What I wish my dentist knew

I’ve been going to the same dentist since middle or high school. I remember when he graduated from the only dental school in our state. Now, years later, he’s balding and carrying some extra weight around the middle—a sign that time moves for us both. In my younger years, I had more energy to mask the stress of dental appointments. Today, so much of that energy goes to my full-time job, where I work hard to present as professional and competent, often at the expense of self-care.

As I’ve aged, I’ve noticed changes in myself, too—gray hairs and a growing waistline. Most of my interactions with my dentist have been pleasant, and I genuinely like him as my provider. But one negative experience lingers: I missed an appointment during a period of poor mental health, and my oral hygiene suffered. When I finally returned, I learned I had developed periodontal disease. My dentist was visibly displeased.

From what I remember, he completed his exam, took off his mask in an irritated manner, and stated: “You were supposed to come back for a six-month follow-up, and you didn’t. Now you have periodontal disease. The gums are inflamed. If you don’t keep up with the maintenance care, you could start losing teeth in your forties.” I felt so ashamed in that moment. My recurrent major depressive disorder had come back with a vengeance that year, and I knew I had neglected my oral health.

I took his disappointment to heart. As an autistic person, I often struggle to read emotions and social cues. I interpreted his reaction as personal anger, which haunted me for years. At every subsequent visit, I asked the dental hygienist if the dentist was angry with me. They always looked at me, confused, and reassured me, “He doesn’t get angry at patients!” It took several conversations with my dentist, and I really don’t think he remembered the interaction with the intensity that I did. Eventually, I think he realized I was a patient with a lot of anxiety about coming to the dentist, and even when my results weren’t the best, he never approached it the same way again.

Looking back, I realize he was upset about the preventable decline in my oral health, not angry at me as a person. I wish dentists and healthcare providers understood how difficult it can be for autistic patients to interpret emotions and social situations. A little extra clarity and reassurance can make all the difference. It’s important for dentists to keep in mind that for adults with autism, regular dental cleanings can be very uncomfortable. Communication that leaves a patient feeling shamed can make it unappealing to return for care. It’s hard to find providers who are competent when it comes to providing care for autistic individuals, and providers I’ve interacted with genuinely seem confused by my autism. I can see they are highly trained and intelligent experts in their area. They are trying to address a problem in their organ or organ system. Eventually, because autism is a cognitive disability that affects communication, one of us trips up on the communication piece, and it takes time to translate between neurotypical doctor speak and autistic patient speak to get to the resolution we both need.

Hygienists always seem perplexed by how much discomfort I display in the dental chair. I wish they offered darker glasses because the light still pierces through the tinted ones they provide. It would also help if they provided earplugs for autistic patients, because the noise the instruments generate can be painful. I’ve solved most of these problems by bringing my own hearing protection and even my own sunglasses.

When I was first diagnosed the better part of a decade ago, I used to think that most of the world, especially healthcare providers, didn’t care about my disability. Now I believe most, like my dentist, don’t receive adequate training on autism and intend to help their autistic patients but get lost in translation. By sharing my experience, I hope I can make translation less difficult.