At Autism Smiles, Easing Anxiety About the Dentist

A morning at the Tufts clinic teaches kids on the spectrum what to expect

Many children have some degree of anxiety about the dentist. For kids who have been diagnosed with Autism Spectrum Disorder (ASD), that can be compounded by sensory and spatial issues, and difficulty communicating.

“Our dental visits were something of a nightmare,” said Maggie Johnson, about her young son Alex’s first few appointments. “He wouldn’t let the dentist touch him. Once, he bit him.”

So when Alex, a third-grader at the Joseph Lee School in Dorchester, brought home a flyer advertising an event at Tufts School of Dental Medicine called Autism Smiles, where children on the spectrum could become familiar with the dentist’s office, his mother was eager to sign up.

For the fourteen children who attended the weekend event, there were no cleanings, treatments, or even basic exams—just lots of hands-on experimenting with the equipment, friendly explanations from Tufts students, and a chance to get comfortable in the dental chair.

Faculty and staff from the Department of Public Health and Community Service and the Department of Pediatric Dentistry organized a pilot program in early 2019. The next Autism Smiles event is scheduled for Saturday, February 15, 2020, said Nancy Marks, the dental school’s community service coordinator. (See details for registration below).

It’s modeled on Logan Airport’s Wings for Autism program, where children can visit an airplane in advance of taking a flight. With approximately one in fifty-nine children in the U.S. diagnosed with ASD, according to 2018 data from the Centers for Disease Control, experiences like this are particularly needed, said Kathryn Dolan, assistant professor of public health and community service at the dental school, who supervises the school’s outreach programs with Boston public schools. 

Autism Smiles grew out of the final project of a group of first-year dental students who were taking a course in health literacy and wanted to put what they were learning into practice. “Fear is the biggest thing that keeps a lot of clinicians from working with people with disabilities,” said Jason Cummins, D22.

For the dentists-in-training, particularly for those students who hadn’t yet had their rotations in pediatrics or at the special-needs clinics Tufts operates throughout Massachusetts, it was an opportunity to learn more about caring for an underserved group of patients.

Not all the kids were comfortable climbing into the chairs in the eighth-floor pediatric clinic, although some who were apprehensive at first ultimately made their way in. In the operatories, the children had a chance to squirt water, shine lights, and ride the chair up and down—all things they would encounter during a dental check-up.

“One little girl was nonverbal, but as soon as she sat in her dad’s lap in the chair, she started touching the equipment, then playing with it, and that process of being desensitized to the operatory was a good step,” Cummins said.

The students and faculty reached out to the kids wherever they were needed to, even if that meant doing the presentations in the waiting room or in the hallways. “You have to tailor the experience to the child, and every child is different,” said Vendita Correia, D20, president of the Tufts student chapter of the American Academy of Developmental Medicine and Dentistry.

“Autism means so many different things,” she said. “Some kids don’t need as much accommodation, and some need a lot—it’s important to recognize the diversity of health-care needs among all the children, despite that one diagnosis.”  

For the families, the emphasis was on providing ways the experience could be continued at home. “We didn’t want it to be an event that happens only for a day, and then people go home and try to remember what they learned,” said Martha Forero, assistant professor of pediatric dentistry. “It’s important that we work with the parents and the caregivers.”

The families left with a bag filled with a book, which is available in English and Spanish, tooth-brushing timers, flossers, and other goodies. A particularly welcome item was a small handmade weighted blanket, which can help calm a child.

Back home, Alex Johnson and his mom have been talking about the dentist a lot, in preparation for an appointment this summer. Alex’s mother often used to have to brush his teeth for him. After his morning at Tufts, that’s changed. “He’s now brushing his teeth twice a day, all by himself, which is fabulous,” said Maggie Johnson. “He says: I got this!”

Editor's Note: Since the pandemic, the Autism Smiles program has been held virtually by Assistant Professor Martha Forero and predoctoral dental student volunteers. An in-person event is being planned for April 2024. 

For information about upcoming Autism Smiles events, contact Zhanea Nicholson in the department of public health and community service,, or call 617-636-3683.

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