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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.
Dentists will be able to advise whether medications are affecting saliva production or may contain sugar. Lower saliva productions levels have been shown to increase the possibility of the development of the bacteria that causes cavities and bad breath. Add that to increased sugar intake and it becomes clear that this situation has to be monitored closely. Simply rinsing with water after taking sugary medications or treats can help.
For those with seizure disorders trauma and injury can be common. Caregivers should know how to preserve the lost or broken tooth and know to seek dental treatment right away.
Dental visit tips
1) Arrange for a tour of the office. Let the patient sit in the chair with normal overhead lights. No drills running. Let them see the trays and touch and feel everything, including the X-ray machine. Let them meet all the staff.
2) Make the first official dental visit short and as uninvasive as possible.
3) Ensure that the dentist or hygienist explains (or you explain on their behalf) what is going to happen, what is going to be touched, what instrument is going to be used, what that instrument is going to feel like, how long it’s going to take.
4) Never be afraid of insisting that you be present during the dental appointment – it’s likely inevitable that your child or dependent will require you there anyway. Make sure the dental staff is comfortable with this.
5) More extensive dental treatments, extractions, fillings and even X-rays can be done under sedation or general anaesthesia if the patient’s behavior is likely to create difficulty for the dentist in providing safe care.
Sources: www.usc.edu/hsc.dental, www.nidcr.nih.gov, http://dentalresource.org, www.nfdh.org
Add a Comment25 Comments
"Reactions or side effects to nitrous are not very common."
Maybe you should read this article.
When Nitrous Oxide is No Laughing Matter
Victor C. Baum, M.D.
University of Virginia
And BTW, why would anyone put a toxic metal in a child's body?
SCR
August 30, 2009 - 8:37pmThis Comment
That's not part of this discussion.
I worked for a oral surgery practice where 5 out of the 6 had over 30 years of experience and never heard them once talk about any incidents regarding a reaction to nitrous. It certainly never happened while I was there 6 years. If you read part of it, any reaction has been due to other extenuating health circumstances - improper levels of nutrients in the body. It's important that people are aware of this conflict.
But again, I made no mention of nitrous in my article or of mercury and amalgam fillings.
Keep the discussion on topic, please.
August 31, 2009 - 4:05amThis Comment
Reports and studies on mercury toxicity:
"Mercury in Medicine: Taking Unnecessary Risks"
Three Year Investigation - A Report Prepared by the Staff of the Subcommittee on Human Rights and Wellness, Committee on Government Reform, United States House of Representatives (May 2003)
http://www.generationrescue.org/pdf/burton.pdf
Mercury toxicity from dental amalgam: Studies assembled by Boyd E. Haley Ph.D., Professor and Former Chair, Department of Chemistry, University of Kentucky, Lexington, KY
http://www.iaomt.org/testfoundation/amalgampage.htm
"Amalgam Illness Diagnosis and Treatment: A book on how to cure mercury poisoning" by Andrew Hall Cutler, PhD, PE
August 30, 2009 - 1:05pmhttp://www.noamalgam.com/
This Comment
I wanted to provide you with the link to the discussion that Darlene Oakley was referring to below, if you would like to comment further on this topic: Amalgan Fillings Versus Composite Fillings.
August 30, 2009 - 9:14pmThis Comment
Let's keep this a discussion about autistic patients and not get into the debate on mercury. I have another article that looks at the differences between amalgam and composite fillings. If you want to comment on the effects of mercury do it there. But we're talking about how to deal with people in dental situations that already have these disorders not how they might have gotten the disorder from these procedures.
Let's stay on topic.
August 30, 2009 - 4:07pmThis Comment
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."
August 30, 2009 - 12:59pmThis Comment
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.
August 30, 2009 - 4:04pmThis Comment
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.
August 30, 2009 - 11:55amWhen 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
This Comment
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.
August 30, 2009 - 11:06amThis Comment
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.
August 30, 2009 - 11:06amThis Comment