Our journey through autism

Posts tagged ‘teeth’

Dentist Visits

Dental visits can be very tough for a child with autism. The sensory overload, too much touching, noise, instruments, lights, possible pain. Even typical children and adults have a tough time at the dentist. Thankfully Bilal’s experiences have been good so far. When he was a baby or toddler, I never brushed his teeth, as a baby he had a toothbrush he would sometimes chew on and then as a toddler he liked to copy me and brush his teeth and I was fine with that, with doctor visits so difficult I didn’t see the point of visiting a dentist with his no issues or complaints with his teeth. As we were applying for pre-k it was required to get a dentist form, so I asked his pediatrician for a referral and we went to the first name on her list. Bilal absolutely refused to put the x-ray film into his mouth and the screaming and tense body reactions started so the dentist said it was fine for now due to his age (3 and a half) the check up, cleaning and fluoride was another struggle with the dentist holding him down. On the form I was honest and marked that we didn’t brush every day so when the dentist saw that he went on to give me a long lecture about how horrible and irresponsible that was of me and how important teeth health was and that it was essential that I brush his teeth for 3 minutes twice a day and floss daily and on and on he went. I thought by telling him my son has autism and sensory issues it would shut him up some. Surprise surprise he said that his son has autism too and he wraps him up in a blanket burrito style, puts him on the floor, puts his legs over him and tilts his head and brushes his teeth, every night its a struggle but its for his son’s own good. I was shocked he was telling me practically to tie down my son and force brush his teeth, how will he ever accept to brush his teeth without a fight and how will he ever enjoy it. At the end of the visit he gave Bilal the bag with the toothbrush, toothpaste and from the treasure box he gave him a little sand timer so he can (or I can) make sure to brush for the 3 minutes. He also snapped a Polaroid picture of him and Bilal together saying it would help Bilal recognize him and the office and it would help with our follow up visits. That picture ended up in the garbage. I thanked him and got the form, went home and cancelled the 6 month follow up visit that the receptionist had set and decided never to go see him again.   Our dental routine was the same after that, he had a toothbrush that he would use occasionally by himself no complaints or battles. A couple years later I really don’t remember what it was that made me decide to pay attention to dental health, his younger brother had fallen a couple of times and bumped his teeth so I called their pediatrician again and asked for another dentist and we went there, the clinic was set up with a large waiting area and a lot of play areas for the kids, all the decor was colorful and child appealing. I felt more comfortable there and the boys did too. The check-up went more smoothly, we got the x-rays done and I didn’t get a lecture only a quick piece of advice. At home I brushed their teeth every night in the bath, it was quick and easy and they had no complaints, it was a part of the bath routine. We went back again for the 6 month follow up and it went even better as the older Bilal gets the more mature and less sensory issues he faces. A cavity was found and he was only given laughing gas, no sedation, no restraints, he did a really good job and the nurses were very friendly and explained everything to him and answered all his questions and they explained the need to floss and he was okay with it after that, so now the flossing has been added to the bath routine with no complaints. At this clinic they get the little bag with the toothbrush and toothpaste but attached to that bag is a helium balloon that they love, and if they had more than a check-up and cleaning they get a little fun toy (not a timer)

 

teeth

This was when Bilal was 2, I heard him in the bathroom so I go check on him and find that he had climbed into the sink to play with our toothbrushes.

teeth 2

I give him his own brush and snap this shot. He doesn’t enjoy it much.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

So in conclusion yes dental health is important but I believe that it can be taken in a slower pace and also very important is choosing the best dentist and practice, someone who can understand your child’s sensory needs and is patient and friendly enough to have the child enjoy the visit. You’d think a parent of a child with autism would be more understanding but surprisingly it wasn’t for us.

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Myofunctional Therapy

Myofunctional therapy is basically therapy of the facial and oral muscles, (tongue, lips, mouth, jaw, cheeks, etc…) A couple weeks ago Bilal’s OT therapist was traveling abroad and the owner of the facility took over for 4 sessions, she wasnt used to his speech patterns and asked whether he was getting any speech therapy and she suggested that I get him evaluated by her friend and colleague for this myofunctional therapy. We set an appointment, for the beginning of the month but he woke up with a slight fever that day so we rescheduled for the 15th of May. We go in and Dr. Sharon Wexler starts her evaluation, she checks his stance, posture and neck alignment, she explains to me with a mouth and tongue model what a normal swallow should look like and what a lot of children with autism look like. She says infants have a thrust swallow, as they nurse and deal only with liquids they move their tongues inwards and outwards as they swallow as they mature and start taking in solids they swallow by moving their tongues upwards and backwards. As with many of Bilal’s fine motor delays his tongue thrust never developed properly,  also while your mouth is shut and relaxed the tongue usually rests and touches the roof of your mouth but for Bilal its at the bottom, when asked to swallow with your teeth set closed your tongue goes up but for Bilal he had to push it out. She had him bite and chew an animal cracker, he bites with his side teeth and takes a lot of small bites, and swallows it as it is. A normal person will usually bite with his front teeth, chew, move the food around his mouth with his tongue and gather it towards the back and swallow, all this is done unconsciously and involuntary but that’s how it is done. She also had him chase a lollipop around with his tongue sticking out and it took him some effort to stick his tongue out at the correct side, he’s also unable to lift his tongue for the “LLL” position. His tongue weakness explains why he takes a lot of small continuous bites of food so that the new food will push the other food down as he cant manage to swallow it correctly, that’s why he overstuffed his mouth as well. She then measured the strength of his tongue and found it to be weak, and then finally she had him identify some pictures to see how he pronounced those words, he misses a lot of letters but not always indicating a weakness. The good news is that his mouth and lips are fine, no drooling or other issues. She says he’s at the perfect age for this therapy as he’s old enough to understand and follow directions, and to learn to be conscious of his swallow and learn the proper method of doing it. She says speech therapy is great and all, for vocabulary and grammar development but for pronunciation its all wrong trying to build on weak foundations, it will never build up correctly. She does half hour sessions with him once a week while we practice at home the rest of the week. Her testimonials say that parents noticed results within 6 months. It was a very interesting and beneficial evaluation explained a lot of his eating habits, why he only eats these particular foods because its what he can manage, chew and swallow on his own, he doesnt take any hard foods which are apples with the peel or meats, everything he eats either breaks down or melts easily and gets pushed back almost on its own, its also why he chews with his mouth open and why he’s a messy eater. She’s still in the research process of the relationship between reflux and tongue weakness, but it makes sense, she says that with this method of swallowing an air pocket gathers and when he burps it pushes up all the food again, Bilal had reflux until he was 18 months. I’m looking forward to this therapy and the results we’ll get, better prouounciation leading to better communication and better eating habits and hopefully a more varied diet.

The only drawback is that The Institute of Myofunctional Studies does not file insurance claims, I have to send in the receipts and wait for them to refund me, so its expensive and time consuming and there is the risk of the insurance company delaying refunds and making up stories of not receiving it, getting lost in the mail and so on, but its worth it inshaAllah.

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