SPD at the Dentist’s Office

Question:  Hi, I am a dental hygienist looking for ideas on treating patients with SPD in the dental setting.  Can you give me some suggestions?  Thank you!

 


 

If the patient has sensory issues in the mouth, then they may require a lot of desensitizing before they could even go to a dentist and/or tolerate anything in their mouth.  This oral sensitivity is also known as oral defensiveness.  For more background on this plus some ideas to help de-sensitize, click here.  And for some ideas on how to make toothbrushing more comfortable for individuals with oral defensiveness, click here.
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An Alternative for Fidgeters Who Like to Pick

Question:  My son has Asperger Syndrome and severe ADHD.  He has a picking problem and will pick his nails, credit cards, scabs etc.  I am looking for something he can wear on his wrist he can fidget with instead.  Do you have any recommendations of your products?  Thank you in advance.
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It sounds like our Brick Bracelet would be a perfect fit for that.  It has bumps around the entire circumference that he can pick at, not unlike scabs.  You could even take a box cutter and slightly start a cut at the base of one or more of the bumps to get it ‘started’ before you give it to him.  That way he can pick at them and get the satisfaction of eventually being able to actually get some of the bumps off.  Better the bumps than his nails, scabs, etc.
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A solution for kids who like to pick /  fidget

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Giving him other ways to pick safely may help too.  He can peel stickers for instance (they have re-stickable ones he could put on his binder for instance).  Or you can have him help you peel vegetables for dinner, play with play dough, etc.

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Consulting with an OT (occupational therapist) if he doesn’t already might be a good idea.
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I hope some of this helps!
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All my best,

Debbie

Building a Therapy Lego Wall

A lego wall is a very simple DIY project that packs a ton of therapeutic benefit.  To assemble:  simply attach a lego board to a wall.  Mine is from at least 20 years ago so I don’t know the exact brand anymore, but any lego / brick set that comes with a mat to stack them on should work.  Then I used heavy-duty velcro to attach it on the wall.  There’s probably a better way of attaching it to the wall, but I’ve had this up with velcro for almost a year and it’s still going strong.

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The Benefits of Building a Lego Wall

WHAT SKILLS DOES THIS ACTIVITY WORK ON?
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As a speech therapist I use this building block station to help kids work on spatializations, motor planning, eye-hand-coordination, and social skills.  I don’t personally work on colors in therapy (usually colors are practiced at length at home, so I focus on other goals), but this would be a great opportunity to work on color identification as well.
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Therapy Quick Tip: Preparing for Halloween

With just over two weeks left before Halloween, now is a good time to help children get ready for trick-or-treating.  Some of my kids say “fick or feet” or “sick uh seat” or “twick or tweet.”  So we’ll spend time practicing how to say “Trick or Treat” correctly (or the best way they can to be understood).

Halloween Therapy Tip

I also role play to help them be better prepared.  We take turns re-enacting how they will walk up to the door, knock or ring the doorbell, say trick or treat, follow directions (such as to pick one or two pieces of candy), AND say thank you with good eye contact.

It takes a while the first session to get it down, but only 2-3 minutes to review it in following sessions.  And it gives the child a sense of accomplishment, decreases any anxiety they may have, and gives them confidence so Halloween can be all about fun!

Happy Halloween!

Debbie

Thumb Sucking Side Effects on Tongue Protrusion, Speech, Feeding & more

I have a client (5-years) who sucks her thumb.  She has a lisp and produces most of her consonants while protruding her tongue.  I perfectly understand that unless we resolve the thumb sucking, the protrusion will not going to go away, but her parents are not on the same page as me.  What techniques would you recommend to decrease the thumb sucking?
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Dear SLP,

You’re definitely right in that the tongue protrusion/thrust isn’t going to go away until the thumb sucking goes away.  And the thumb sucking isn’t going to go away until mom and dad get on board.  There are many potential side effects you can discuss with them to help them understand the situation:
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Thumb Sucking's Side Effects on Speech & Feeding, & Strategies to Help

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DENTAL
Suggest that she make an appointment with her daughter’s dentist and/or an orthodontist who knows about tongue thrusts.  They’ll be able to show that the teeth are being pushed forward or if the palatal arch is high from thumb-sucking.  And even if there are no visible side effects yet, they can explain their likelihood and discuss potential dental/orthodontic bills later on.
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SPEECH
Explain that similar to the effects of a spouted sippy cup, sucking her thumb has promoted a tongue thrust, which is not a normal tongue position except for in young babies suckling from a bottle.  This is why she’s producing certain consonants with her tongue protruding (or against the front teeth), and why she has a lisp.
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FEEDING
Explain that in addition to the speech problems already present, tongue protrusion can cause feeding problems.  There are a couple ways you can demonstrate how a tongue thrust affects feeding/drinking:
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•  Pull the lower lip down with your thumb and ask the child to swallow.  She may not be able to because she needs her lips to assist the swallow.

•  Ask the child to chew a cracker.  Have her open her mouth to show you the chewed food before she swallows.  You may see food particles scattered throughout the oral cavity without any bolus formation, as the tongue is not strong enough to manipulate the food into a ball.

•  Sometimes individuals with a tongue thrust are not able to drink from a water fountain without making some kind of adjustment to get the water into their mouth (like turning sideways).  So have her take a sip of water, lean over a garbage pail, and swallow without turning her head.  See if the water falls out of her mouth.

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The tongue is the major factor in all of these situations and many more.  When you suck your thumb, the tongue often rests forward and low under the thumb, which can allow the tongue to become flaccid and unable to function properly.
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Tooth Grinding – Possible Causes & What You Can Do

While most kids outgrow grinding their teeth, intervention may be necessary if they don’t.  Tooth grinding over a prolonged period (especially with permanent teeth) may put them at risk for worn-down teeth, tooth sensitivity, jaw pain, headaches, etc.  There is no one accepted reason as to why it happens, but there are several factors that may be contributing to the problem:

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Tooth Grinding Tips

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DENTAL PROBLEMS

First and foremost, I recommend that you see a dentist to rule out any underlying medical issues that may be the cause of tooth grinding, such as an abnormal bite, misaligned teeth, etc.  A dentist may also recommend a bite guard, especially if the problem only persists at night.
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MEDICATION SIDE EFFECT

Check the medications that your child is on.  Is tooth grinding a side effect?  If so, consult with his doctors to see if there is a suitable alternative.
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Tips for Easier and More Effective Therapy Homework

I can’t stress enough the importance of homework exercises.  With consistent practice, children progress through their speech/feeding goals noticeably if not significantly faster.  For example, I recently saw a child with an L distortion in a private school. She was four-years-old, and I knew the parents were very conscientious about her development.  After providing a tactile cue, she was able to elevate her tongue to the alveolar ridge and produce the L sound.  I provided her parents with information to work on at home. After a couple weeks of home practice, I checked her and found that the L in blends was developing. I’ll check her once again in a few weeks.  Not only is this progress wonderful on its own, but it also means that her parents will be saving money.
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Granted, most cases are not this simple.  But home practice is advantageous across the board.  Remember, I see my kids in therapy once a week, but parents see them every day!  So, to make homework easier and more effective:
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•  Whatever tools I use in therapy, my parents have their own set at home.  If money is a concern, ARK’s Probe is only $3.99 (and even more affordable in the multi-packs).  It’s a basic yet versatile tool that can be used for a variety of speech, feeding, oral motor, and sensory exercises.

•  I show my parents exactly how to do each exercise.  Then I have them repeat the exercise in front of me so I can correct them if necessary.  Just like exercising any other muscles, it’s important to have proper form.

•  Never demand that the child do the exercise.  In my experience, this causes anxiety and frustration for the child, which in turn creates an aversion to therapy where the child doesn’t want any tool near his/her mouth.  Always follow the child’s lead.  Proceed slowly and stop BEFORE he/she becomes overloaded.  You can always try again later.

•  To limit anxiety and frustration, I recommend starting with one practice session per day.  Over time, you can work up to whatever the therapist prescribes.  But in general, the more practice, the better.

•  The same goes for the number of repetitions for each exercise.  Start slowly, follow the child’s lead, and stop before he/she becomes frustrated.  Keep track of progress using these Therapy Practice Sheets.
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•  Don’t practice when the child is hungry or tired.  It is also important for the parents to evaluate themselves as well.  If they themselves are impatient, too tired, etc., then it is not a good time for therapy.

•  Parents should try the exercise on themselves first to understand how the tool feels, to evaluate their pressure, etc.

•  If the child is cognitive enough, a behavior modification program can be put in place for practicing with appropriate reinforcers.  For example, you can set up a visual schedule to picture the activities and rewards.  Be sure to establish a timeline and finish on time.

How to Desensitize Gloves

For some kids, gloves can be scary.  The rubbery feel, the unfamiliar smell and taste, the strange look (where did your hands go?!), and the squishy sound they make – these are all possible triggers for a sensory overload.
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I have some kids who absolutely won’t allow me to go near them with gloves.  So I just have to wash my hands thoroughly before and after therapy.  And that’s okay.  But in most cases, you’ll probably want to wear gloves as a hygiene measure for both parties.  So what can you do to decrease an aversion to gloves?
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•  Use your hand as a puppet and engage the child in a game.

•  Allow the child to become acquainted with the gloves before using them.  Let him pick which gloves to use.  Then let him feel the material in his hands before putting them on your hands.  Or, he can even wear his own set!

•  Using a pair of scissors, snip off the fingers of the glove and put on a fingerless glove.  I did this with one child of mine who developed a fear of gloves.  Once she saw how silly my hand looked, her fear disappeared.  A lot of anxiety also comes from the unknown, so these fingerless gloves let her see that my fingers were still there, just covered up temporarily.
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*Please be cautious with the finger tips of the gloves, as they are small and may pose a choking hazard.
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How to Teach Blowing

All parents want their children to be able to blow out their birthday candles.  While most children pick up this skill naturally, others need a little more help.  Below is the process that I have used over the years.  I hope it works for you as it does for me!
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1.  The first step is to establish the concept of blowing air out of your mouth.  Put your hand to your mouth and say, “I can feel air on my hand!”  Have the child feel his own breath as well.  This provides a tactile cue.

2.  Put a tissue in front of your mouth and exhale to make it move.  This provides a really good visual cue.  Say to the child, “Did you see that?  Air came out of my mouth!”  Put a tissue in front of the child’s mouth and let him exhale to make it move.  Use a mirror for visual feedback.

3.  Once the child understands the concept of blowing (which may take a few sessions), it’s time to work on lip extension.  Place a DentaSwab, Toothette, proPreefer, Preefer Tip, or Bite-n-Chew Tip in between the center of the lips.  Have the individual close his lips around the tip.  Squeeze and hold for 3-5 seconds.  For added sensory input, awareness, and focus, turn the Z-Vibe on to vibrate.  You can also hold one of the tips slightly away from the lips and instruct the child to touch it for a kiss.  Or, instruct the child to say “oo” as in “boo.”  Use a mirror so he can watch his lips move.  Then have him extend his lips in the “oo” position without voicing (just the movement, no sound).

5.  Next, place a tissue up to your mouth and said the “h” sound really hard.  Don’t say the letter with voice, just the sound that the letter makes.

6.  Now it’s time to put these skills together.  Have the child extend and round the lips.  Then have him produce the “h” sound.  Extending/rounding the lips on the “h” sound will narrow the air stream and turn it into a blow.  With practice over time, this will become an easy task.
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Tips for Toothbrushing with Oral Defensiveness

Oral defensiveness falls into two main categories: HYPOsensitivity and HYPERsensitivity.  Individuals with hyposensitivities have low oral tone and very little awareness of what’s going on inside their mouths.  This “oral numbness” so to speak can cause anxiety and fear when it comes to toothbrushing.  On the other hand, individuals with hypersensitivities are overly conscious of and sensitive to oral stimulation.  Even the slightest touch can be overwhelming and even painful.  In both cases, it is important to normalize sensation within the oral cavity in order to take care of those pearly whites!
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