Sir, patients with autism and other special care needs often rely on familiar surroundings, processes and faces when attending the dentist to reduce the sensory burden and anxiety of being in the dental environment. Any change to the 'routine' of attending may present such patients with difficulties that the dental team should have awareness of and be sensitive to. We must make every effort to prepare patients for the changes to the dental environment that they are used to attending such as the increased use of PPE.

Sending photographs and advice of how layouts and processes may have changed within the practice and what to expect regarding PPE and infection control procedures ahead of their appointment to patients and carers could prove invaluable in maintaining both attendance for this potentially higher risk group, as well as talking through any new steps during their visit or procedure to maximise compliance. Technology can also be utilised to facilitate this, such as 360 degree photographs or video tours on practice websites or social media. Although aerosol generating procedures would ideally be carried out in a single visit, this may not be possible or practicable for this patient group.

Any additional barriers to attending for regular preventive dental care could have significant longer term risks to the dental health of this already vulnerable patient cohort. A decrease in regular professional preventive input risks increasing the need for invasive procedures and sedation or general anaesthesia, in turn increasing risks to both dental and general health. We must therefore do everything we can to minimise the impact of these changes for patients with special care needs.