Using First-Then Visual Strategies for Dental Cooperation

Visiting the dentist can be a challenging experience for many patients, especially those with developmental disabilities, autism, anxiety, or sensory sensitivities. At McLevin Dental, we are proud to use supportive behavioral strategies to make dental care more accessible, comfortable, and stress-free for everyone.

One of the most effective tools we use is the First-Then visual strategy. Simple but powerful, this approach helps patients understand what is happening, what to expect, and what reward or activity will follow a task. It’s a tool widely used in educational and therapeutic settings—and it works beautifully in dental care as well.

What Is the First-Then Strategy?

The First-Then strategy is a visual communication tool that lays out two steps:

First: The task that needs to be done (like sitting in the dental chair or opening the mouth).

Then: A preferred activity or reward (like watching a video, getting a sticker, or playing a game).

It clearly sets expectations and provides motivation.

For example:

First: Brush your teeth.

Then: Play on the tablet.

Or during a dental visit:

First: Count your teeth.

Then: Pick a prize.

Why First-Then Works in Dental Settings

Reduces anxiety by providing predictability.

Helps patients understand tasks when verbal instructions alone are overwhelming.

Motivates cooperation with the promise of something positive afterward.

Supports patients with limited communication or cognitive differences.

This strategy works well with children, patients with autism, individuals with intellectual disabilities, and even adults with high dental anxiety.

How McLevin Dental Implements First-Then Visuals

1. Clear Visual Boards or Cards

We use simple boards that show two images:

A picture of the dental task (e.g., open mouth, use the suction, lie back in the chair).

A picture of the reward (e.g., toy, tablet, snack, favorite video).

These visuals reduce the overwhelm of verbal-only instructions.

2. Step-By-Step Breakdown

Dental procedures can be broken down:

First: Sit in the chair.

Then: Watch a video.

First: Let us count your teeth.

Then: Choose a prize.

This makes large tasks feel smaller and more manageable.

3. Customizing for Each Patient

What works for one patient may not work for another. We work with families to identify:

The best motivators (a toy, music, tablet, or favorite activity).

The tasks that are most challenging and can be paired with rewards.

Any sensory needs that need to be accommodated (e.g., headphones for sound sensitivity).

First-Then at Home: Extending Dental Routines

Caregivers can use the First-Then strategy at home to support daily oral care:

First: Brush teeth.

Then: Storytime.

First: Floss.

Then: Watch a favorite show.

Adding this predictability often reduces resistance to brushing and flossing.

Why It’s Effective for Special Needs Dentistry

Patients with autism, ADHD, or sensory processing challenges often thrive when routines are predictable and visual. The First-Then approach:

Offers visual clarity.

Reduces power struggles by focusing on positive reinforcement.

Supports non-verbal communication needs.

Can be paired with other strategies like social stories and visual schedules.

Pairing First-Then with Other Supports

At McLevin Dental, we often combine First-Then with:

Social stories: Narratives explaining what will happen at the dentist.

Visual schedules: A step-by-step guide through the entire visit.

Sensory supports: Weighted blankets, noise-canceling headphones, dim lighting.

Desensitization plans: Gradually introducing dental tools and procedures.

Real-Life Example from Our Clinic

A young patient with autism was struggling with letting the hygienist clean his teeth. Using the First-Then board, the hygienist showed:

First: Let’s count your teeth.

Then: You get to play with the iPad.

The patient hesitated at first but then completed the task because the expectation was simple and the reward was visible. This success built confidence for the next steps, eventually leading to a full cleaning without distress.

How Families Can Prepare with First-Then

Ask our team for printable First-Then cards before your visit.

Bring a favorite toy, tablet, or snack as the “Then” reward.

Practice First-Then at home with daily routines to build the habit.

Communicate with us about what motivates your child or loved one.

A Caring, Supportive Dental Home

At McLevin Dental, we believe that every patient deserves a dental experience that is calm, respectful, and supportive of their individual needs. The First-Then strategy is just one of the many tools we use to ensure that patients feel comfortable, safe, and successful in their dental care.

Ready to Make Dental Visits Easier?

If dental appointments have been stressful for you or your loved one, let’s talk. McLevin Dental is proud to serve families in Scarborough with patient-centered, sensory-friendly, and inclusive care. Contact us to learn how we can create a personalized support plan that includes visual strategies like First-Then.