Autism – a developmental disability that significantly affects communication (both verbal and non verbal) and social interaction, generally evident before age three, that adversely affects educational performance. Other characteristics often associated with autistic people are, engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.
-1 percent of the population of children in the U.S. ages 3-17 have an autism spectrum disorder.
-Prevalence is estimated at 1 in 88 births.
-1 to 1.5 million Americans live with an autism spectrum disorder.
Autistic patients, as well as patients with similar behavioral and possibly intellectual challenges, present a unique challenge for dentists as well as parents. Most dental procedures involve the use of bright lights, loud noises, and touching of a very sensitive part of the body. Most people in general are uneasy, and apprehensive about dental treatment, imagine what it is like for an autistic child or adult.
Hypersensitivity to one’s environment is usually a hallmark trait for most autistic patients. This makes dental care even more challenging, as they may react adversely to the sensory overload. Autistic patients do not like change in their daily schedules, new noises, new people, or new activities. In the past, these challenges would lead to most dentists turning away such patients, but in modern dentistry this is no longer the case. There are many dentists who have training to help them with the special challenges that come with autism.
Dental Issues For Autistic Patients
-Poor Dental Hygiene. While this is not isolated just to Autistic patients, the autistic population has an increased risk of poor maintenance.
-Increased Tooth Decay. Poor dental hygiene and tooth decay go hand in hand but for these patients there is increased risk due to many parents and caregivers use of candy as a reward for good behavior, and a common habit of pocketing of food in the cheek. The increased exposure to sugars, and leaving carbohydrates in direct contact with the tooth surface over prolonged periods an will lead to increase in tooth decay.
-Teeth Grinding or Bruxism. While many people suffer from this, we have seen a higher rate of autistic patients vs the general population exhibiting this behavior.
-Self Injury. Many autistic patients will bite or pick at their gums creating an issue dentally. A mouth guard might be recommended as long as the autistic patient can tolerate it.
-Medication related issues. Many autistic patients suffer from seizures and therefore take medication for it. These medications can lead to decreased saliva production which can lead to dry mouth and subsequent bad breath and tooth decay.
Techniques for Handling Autistic Patients in Dental Chair
1) Set up a Pre-Appointment Tour and Introduction. Parents should talk to the dentist ahead of time to let him/her know a bit about the child, including what helps to soothe and what is an easy set off for behaviors. Let the patient come to the office to tour the facilities and get a feel for the surroundings and the people there. Let them see the trays as well as touch everything that is safe for them to touch. This should include the x ray machine so they are familiar with it when they arrive for the actual appointment. Meeting the entire staff is very important as well.
2) Keep Initial Visit as short as possible. Make the first visit quick and as noninvasive as possible.
3) Always keep Communicating. The dentist and Hygienist needs to explain what is going to happen to the child directly, what instruments are going to be used, what it might feel like, and about how long it is going to take to finish. The child should feel free to ask questions, and be taught hand signals to let the dentist know if they need a break, or if they cannot tolerate any more.
4) Have Parents in Room if Needed. This one becomes a personal choice between parent or caregiver and dentist. Some patients do well with them in room and some do not. It is totally a case by case decision. Never be afraid of insisting that you be present during the dental appointment – your child may require you to be there anyway. Make sure the dental staff is comfortable with this.
5) Possible use of General Anesthesia, Sedatives, restraints. More involved dental procedures like tooth extractions, dental fillings and even radiographs can be done under sedation or general anesthesia if the patient’s behavior is likely to create difficulty for the dentist or patient in providing safe dental care. Restraints sound scary to most, but autistic children, especially those with Aspergers are calmed by a tight pediwrap. Aspergers children often squeeze themselves in a hug or wear tight clothing to self soothe in an intense situation.
Conclusion For Autistic Patients Dental Care
Autistic patients are presented with challenges everyday of their lives so it is up to those around them to come up with solutions to make it as seamless as possible for them. The challenge is there, but it can be overcome with patience between dentist, patient, and parent/caregiver. With proper planning, dental care is possible to maintain autistic patients teeth and gums for a lifetime.
