Autism/ Dispersed growth disorders
Source of information: “Dentistry guide for parents and carers of children with disabilities and health problems” of the Pediatric Dental Association of Cyprus
The range of Autistic disorders is very large and the symptoms range from very mild to severe. Some people who suffer from Autism appear distant, do not have any contact with others, while others react naturally to ordinary social contacts.
Depending on the severity of the symptoms, the difficulty in providing dental care and home care also increases. The Dentist, parent or caregiver has to deal with a variety of issues arising from some Autistic features such as:
- The social interaction and communication ability of the child.
- His perceptiveness and his intelligence index
- His fanatical obsession with routines
- His repeated movements and behaviors
- Sensitivity to sounds and physical contact with other people.
- Unpredictable body movements that compromise their personal safety and those around them
- Hyperactivity and cyclothymic behavior
- If he suffers from epilepsy
Cooping mechanism at the Dental clinic
Generally, Autism is probably the most difficult medical condition in terms of dental care.
Autism – First visit at the age of one or the year of diagnosis
The key to success in the case of children with Autism is the early visit to the Dentist for prevention purposes. Because Dental prevention is a much simpler procedure than treatment, there is not much effort required from the child and the Dentist. But if there is a need for treatment, then things become more difficult. The specialist has techniques to resort to, in order to help the child such as:
- Dedicate time until the child accepts to sit on the Dental chair alone
- Initially examine the child with the fingers, without using any instruments
- Brushing of the teeth takes place as a means of habituation
- Then familiarization with the Dentist is slow, i.e. one instrument, one sound. Pay particular attention to the sounds as they can cause sudden movements and reactions to the child.
- Silence, low light, soft music, avoiding movement in the clinic, and avoiding the change of Assistants and Doctors. These people prefer familiar faces, the area and calmness.
- The repetition of orders which must be clear and almost monolingual
- The shortening and segmentation of the treatment in small – sized pieces, to the extent that a whole visit can be expended only in a simple cleaning.
- The use of numbers, i.e., we count e.g. from 1-10 each time, taking a small step
- Confirmation that he will leave soon (again identified with the numbers)
- A soft stuffed animal or a blanket is sometimes a useful aid to calm the child in the Dental chair.
- Where appropriate, the use of Nitrous Oxide mask (see chapter of mental retardation) is very effective and allows us to do even more extensive treatment
- The use of restraint to restrict movements where the safety of the child requires it.
- General anaesthesia if everything else fails.
- The use of an electric toothbrush at home usually helps to familiarize the child with sounds and vibrations and therefore there will be a much better acceptance of brushing in the Dental clinic (hand piece, suction etc.). Sometimes however, it also causes hypersensitivity with adverse effects, so caution is needed.
- Vigilance and continuous effort on the part of parents / caregivers is needed, as well as imagination as to how to help the child cooperate during the oral hygiene routine. This effort is worth it, since it will save the child and the parent from a much longer adventures later.
Traumatic habits: The Autistic child can sometimes self-injure himself with his nails and in turn create sores in his gums, biting his lips, he may present with severe wear of the occlusal surfaces from grinding, injuries that can lead to dental and other types of problems. We can help the child by placing splints in the mouth which are often cemented on the teeth so that the child cannot bite and injure his tongue or his cheeks.