment is a look, a count and a conversation. Where a child is comfortable and time allows, a polish may follow, but treatment is not the purpose of the visit.

Is happy gas offered to every child who finds it hard?

No. It is assessed case by case by the clinical team, and it is only one of several options. Several short desensitising visits are often tried first.

Planning a first visit

You can read more about children's services on the paediatric dentistry hub, and about what a first appointment involves in the article on your child's first dental visit.

Phone ahead and describe what your child needs, and the appointment will be set up around it.
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Written and reviewed by Humzah Aly, Oral Health Therapist. This article is general information only and is not a substitute for personalised dental advice. Please see a dental practitioner to discuss what is right for you.