Healthy smiles: Dental aspects of autism – Guest column by Dr Manikandan G R

Our guest column this week is by Dr Manikandan G R, a consultant periodontist from Trivandrum, who talks about the dental problems commonly found in people with autism.

Every year 2 April is observed as World Autism Day. This year’s theme is ‘Assistive Technologies, Active Participation’. The term autism describes a brain disorder that affects social interaction, communication and often results in repetitive or stereotyped behavior. Autism may refer to a specific diagnosis that is consistent with a number of specified symptoms. Autism may also be used as a general term to describe other Pervasive Developmental Disorders (PDD), which include Autism, Asperger syndrome, Rett syndrome, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS).

Patients who have an Autism Spectrum Disorder (ASD) diagnosis do not differ from other patients as far as their dental presentations and problems. What will be different is the flow of these patients through your office and management techniques that can be employed to have a successful visit.

Patients with an ASD diagnosis may, however, be at a higher risk than typical patients for some dental problems. This may be due to a variety of factors including behavioral difficulties that make oral hygiene at home difficult. They also may have a diet higher in fermentable carbohydrates and sugars. Patients with a ASD may also be at higher risk for some common dental problems depending on the severity of the manifestations of their symptoms.

The common dental problems are:

Self injury, especially lip biting and cleft in gums caused by frequent injuries due to sharp uncut finger nails.
Teeth grinding or Bruxism.
Tongue thrusting.
Erosion.
Non-nutritive chewing.
Frequent dental injuries.
Dental cavities, even though less sometimes aggravated in those who take time to chew the soft sweet foods keeping them exposed to oral environment for more time.
Dry mouth or xerostomia due to the side effects of medication they are taking.
Ogive palate which often creates a hyper gag reflex.
Phenytion drug taken by children which creates gum hypertrophy leading to delayed teeth eruption.

There are various methods that can be used to gain child’s attention to render effective treatment are:

Tell, Show, Do.
Desensitisation.
Distraction.
Communication — Using certain softwares and technologies using pictures which are effective.
Voice Control.
Sensory Technologies – It’s better to use electric toothbrush first to train the brushing technique in these kids. Avoid unattractive toothbrushes and use nice flavoured paediatric toothpastes only.
Applied behavioural analysis.
Dentists and assistants should avoid unnecessary sudden movement of dental chair, adjustment of light and chair positions and high speed high sound devices etc during the first few visits to develop a rapport with child and to keep the child in good mood.
Conscious sedation —When all non-pharmacological methods become a failure conscious sedation using drugs can be undertaken as a last resort to ensure cooperation.

These lovely kids deserve quality treatment like every others. If we show patience and empathy and have a loving approach to these lovely angels, we can impart long lasting healthy smiles to them also.They are no different from us. As the adage goes – “Every child is gifted. They just unwrap their gifts at different times”.