Dental care for children with selective mutism

Abstract

Selective mutism (SM) is an anxiety disorder that is characterised by a consistent failure to speak in certain social settings where the individual is expected to speak while in other situations, speech is normal. It often starts in childhood and is thought to affect around 1 in 140 children in the UK. If recognised and treated early, SM can be overcome but left untreated, it can lead to long-term problems. It is thought to be caused by a complex interaction between various vulnerabilities such as genetics, temperament, environment and neurodevelopmental factors. Treatment methods are variable and can include non-medication-based therapies (eg behavioural therapy) or pharmacotherapy. This paper specifically addresses the child with SM. Few professionals are trained in dealing with SM and many have little knowledge of the condition. SM awareness for parents and professionals along with appropriate information and intervention techniques are vital. For children with SM, dental visits can prove challenging. Each child is unique in how they present with their difficulties. A child attending the dentist for a dental problem or a routine examination may not yet be diagnosed with SM, and so knowledge of the condition and what appropriate services are available is important. The dental team should understand the possible modes of therapy that the child is receiving and work with these principles during dental appointments. Simple strategies such as asking the parent how best to communicate with the child, understanding what makes the child feel at ease and whether the child has any other phobias or anxieties can help.