By: Dr. Faisal M Alzahrani

Autism and oral health

What Is Autism? a mental condition, present from early

childhood, characterized by difficulty in communicating and forming relationships with other people and in using language and abstract concepts.

Children with autism have trouble communicating. They have trouble understanding what other people think and feel. This makes it very hard for them to express themselves either with words or through gestures, facial expressions, and touch.

Children who are autistic may have repetitive, stereotyped body movements such as rocking, pacing, or hand flapping.

Symptoms of autism : typically appears during the first three

years of life. it is now recognized that some

individuals may not show symptoms of a communication disorder until demands of the environment exceed their capabilities.

These disorders may now be diagnosed as either:

a social communication disorder or autism spectrum disorder based on the primary impairments.

Type of autism :

Asperger's syndrome. These children don't have a problem with language -- in fact, they tend to score in the average or above-average range on intelligence tests. But they have the same social problems and limited scope of interests as children with autistic disorder.

Pervasive developmental disorder or PDD -- also known as atypical autism. This is a kind of catch-all category for children who have some autistic behaviors but who don't fit into other categories.

Rett syndrome. Children with Rett syndrome, primarily girls, start developing normally but then begin losing their communication and social skills. Beginning at the age of 1 to 4 years, repetitive hand movements replace purposeful use of the hands. Children with Rett syndrome are usually severely cognitively impaired.

Childhood disintegrative disorder: These children develop normally for at least two years and then lose some or most of their communication and social skills. This is an extremely rare disorder and its existence as a separate condition is a matter of debate among many mental health professionals.

SOURCE: 

American Academy of Pediatrics: Pediatrics 2010. 

Parker, S., Zuckerman, B., and Augustyn, M. (editors). Developmental and Behavioral Pediatrics: A Handbook for Primary Care, Lippincott, 2005.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5

Autism and oral health Practical Oral Care for People With Autism Health Challenges in Autism and Strategies for Care

Communication Problems and Mental Capabilities Behavior Problems Unusual Responses to Stimuli Unusual and Unpredictable Body Movements Seizures

Oral Health Problems in Autism and Strategies for Care Damaging Oral Habits Dental Caries Periodontal Disease Tooth Eruption Trauma and Injury 

COMMUNICATION PROBLEMS and MENTAL CAPABILITIES Talk with the parent or caregiver to

determine your patient's intellectual and functional abilities

Use a "tell-show-do" approach to providing care.

BEHAVIOR PROBLEMS hyperactivity and quick frustration--can

complicate oral health care for patients with autism.

Plan a desensitization appointment Use immobilization techniques only

when absolutely necessary If all other strategies fail,

pharmacological options are useful in managing some patients.

UNUSUAL AND UNPREDICTABLE BODY MOVEMENTS are sometimes observed in people with autism. These movements can jeopardize safety as well as your ability to deliver oral health care.

UNUSUAL RESPONSES TO STIMULI can create distractions and interrupt treatment.

SEIZURES may accompany autism but can usually be controlled with anticonvulsant medications. The mouth is always at risk during a seizure: Patients may chip teeth or bite the tongue or cheeks. People with controlled seizure disorders can easily be treated in the general dental office.

Oral Health Problems in Autism and Strategies for Care

ORAL HABITS: bruxism; tongue thrusting; self-injurious

behavior such as picking at the gingiva or biting the lips; and pica--eating objects and substances such as gravel, cigarette butts, or pens. If a mouth guard can be tolerated, prescribe one for patients who have problems with self-injurious behavior or bruxism.

DENTAL CARIES:

Recommend preventive measures such as fluorides and sealants.

Caution patients or their caregivers about medicines that reduce saliva or contain sugar. Suggest that patients drink water often, take sugar-free medicines when available, and rinse with water after taking any medicine.

Encourage independence in daily oral hygiene. Ask patients to show you how they brush, and follow up with specific recommendations.

Perform hands-on demonstrations Some patients cannot brush and floss

independently. Talk to caregivers about daily oral hygiene and do not assume that they know the basics. Use your experiences with each patient to demonstrate oral hygiene techniques and sitting or standing positions for the caregiver. Emphasize that a consistent approach to oral hygiene is important--caregivers should try to use the same location, timing, and positioning.

PERIODONTAL DISEASE occurs in people with autism in much the same way it does in persons without developmental disabilities.

TOOTH ERUPTION may be delayed due to phenytoin-induced gingival hyperplasia. Phenytoin is commonly prescribed for people with autism.

TRAUMA and INJURY to the mouth from falls or accidents occur in people with seizure disorders.

Making a difference in the oral health of a person with autism may go slowly at first, but determination can bring positive results--and invaluable rewards. By adopting the strategies discussed in this booklet, you can have a significant impact not only on your patients' oral health, but on their quality of life as well.

SOURCE: 

http://www.nidcr.nih.gov/oralhealth/Topics/DevelopmentalDisabilities/PracticalOralCarePeopleAutism.htm

Thank you