Interview children autism mainstream healthcare dentistry

Iveta Ramonaite, Dental Tribune International

Fri. 2. April 2021

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The number of children with autism spectrum disorder is on the rise, and the challenges they face are plentiful and include problems in maintaining a healthy mouth. To commemorate World Autism Awareness Day, which is celebrated on 2 April every year, Dental Tribune International spoke with Dr Yasmin Kottait, an internationally renowned paediatric tooth fairy with a passion for treating children on the spectrum and expertise in doing so. As a certified autism specialist, Kottait discussed why it is important that children with autism are given the option of receiving a typical dental treatment. She also shared some ideas on how to make an autistic child’s visit to the dental office a pleasant experience.

Dr Kottait, could you tell our readers something about yourself and about what motivated you to become a paediatric dentist and a certified autism specialist?
My name is Yasmin Kottait. I am a fun-loving, TikTok-dancing, paediatric dentist. I am an avid problem-solver, and the main problem I used to face was that there were some children on whom my child-whispering superpowers didn’t work. Since they were resistant to all my efforts, they ended up not enjoying the full experience of happy dentistry. This pushed me to read more and to understand more, and I ended up by obtaining two certificates in autism.

Dr Yasmin Kottait is a committed paediatric dentist based in Dubai. She has almost two decades of experience of working with children, including those with autism spectrum disorder. (Image: Yasmin Kottait)

The more I read about autism, the more I understood that just reading about it from one perspective was not enough. The more I read, the more I wanted to go deeper so that I would be able to understand the child’s experience, know what he or she was going through and offer suitable dental treatment.

What does a typical treatment involve? Are there any special preparations that dental professionals need to make before the dental appointment?
The treatment consists of the consultation visit, which involves cleaning the teeth with fluoride, taking some radiographs in order to be able to diagnose properly and then filling a cavity, if necessary. It also sometimes involves root canal therapy and crowns. I have treated children successfully using nitrous oxide, and I have treated children that I have had to put under general anaesthesia, and there have been very many children that I have been able to treat in the chair.

I also offer white crowns for children with autism, and whenever I give lectures, I always say: let’s not preclude children with autism from mainstream healthcare. We need to rise to the challenge. And parents appreciate that. So, when I offer them sedation or nitrous oxide, parents appreciate that I’ve given them the choice because, unfortunately, most providers will say something like: “No, no, no! I cannot take the hassle in the chair. What I’m going to do is I’m going to put them under general anaesthesia and do the treatment while they’re asleep. And that’s the only way I’m going to be doing the treatment.”

We need to include children with autism in mainstream care, which means that anything we typically do in the chair for a neurotypically developing child we will do for a child with autism in the chair as well.

The number of children diagnosed with autism spectrum disorder is on the rise. What are some of the most common issues that children with autism face in a dental practice, and what can dental professionals do to make them feel at ease during their visit?
What a wonderful, beautiful question! Yes, unfortunately, it is on the rise. Recently, one in 68 children worldwide had autism. The last time I checked it was one in 48, so the number is increasing rapidly. Now, some of the common problems I do see in autistic children include neglected dental caries. Periodontitis is a second problem; then there can be some bite problems or bruxism. These are some of the problems that children with autism face more than their peers do.

Now let’s shed some light on why caries is often left untreated, since it’s a major part of their experience. It’s because parents have a priority list, and teeth happen to be at the bottom of that list. But, more importantly, parents are unable to find the right provider who can give them an experience in the treatment of dental caries that is smooth sailing, and parents say to themselves: “You know what, I’m going to ignore it, there’s nothing I can do.”

So, what can dentists do to make children with autism feel at ease during the visit? At first, familiarise yourself with autism. What does it mean? What does the child go through when they come to a paediatric dentist office for the first time? The sound, the smell, the staff—all these are stress factors for children with autism because they don’t know who their dentist is, they have never seen him or her before. It’s something unfamiliar. They have also never seen the staff before, and the smell is one of disinfectants.

“The dentist has to be extremely familiar with who the child is and know what his or her preferences are and whether he or she has a sensory aversion”

Also, the dentist has to touch the child, and most children on the spectrum don’t like to be touched. So, everything is an assault on the child’s senses. That’s why the dentist has to be extremely familiar with who the child is and know what his or her preferences are and whether he or she has a sensory aversion.

Personally, what I do is to use social stories. I use the power of these stories to make the children more comfortable, happier and more familiar with who I am. Through social stories, they learn what procedures I’m going to carry out during the treatment, what tools I’m going to use and what it’s going to taste like. I’m not trying to change dentistry, but I’m trying to make dentistry more acceptable to children with autism.

Not every experience with a child with autism spectrum disorder is all fun and games, nor does it have to be. (Image: Yasmin Kottait)

I think you would agree that, although treating children on the spectrum has its fair share of challenges, it is highly rewarding. What are some personal qualities that dental professionals need to have when treating children on the spectrum, and what is the greatest lesson you have learned while treating children with autism?
The necessary personal qualities are patience, compassion and love—and maybe empathy. The most important lesson that I have learnt from treating children with autism is that, after treating one child with autism, you have gained only one experience with autism. Every child is different. I have videos of children doing fantastically well. They’re on the autism spectrum, and they are severely affected by it, but I managed to gain their trust because we worked on our communication and our trust, and so they breezed through the time in the chair. I was able to do root canal therapy, dental restorations—you name it, I was able to do it.

But then there are other children. No matter how much I try to gain their trust, no matter how much I try to help them, no matter how much I try to offer massages—which is something I do as a social reward—it’s just doesn’t work. With that being said, they still come to my office and they still accept my treatment, but, in the chair, they scream and shout. And some children are just like that. So, what I have learnt is that you need to be patient and believe that one day you’re going to figure it out—it’s okay.

“After treating one child with autism, you have gained only one experience with autism”

In your opinion, why should dentists expand their skills to treat children with special needs, and what is one piece of advice you would give to dentists who are working with children on the spectrum?
It is extremely important. Becoming a dentist for special needs gives you this “superdentist” approach that I recommend for everyone, and my opinion is that it makes me a better human being with even more compassion and more love.