By Kathryn Kupczyk, RDH, BSDH, BS
“There isn’t a spot for it on the health history I was given, but my child does have sensory processing disorder (SPD).”
This is a phrase that I hear more often during pediatric patient appointments in the general practice where I work. Although at first it may seem intimidating, armed with questions and modifications that can be made, working with a patient with a sensory processing disorder can be easier and more successful for both the hygienist and patient.
Pediatric occupational therapist Claire Heffron lists several questions for parents and teachers to ask in a school setting for children with diagnosed SPD in the book, Sensory Processing 101, that she co-authored. I adapt some of these questions to ask parents or guardians when reviewing the health history, or better yet, over the phone prior to the scheduled appointment.
- What works at home (calming strategies, strategies to promote attention, strategies to help regulate behavior?
- What are the biggest challenges at home?
- Are there any patterns surrounding the child’s behavior (for example, situations that typically cause a meltdown, ways to tell when a meltdown is coming, or times when is the child most calm)?
- What are the child’s likes/dislikes (rewarding/comforting objects, tasks, activities, and types of interactions)?
- What are the child’s biggest worries or fears about school (the doctor/dentist)?
- What is the child most excited about when it comes to school?
- What does the morning routine and after school routine look like at home?
- How is the child sleeping and eating?
- When do you see that the child is happiest/most calm/most attentive during the day?
- Tell about any specific sensory behaviors you see at home and ask if they are also present at school (for example, chewing on clothing, rough play, sensitivity to sounds, etc.)
Using these questions can give insight to things such as:
- What time of day the appointment should be scheduled
- How to celebrate during the appointment
- Regulators and stressors to manage the appointment
- Nutrition and diet
- Routine at home can mimic during the appointment, such as. counting through moments of the appointment
- Challenges and triggers, such as light, noise, sound, spatial awareness
While recently providing care for a 15-year-old patient with SPD, he explained to me the experience of fluoride varnish as one he had to prepare himself for all morning. The texture of being cold and wet liquid, yet sticky and hard is a true challenge for someone with SPD.
His mother chimed in, explaining that eating tacos was actually how she came to relate to how her son was feeling. “A taco is a sensory nightmare,” she said. “Think about it. It’s hard, yet soft, hot and cold, crunchy and squishy all at the same time. I’ll never be able to not think about that when I eat tacos now.”
Since this conversation, our office has added an option for sensory patients to have an in-office fluoride rinse at the end of the appointment, as well as having finer grits of prophy paste to minimize the amount of texture variations during an appointment.
Modifications are an important conversation to have in your practice. It is important to partner with your doctor and communicate often.
In an article written by Bethany Durden, RDH, in the June 2017 issue of RDH magazine, she notes that appointment modifications can include “homework” to help these patients get to know the office staff and routines. Our office offers parents or guardians something we termed a “happy visit.” Happy visits most often do not entail use of any radiographs or dental tools. Instead, it is about acclimating to our office and to us as providers. Patients are allowed to tour the office, explore the operatory, and watch video content to show what happens at a dental prophylaxis appointment.
It takes patience and time for happy visits to work into an actual prophylaxis appointment. The end result, though, can be very rewarding for the patient, providers, and parents. Building trust and finding what works (and does not work) is key. One approach will not work for all SPD patients, and it may take time to learn more.
Durden also recommends using guided touch and massage to help stimulate or desensitize a patient as needed with permission of the parent or guardian in the operatory. More information on guided touch for dental patients can be found on YouTube and the internet. “Help them be comfortable with music, low light, and a fidget toy before the appointment begins.” Fidget toys are something great to have on hand in the office for patients to calm down. They can be purchased online or distraction jars can be handmade with help from instructions on the internet at places like Pinterest.
One thing that frustrates me as a hygienist is when I cannot provide a thorough prophylaxis for a patient. However, doing your best with a sensory patient is what counts. Be flexible, creative, and patient with appointments. When there is a success in the appointment, big or small, be sure to make it known and celebrate with the patient.
Know the limits you have, however, in your office. Some patients are not able to receive optimal treatment in the traditional office setting. In this case, Durden quotes Greg Evans, DDS, suggesting that “sometimes we must do the best we can in the dental office, but we may have to do general sedation every two years or so in order to perform a thorough exam.”
Know where you can refer patients to in your area. Start asking more questions and do not be afraid to modify and build during appointments. Even “failures” are successes in learning how best to care for that patient.
Kathryn Kupczyk, RDH, BSDH, BS, attended DePaul University and completed her bachelor’s of science in biology with a concentration in biotechnology where she performed and presented at several research symposiums in Chicago. She graduated from the University Of Michigan School of Dentistry with her bachelor’s of dental hygiene and minor in business from Ross School of Business. Currently, Kathryn is an independent product consultant, member of Sigma Pi Alpha, working full-time in private practice, and enjoys culinary experiences, Netflix, and travel.
