A quarterly publication of the Autism Research Institute

The Autism Research Review International is quarterly publication of the Autism Research Institute

Summer, 2023 | Number 3, Volume 37

Sensory-adapted dental offices lower stress of kids with ASD 

Adapting dental offices for children with autism spectrum disorders (ASD) may make dental cleanings significantly less stressful for this population, according to a new study. 

In a randomized crossover study led by Leah Stein Duker, 138 children with ASD underwent two dental cleanings, approximately six months apart. Half of the children initially underwent cleaning in a regular dental environment (RDE), and the other half in a sensory-adapted dental environment (SADE). At the second cleaning appointment, the two groups switched treatment modes. 

The SADE condition used by the researchers was designed to address a wide range of sensory issues. “For the visual sensory domain,” the researchers say, “all overhead fluorescent lights and the dental operatory lamp were turned off and darkening curtains were applied to windows. A glasses-mounted headlight directed light into the child’s mouth (avoiding eyes), and slow-moving visual effects (i.e., bubbles or fish scenes chosen by the child or parent) were projected onto the ceiling in the child’s visual field. For the auditory sensory domain, a playlist of calming music (e.g., classical music with nature sounds) played in the room via a small speaker. Finally, for the tactile and deep pressure domain, a butterfly-shaped wrap weighted with a pediatric dental radiograph vest was used to apply deep tactile pressure stimuli to the child. The butterfly wrap fit around the dental chair, with the wings wrapping around the child from shoulders to ankles to provide a calming deep hug sensation.” Children could opt out of any of the sensory adaptations if they did not find them calming.

The researchers observed the children’s behavior during treatment and used finger electrodes to measure their electrodermal activity. They report that children exhibited significantly lower physiological stress during dental care in SADE compared with RDE. In addition, video analysis indicated that they exhibited a lower frequency and duration of behavioral distress in the SADE condition. The researchers also found that children’s physiological stress dropped as soon as they entered the SADE, before the cleaning even began, and that this initial level of physiological stress predicted behavioral distress during the cleaning. Younger children and those with a lower IQ or less expressive communication benefitted the most from the SADE setting. 

“So many interventions try to change the person,” Stein Duker comments. “Instead, this intervention sees children for who they are—it does not try to fix or change them— focusing on the intervention to modify problematic environmental factors as a way to empower the child and family to engage successfully in [the experience].” 

Stein Duker says dental professionals and parents should work together to find ways to make the dental office less stressful for children with ASD or other children with sensory issues. She notes, “There are weighted X-ray bibs in every single dental office that may help calm the child; they can wear sunglasses; they can wear a beanie hat covering the ears to muffle noises—all of these are completely free and easy adaptations that have the potential to improve the clinic experience for those with sensory sensitivities, without negatively impacting dentists’ ability to provide care.”


“Sensory adaptations to improve physiological and behavioral distress during dental visits in autistic children: a randomized crossover trial,” Leah I. Stein Duker, Dominique H. Como, Caitlin Jolette, Cheryl Vigen, Cynthia L. Gong, Marian E. Williams, José C. Polido, Lucía I. FloríndezCox, and Sharon A. Cermak, JAMA Network Open, June 2, 2023 (free online). Address: Leah I. Stein Duker, Division of Occupational Science & Occupational Therapy, University of Southern California, 1540 Alcazar St, CHP 133, Los Angeles, CA 90089, [email protected]


“Sensory adapted dental rooms significantly reduce autistic children’s physiological stress during teeth cleanings,” news release, Mike McNulty, University of Southern California, June 1, 2023.