3 minute read
Orthodontic Care for Patients with Tactile Hypersensitivity
Series - Initial 4/2/2019
Series - Final 1/25/2022
By Sarah Howle, DDS
Every patient is undoubtedly unique in their dental needs, home care capabilities and comfort levels, so our treatment must be specifically tailored to meet the needs and tolerance levels of each patient. Orthodontics is a largely elective field; most people can adequately speak and function without orthodontic care. However, most parents of special needs children hope that their child can live as normal of a life as possible, which may involve orthodontics to improve esthetics, function or cleansability. In this article, I was asked to explain why our practice decided to treat patients with special needs; however, it was never a question of if or why we would care for these patients, but of how!
Many patients with autism spectrum disorder display symptoms of sensory hypersensitivity. Thus, one of the main hurdles we encounter with special needs patients in our practice is their tactile sensitivity. Most average patients will have some sort of adjust-
Photos:
Top photo is initial photo series in 2019.
Bottom phot is final photo series in 2022.
ment period with the delivery of a new appliance. The difficulty of acclimation, is of course, amplified in patients with tactile hypersensitivity. Thorough explanation of the appliance, showing the patient what the appliance looks like, and letting them hold and feel the appliance before cementation may help ease anxiety. This tell-show-do technique is an essential component to behavior management during appliance delivery and bonding appointments. Yet, despite your efforts, many special needs patients will have a tendency to play with their appliances or pull out their wires, which can ultimately lead to repeated breakage, emergency appointments and delayed progress in treatment. Therefore, in our practice, we’ve moved further from braces or fixed appliances for tactile-sensitive patients and have found that they adapt incredibly well to clear aligner therapy.
Clear aligner therapy has revolutionized the orthodontic field in the past 20+ years. Alignment and bite correction can predictably be achieved in compliant patients. Both younger patients (ages seven to 10) and patients with special needs are typically eager to please their parents, so they tend to have the highest compliance with aligner wear in our office, even better than the majority of our adult patients! Furthermore, many patients on the Autism spectrum have obsessive-compulsive tendencies, which typically translates to exceptional compliance. With aligners, patients feel like they are more in control-trays can be removed periodically throughout the day, and they are much more comfortable than traditional braces, with lighter forces being distributed over several trays. In this patient base, aligners are a win-win: we do not have to take any alginate impressions (we use a digital scanner); there are no broken brackets; the patient cannot pull out their wires; great hygiene is easier to manage; there are less food restrictions; and the overall course of treatment is much less stressful for the patient, parent and clinician.
This was the case for my patient, Nathan. Nathan presented to our clinic initially in 2019 with a 100% deep impinging overbite, severe overjet of 9mm, maxillary spacing and protrusion, mandibular crowding, ectopic eruption of #22, and lower lip entrapment. His mother’s chief concern was his bite- the severe overjet predisposes Nathan to trauma to the maxillary incisors. His treatment spanned for 30 months, and the transition to retainers was flawless because he was already used to the fit and feel of his retainers. Although Nathan had very good compliance with aligner wear, he did struggle with wearing the prescribed Class II elastics. Despite the slight Class II finish on his left and 2mm midline discrepancy, Nathan, his parents, and I were thrilled with the results.
Once we explain the success of aligners for patients with tactile hypersensitivity to parents, case acceptance is usually high. However, if a parent is hesitant toward aligners, you can prescribe a “therapeutic aligner,” or an essix retainer, to gauge their compliance before committing to treatment. You can also walk the patient into treatment slowly by starting with no attachments or elastics, then adding them into the course of treatment as needed. An additional tip is using a weighted blanked, or even an X-ray vest, during longer appointments, such as bonding or removing attachments. The deep pressure aids in decreasing anxiety and elevating their feeling of security.
One of the main hurdles we encounter with special needs patients in our practice is their tactile sensitivity. The difficulty of acclimation is, of course, amplified in patients with tactile hypersensitivity.
