By Dave DeFusco
At the Katz Schools Graduate Symposium on Science, Technology and Health, Lior Nissanian, a student in the Occupational Therapy Doctorate, presented a plan that would ease the anxiety-inducing experiences of dental visits for children on the autism spectrumand to empower the dental professionals who care for them.
In her capstone project, Resource for Dental Professionals Providing Care to Individuals with Autism Spectrum Disorder Utilizing Occupational Therapy Modalities, Nissanian was answering a call from two distinct yet overlapping worlds: occupational therapy and dentistry.
Theres a real need for accessible tools that help dental professionals understand sensory processing and emotional dysregulation in children with autism, she said. These are kids who often find a routine checkup overwhelmingbright lights, unfamiliar instruments, strange sounds and close physical contact. Its a sensory storm. My goal was to develop a resource that translates occupational therapy strategies into practical steps that dentists can use to reduce anxiety and increase cooperation.
According to the National Institute of Health, one in 36 children in the United States is diagnosed with autism spectrum disorder (ASD). Among these, over 91% experience sensory processing difficulties, making everyday activities, especially something as invasive as dental work, significantly more challenging. Routine checkups frequently trigger heightened anxiety and noncompliance, with 60% of parents reporting moderate to extreme difficulty getting their child through a basic dental cleaning. Yet, despite the demand for specialized care, only 40% of general dentists feel equipped, or even willing, to treat these patients.
Children with autism often struggle with oral health long-term because theyre unable to engage consistently in preventive care, said Dr. Amiya Waldman-Levi, Nissanians faculty advisor and clinical associate professor of occupational therapy. Liors project is not just about minimizing stress in the dental chair. Its about equity in healthcare. It offers a bridge between disciplines that have historically worked in silos.
At the heart of Nissanians project is a carefully crafted resource that equips dental professionals with actionable strategies tailored to three key sensory modulation disorders common among children with autism spectrum disorder: Sensory Over-Responsivity, Sensory Under-Responsivity and Sensory Seeking. Each category includes easy-to-implement suggestions, from blackout sunglasses and noise-canceling headphones for overstimulated children, to projector lights, fidget toys and even essential oils for those needing more input.
Dentists are already making accommodations, said Nissanian, but they often do so without a clear framework or understanding of why a child is reacting a certain way. This resource gives them that framework, along with specific, tested evidence-based tools they can adjust to individual needs.
For example, for children who are sensory seekingthose who may be impulsive or constantly in motionthe resource recommends body socks, preferred music and visual cue cards. For sensory over-responsivity, it advises reducing stimulation in the environment and avoiding flashing lights or overpowering smells.
But Nissanian didnt stop at theory. She evaluated her resource feedback from seasoned occupational therapists, each with over three decades of experiencemore than two decades of which was in pediatrics and sensory processing.
The response from the expert OT panel was encouragingand constructively critical. While both therapists agreed that the resource had a logical flow and relevant content, one emphasized the need for more concise writing and additional clarification for dental professionals with no OT background.
This kind of cross-disciplinary communication is exactly whats needed, said Nissanian. If a dentist reads a term like stimming and doesnt understand its functionor worse, tries to suppress it during treatmentthey may inadvertently increase the childs distress. I revised the resource to include explanations of self-soothing behaviors and how professionals can safely support them.
Other expert suggestions led to improvements visual formatting and the inclusion of real-world scenarios. Nissanian added a mock action plan for a fictional patient to help guide professionals through implementing the strategies. She also incorporated safety considerations for weighted items, such as lap pads and compression garmentsitems often used to provide calming pressure, but which must be handled carefully.
Another critical improvement addressed an often-overlooked challenge: long wait times. One expert noted that waiting, whether in the lobby or once in the dental chair, can be a major source of agitation. Nissanian updated the resource to help practitioners plan ahead, modifying the action plan template to include wait-time strategies.
This kind of collaboration is vital for the future of healthcare, said Dr. Waldman-Levi. Occupational therapy has so much to offer in contexts beyond our traditional scopefrom dental clinics to emergency rooms. What Lior has done is plant the seed for a new model of care, where professionals work together, not apart.
