Special Needs and Braces

[virginia]

Does anyone have experience with this? My son is HFA and needs braces. I’ve delayed for awhile but it’s time. He has severe overbite and cross bite and the 2 orthodontists I’ve consulted with have recommended upper and lower and rubber bands.
Knowing my son I’m just so fearful he’ll be miserable and that he won’t be able to tolerate it. Hygiene is an issue for him and I still have to brush his teeth, so I’m also thinking he’ll get food stuck in them and not be able to clean them himself at school/walk around a mess (he’s in middle school and I don’t want anything to further stigmatize him from his peers).
Any experience or ideas? The 2nd ortho we saw, I pushed her for non traditional treatments but the only thing she could offer was Invisalign with rubber bands, and she thought that would be a bad idea because of compliance.

[waverly]

I don’t have experience with a child but I had Invisalign as an adult and even then compliance was hard and I spoke to several other people who tried it with teenagers and wasted their money due to compliance. So I agree with her there.

But as far as regular braces I know how hard they can be, but I don’t really have any suggestions on it.

[coltsfan85]

I don’t have a special needs child, but my husband has cognitive difficulties. After his initial injury, he had a ton of dental work he had to have done. I delayed it for as long as possible until he understood at the very least that it was okay for the dentist to put tools in his mouth and that it was for his benefit. I’m not sure how much your son would understand, but I think that communication can be important too. He learned pretty quickly that he could raise his hand up and the dentist would give him more Novocain, for instance.

Specifically for braces, is it possible to maybe use high fluoride paste or something as a preventative to try to counteract some of the decay that seems inevitable? Depending on how healthy his teeth are, maybe you could heed off some of the issues but realize there may be some dental work following the braces?

I don’t think that’s a perfect answer but it’s an option.

[virginia]

Jul 25, 2018 18:51:01 GMT -5 waverly said:

I don’t have experience with a child but I had Invisalign as an adult and even then compliance was hard and I spoke to several other people who tried it with teenagers and wasted their money due to compliance. So I agree with her there.

But as far as regular braces I know how hard they can be, but I don’t really have any suggestions on it.

Thank you for your response!
If we were to do Invisalign, I’d be on it 100%, I could never leave it up to him, so to me compliance wouldn’t be an issue. Maybe that’s naive of me?
Also I wouldn’t let him wear to school because there’s zero chance they wouldn’t end up in the garbage at lunch, so he’d be wearing them for 15 hours, realizing that it could take much longer to be done.
Thoughts on that given your experience?

[virginia]

Jul 25, 2018 19:36:07 GMT -5 coltsfan85 said:

I don’t think that’s a perfect answer but it’s an option.

Thank you for your response!
I’d be the one doing all brushing and flossing because he just doesn’t do a good job now, I’m more worried about him walking around after lunch with food all up in his braces. When my daughter had braces she would go to the nurse every day after lunch to brush and floss. My son won’t do a good job even if I could get him to do that, realistically I don’t think he would even try because he also has anxiety around being late to class (even when given extra passing time in his iep), and he just doesn’t have enough time during lunch.
Did you experience this? Him not being able to care for them himself? Any suggestions?

[sahara78]

My DD is only 6, so I don’t have any kid experience with braces.

I do currently have Invisalign. I wouldn’t recommend it for your son. The tray containers all include the recommendation to wear at least 22 hours/day. The first few trays were pretty painful, so I’d worry your DS would pull them out overnight. Also, from what I’ve read, Invisalign has recently trended toward more attachments on your teeth so you can wear each tray a shorter time. But, food gets caught on them, too.

[auntie]

My son's has an Asperger's dx- no intellectual disability, excellent fine motor skills and the usual sensory issues. He also has a weird pain interpretation thing- he has a ridiculously high threshold for real pain but over-reacts to things like papercuts. I think the latter is related to his issues with injustice. He did fine with braces. It was kind of a non-event. I have a couple of friends with sons a little younger than mine with AS and HFA; none of them had major issues with braces.


I shopped really hard for the right orthodontist and interviewed several. I my short-list from my dentist (who fixed his kids' teeth), DS's pedodontist, DS's pedis (2 of them had kids' whose teeth had been done), DS's psychologist (who had many, many clients who'd been down this path) and moms in the local support group. The same name came up over and over- so I went with that one. He had a great waiting room with games, weird little birds and fish to watch. Tx rooms were private. It was great.



TBH, I just presented the whole thing as a "what is/sucks to you" thing. I validated his feelings, but didn't lower the bar for expected behavior on the advice of his psych. It went well for the most part. We had a hiccup when he first ortho died in a plane crash and it took the solo practice some time to get a new ortho with a similar philosophy to take over. And then they moved to a much more assembly-line kind of office. But DS adapted; the new guy seemed a little weirdly Aspergerish and they got along well.



If he's in middle school and HF, I would be working on the hygiene and ADLs first. He needs to take ownership if you envision any independence in adulthood. I mean you can't go to Seabase Scout Camp, the band trip to Soth America or college if mom brushes your teeth. If he has sensory issues interfering, private OT should be able to overcome this. You need to help him frame this as something in which he participates rather than something done to him.


An electric toothbrush works well to keep the teeth clean and the gums healthy. A Waterpik can be helpful. DS's ortho and I stressed his responsibility for keeping his teeth and gums healthy. Ortho 1 would not remove braces until gums are in good shape as a motivator.



We did traditional bands with rubber banding for a crossbite. DS did have an Invisalign as a retainer for a time. He did well with it, but he was in high school by then. They come out for eating and can easily be lost. Plus it is stigmatizing to remove during lunch.



If food in the braces is a concern, maybe he could have a trip to the nurse's office as part of his IEP post lunch. Or have a protein smoothie at lunch. IME, an early exit from class avoids the anxiety around walking into class late. DS had a golden ticket that allowed him to come and go without permission. I don't know that he ever used it, but knowing it existed was helpful to him.

[funchicken]

I have a friend whose oldest daughter is on the spectrum, and they waited until her DD independently maintained good oral hygiene. She's going into 10th grade, and she just got her braces.

Our ortho told DD1 (10) when we when in for a checkup last December that she won't put braces on unless the child is practicing good oral hygiene. DD took that very seriously, and she brushes and flosses with a floss stick every night. She's ready for braces, but the orthodontist said as long as DD isn't feeling social pressure to have straight teeth, she can wait a bit. DD opted to wait until next summer. My DD is on the spectrum, but she's more on the NVLD end. She has a lot of sensory sensitivities, and she HATES the way everything at the dentist tastes, but she's pretty conscientious about her teeth, so she powers through it. She does best if she knows what's going on and has time to mentally prepare herself if she has to do anything other than a regular cleaning.

I agree with auntie that he should work on hygiene first, and traditional braces are probably easier to deal with. I just finished Invisalign, and you have to brush your teeth anytime you take the trays out and put them back in after eating. I was brushing my teeth 5-6 times a day.

[waverly]

Jul 25, 2018 19:58:51 GMT -5 virginia said:

Jul 25, 2018 18:51:01 GMT -5 waverly said:

I don’t have experience with a child but I had Invisalign as an adult and even then compliance was hard and I spoke to several other people who tried it with teenagers and wasted their money due to compliance. So I agree with her there.

But as far as regular braces I know how hard they can be, but I don’t really have any suggestions on it.

Thank you for your response!
If we were to do Invisalign, I’d be on it 100%, I could never leave it up to him, so to me compliance wouldn’t be an issue. Maybe that’s naive of me?
Also I wouldn’t let him wear to school because there’s zero chance they wouldn’t end up in the garbage at lunch, so he’d be wearing them for 15 hours, realizing that it could take much longer to be done.
Thoughts on that given your experience?

Since he could take them out, I wonder if it would be a power struggle you put them in, he takes them out?  Only because they will move the teeth and in doing so it will hurt, and it took 2 weeks for me to get used to them.  I did have cuts and have to go back for them to shave part of it to make it comfortable and to get the braces wax to make it better.  I was told I had to wear them for 22 hours a day to have results.  I often cheated and had them out all morning when I had my tea, and for parties but I still think I was at maybe 20 hours a day.  I don't think 15 hours would be enough to move them- I am sorry to say.  

[coltsfan85]

Jul 25, 2018 20:08:25 GMT -5 virginia said:

Jul 25, 2018 19:36:07 GMT -5 coltsfan85 said:

I don’t think that’s a perfect answer but it’s an option.

Thank you for your response!
I’d be the one doing all brushing and flossing because he just doesn’t do a good job now, I’m more worried about him walking around after lunch with food all up in his braces. When my daughter had braces she would go to the nurse every day after lunch to brush and floss. My son won’t do a good job even if I could get him to do that, realistically I don’t think he would even try because he also has anxiety around being late to class (even when given extra passing time in his iep), and he just doesn’t have enough time during lunch.
Did you experience this? Him not being able to care for them himself? Any suggestions?

Initially, yes. At first, we used an electric razor for shaving though he prefers a regular one now. And for teeth brushing, he uses an electric one with fancy fluoride toothpaste and mouthwash. He is far more likely to believe the dentists suggestions though haha so sometimes I just let him figure it out himself. He is 30 some years old after all.

[freezorburn]

Jul 25, 2018 19:58:51 GMT -5 virginia said:

Jul 25, 2018 18:51:01 GMT -5 waverly said:

I don’t have experience with a child but I had Invisalign as an adult and even then compliance was hard and I spoke to several other people who tried it with teenagers and wasted their money due to compliance. So I agree with her there.

But as far as regular braces I know how hard they can be, but I don’t really have any suggestions on it.

Thank you for your response!
If we were to do Invisalign, I’d be on it 100%, I could never leave it up to him, so to me compliance wouldn’t be an issue. Maybe that’s naive of me?
Also I wouldn’t let him wear to school because there’s zero chance they wouldn’t end up in the garbage at lunch, so he’d be wearing them for 15 hours, realizing that it could take much longer to be done.
Thoughts on that given your experience?

I currently have Invisalign and I understand that there may be different systems for teens but mine also is recommended to wear 22 hours per day. I don’t know if the other systems need the same amount of time or have similar care requirements, but I think those would be good questions to ask.

I would check with the dentist to see if 15 hours per day + more time per set of trays would be effective (I typically start a new set every 2 weeks).