Autism and Dentistry: Dental Challenges for Families and Treating Dentists
Autistic patients – and patients with similar behavioral and intellectual difficulties – present a unique challenge for dentists. Dentistry involves bright lights, loud instruments and touching a very sensitive part of the body. Many “normal” people are uneasy about dental treatment, imagine what it’s like for an autistic person.
Autistic patients are usually hypersensitive to their environment and may react out of sensory overload. They don’t take well to a change in their schedules, new noises, smells, sounds, and activities.
Fortunately, dentists are becoming more aware of the needs of special needs patients. There are still sufficient numbers of dentists who may refuse to treat such patients usually because they’re unsure how to make them comfortable.
Programs like University of South Carolina (which has had a special patients clinic for 24 years), Special Care Dentistry Association (www.scdaonline.org), the National Foundation of Dentistry for the Handicapped (www.nfdh.org), the National Institute of Dental and Craniofacial Research, and the University of Western Ontario (London, Canada) have been cropping up in the last couple of decades to address the concerns of dental practitioners and families. Some offer services where dentists and hygienists will visit care homes, hospitals, personal homes, and treatment centers to care for patients who cannot get out to a dental office. Many will offer their time and care free of charge and offer programs whereby people can donate money to help sponsor this kind of care.
Many autistic patients have the same dental issues as “normal” patients, although sometimes these are exacerbated by improper oral hygiene (either by the patient or caregiver, or where the patient simply won’t allow even a toothbrush into their mouth) and overindulgence in sweets, often used as rewards.
Unique dental issues
For those autistic patients who engage in bruxism or self-injurious behaviors (such as picking at the gums or biting their lip) a mouth guard might be recommended so long as it is tolerated by the patient.
Comment on this postWe value and respect the experiences of all of our HERWriters, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice although we hope you can gain knowledge from their insight.
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Ms Oakley,
thank you very much for this. I thought this information was quite valuable and wrote a post to send some people here for good information. http://leftbrainrightbrain.co.uk/?p=2939
Expect to see a number of commenters being referred by the Age of Autism blog--a blog which promotes vaccines and mercury as causes of autism.
You're welcome and thank you for the referrals.
Hi,
My son has not been diagnosed with autism yet. He is 8 and has taken several of the medications that autistic children take (depakote, Tegretol, Topomax, Lamictal). He took the meds. for a minor tic and abnormal EEG.
I would love more information on the physical damage incurred from either the cause of autism (vaccines) or the treatment there after (drugs) on teeth and gums. For example I know one of the drugs my son was taking can cause his gums to grow and you got into it a little regarding meds. and salivation. My concern is that at 8 1/2 my son has not lost any baby teeth.
He's no longer on meds. as he has recovered, although it has been a year since the meds.
Thanks
Even non-autistic children are sometimes delayed in losing their teeth. Not every child loses teeth at the same age as everyone else. I know our son didn't lose any until closer to 9 - he has Aspergers.
I was not aware picking at the gums,or chewing on the lip/tongue was considered self-injury.I used to do this all the time.
Many of us with sensory disorders cannot stand having a toothbrush in our mouths.
That's why it's important to find a dental routine that works for you. An alternative might be a waterpik. With some of these there is no brush contact with the teeth or gums, but the plaque and food particles are still taken care of. Rinsing everyday with a non-alcoholic/no-sugar solution (I found one with baking soda and witch hazel) works to keep the alkalinity (prime environment for bacteria and cavities) down in your mouth.
Perhaps other products will come available in the future that will address these needs more directly.
I was not aware picking at the gums,or chewing on the lip/tongue was considered self-injury.I used to do this all the time.
Many of us with sensory disorders cannot stand having a toothbrush in our mouths.
One more thing I heard was that a deficiency in zinc could be linked to the finger sucking some children have. This is just a thought having to do with the salivation information.
When my son started supplementing the finger sucking did go away for him.
Not sure it was zinc, but maybe someone could go into more detail or correct me.
Thanks Again
Read about the potential adverse effect of nitrous oxide on ASD children with the MTHFR gene deletion and/or deficiency of Vitamin B-12 (cobalamin).
"Severe Methylenetetrahydrofolate Reductase Deficiency, Methionine Synthase, and Nitrous Oxide — A Cautionary Tale" by Richard W. Erbe, M.D., and Robbert J. Salis, M.D., New England Journal of Medicine, Volume 349:5-6 July 3, 2003 Number 1.
"Adverse Effect of Nitrous Oxide in a Child with 5,10-Methylenetetrahydrofolate Reductase Deficiency" by Rebecca R. Selzer, Ph.D., David S. Rosenblatt, M.D., Renata Laxova, M.D., and Kirk Hogan, M.D., J.D., New England Journal of Medicine, 349;1, July 3, 2003.
A letter in Arch Dis Child 2001;85:510 (December) from Isabel Smith, Clinical Audit Department, Great Ormond Street Hospital in London states: "Nitrous oxide inactivates cobalamin, the active derivative of vitamin B12 and essential cofactor for the transfer of the methyl group from methyltetrahydrofolate to homocysteine to form methionine. For subjects with good body stores of cobalamin this effect is unimportant, but no-one using this agent should remain unaware of the potentially devastating complications in the nervous system of using nitrous oxide in subjects who are of borderline or deficient vitamin B12 status. Onset of subacute combined degeneration affecting the brain and spinal cord is a well documented event when individuals with low body stores of cobalamin are exposed to nitrous oxide."
Interesting information. My son had local anaesthetic for a procedure and he was fine with it - but then he's more high functioning than most and from his very first dental visits I was always in the room with him explaining things.
Mental disabilities/difficulties or not, children will learn how to react to things by observing how you react to things. They are very intuitive and can sense when you're uptight or anxious and they will feed on that.
This is certainly something to monitor with your family physician and to ask your dentist about. Reactions or side effects to nitrous are not very common.
There are alternatives to nitrous, though. IV sedation is often preferred. Some dentists/oral surgeons and pedodontists (dentists that work with children) may also opt for general aesthetic. Although depending on the severity of the disability these too may be decided against.
Many autistic patients will not like having the mask over their mouth and nose, anyway.