Patient Care: The Increasing Prevalence of Sensory Processing Disorder

By Genni Burkhart

As every experienced dentist and hygienist knows, patients present with various health ailments that impact how they're cared for in the dental chair. While some conditions are easily recognized, others aren't as obvious and require more knowledge and attention.

Sensory Processing Disorder (SPD) is one such condition, which most often occurs in children with a variety of disabilities and diagnoses. As with most health issues, SPD can range in severity and manifestation. Furthermore, it often overlaps with Asperger's syndrome, attention deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD).

While dental anxiety (or any anxiety disorder) can be an aftereffect of SPD, they are different diagnoses. Whereas SPD and anxiety play off each other and anxiety is often a result of SPD, not everyone with an anxiety disorder also has SPD.

As with other conditions that affect patients, the more the dental team understands the range and severity of an ailment, such as SPD, the better they can assist them in achieving oral health success. This understanding can help the team provide education, advice, and treatment options tailored to the individual's needs. Understanding the condition also reduces stigma and allows the dental team to provide the highest level of compassionate care, a cornerstone for sedation dentistry.

A "Traffic Jam" in the Dental Chair

In the 1960s, neuroscientist and occupational therapist Dr. Anna Jean Ayres began researching SPD. During her research, Dr. Ayres discovered that a "traffic jam" occurs in how the brain interprets sensory information for some people. For example, the neurology behind how we "feel" ceases to receive the information needed to interpret the senses correctly.

As dental patients, the senses are bombarded. Noise, touch, texture, sounds, lighting, proximity to strangers, smell, and vibrations from dental tools make the accurate interpretation of sensory information imperative to a successful dental visit.

For an undiagnosed patient, a visit to the dentist can be an overwhelming, traumatic experience that negatively impacts their oral health for years, even decades.

A person with SPD experiences hypersensitivity or hyposensitivity to stimuli. For these patients, a simple tap on the shoulder can feel like a hit, or it can go completely unregistered by the brain.

The vestibular system perceives movement and balance, while the proprioceptive system senses pressure and body position. Even the slightest movement can cause extreme anxiety and stress for people with SPD. Similarly, those with proprioception issues may feel the need to touch or break dental instruments due to their inability to perceive their body's position and pressure in their environment (space) accurately.

Caring for SPD Patients

While SDP is most common in children, there is no age limit. Therefore, adults who've not gotten the proper support during childhood can also present with SPD.

Dental patients with SPD can only take small doses of input to their senses before they become overwhelmed. As such, the dental team must know in advance when patients have hypersensitive or hyposensitive sensory issues.

For example, using an electric toothbrush while wearing a weighted vest can reduce fidgeting and motivate those experiencing hyposensitive SPD. For these patients, using an electric toothbrush provides added stimuli that aids the brain in accurately interpreting the sensation of brushing.

However, a manual, dry toothbrush with just a small amount of toothpaste can be more comforting for those with hypersensitive SPD. In children with hypersensitive SPD allowing them to control the speed and pressure of the toothbrush can encourage them to brush longer and more often.

Here are a few suggestions to help SPD Patients reduce stress, anxiety, and fear when visiting the dentist.

• Start with a plan that involves patient interaction. It could be helpful to provide patients (and parents/caregivers) with a pre-appointment "desensitization visit" to help alleviate anxiety and surprise and prepare for the "real" visit.
• Incorporate age-appropriate reading materials for patients. One highly-recommended children's book, "Melvin Goes to the Dentist," written by Sara Cremeno and Colleen Genest, with illustrations by Jonathan Coimbra, is about a child who has SPD and visits the dentist.
• Sensory-adapted dental rooms.
• Provide the patient with a bag that contains dental tools such as a mirror, prophy angle, and suction straw so the patient can become comfortable and familiar with the touch and feel of the instruments before the appointment.
• Utilize "tell, show, and do." Tailor this to what sensitivity issue the patient has. Such as, if noise is a predominant sensory issue, warn the patient that a new noise will be coming. If the patient is sensitive to touch, verbally tell the patient you're about to touch them.
• Incorporate noise-canceling headphones, music, lighting, sunglasses, beanie hats to cover ears and muffle noises, and weighted blankets or X-Ray vests that work as weighted vests.
• Hyposensitive patients could benefit from "waking the mouth up" and using gum massage.
• The use of fidget toys for tactile distraction and self-regulation during the appointment.

For further information on treating SPD patients, visit the STAR Institute, the leading research center for sensory processing disorders, specifically, their page dedicated to dentists.

How Does Sedation Dentistry Help?

The American Academy of Pediatric Dentistry (AAPD) recommends conscious sedation for patients who cannot cooperate due to a "cognitive disability" or whose fear or anxiety makes treatment difficult. 

Dental sedation can help alleviate dental phobia and dental anxiety, but it can also help calm SPD patients' minds, senses, and nerves. Conscious oral sedation can help relax SPD patients while allowing them to interact with their dentist without feeling overstimulated.

Nitrous oxide can aid in the gag reflex while allowing the patient to respond, talk, and listen to the dental team during the visit while alleviating the anxiety accompanying SPD.

As sedation is an accepted standard of care, the three levels of sedation are all supported by the AAPD, the American Dental Association (ADA), the American Medical Association (AMA), and the U.S. Department of Health and Human Services.

In Conclusion

Improving the clinical experience while providing safe, anxiety-free dental care with empathy and understanding remains a foundation of sedation dentistry. For patients with SPD, the compassionate care provided by the dentist and staff can have a tremendous impact on their oral health.

According to a 2009 study, one out of six children experience sensory challenges that disrupt their academic, social, and emotional development. As more people present with SPD, the likelihood of a patient in your operatory with the condition increases.

Assisting patients to overcome sensory processing issues will likely result in a grateful patient who will gladly spread the good news about your exceptional care. In return, you'll build strong relationships with your community and establish a reputation as a caring and compassionate provider who goes the extra mile for patients.

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Author: With over 13 years as a published journalist, editor, and writer Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the Editor in Chief of the Incisor at DOCS Education.