Autistic disorder (AD) is a neurodevelopmental disorder that appears during the first three years of life in which special interaction, language, behavior and cognitive functions are impaired severely. AD is the third most common developmental disability in the United States and almost 400 000 people are affected.AD is not a disease but a syndrome with multiples genetic and nongenetic causes.
It is more common in males than females (4:1 ratio). Practice management in dentistry of autism child is challenging for the dentist and his staff and requires awareness, training as well as from the parents.But one of the articles states that these patients need more familiarity with dental and preventive care that the dental treatment itself. Because caries susceptibilities and prevalence of periodontal disease are not significant different for autistic that nonautistic individuals but compromised oral hygiene can contribute to an increased risk for caries and especially periodontitis in some patients. One of the method to decrease autistic child’s fear and familiarize them with the dental atmosphere call desensitization in order to avoid time consuming before dental procedure.
Parent’s involvement plays a crucial role. For example, rehearsals at home prior the dental appointment or training sessions with guided mastery, symbolic video peer modeling, and reinforcement. The results are promising but limitations of manpower, time and money restrict this kind of program. Secondly the child need several visit to the dental office prior his appointment. This is call slow and gradual exposure same method will be used at the dental chair with the child.Because of their difficulties in communication, highly sensitive to and reactive to and fear of stimuli in dental environment, some unexpected stimuli can occur at the office causing adverse reactions of the child.
That’s why a quiet and shielded single operatory is preferable for the patient. When co-operation on the dental chair is unmanageable and the child requires full mouth rehabilitation, it is advised to treat the patient under general anesthesia in order to perform a comprehensive, necessary preventive, restorative and surgical treatment in a single appointment.Sometimes, when management of the child becomes impossible, sedation could be another alternative. One of the other articles shows a video proving success in providing care to these children without need of any sedation.
This method is called “”D-Termined Dental Program of Repetitive Tasking and Familiarization in Dentistry”. This method, developed by Dr. David Tesini, is a behavior management approach which is separated in several segments: * First is to divide the skill in first step of coming to the operatory and sitting down on the chair means to repeat the task with the child until he will reliably be able to do it next visit.
Then we move to the second step then to the other until the child is able to accept all the specific procedures involved. * Second is demonstrate the skill help from the dental assistance or dental hygienist but in this particular case they have help from the brother is already autistic and had completely the familiarization repetitive tasking of the program.* Third is Drill the skill that the patient will repeat the skill over and over again until he masters it.
Dr. David Tesini hopes that more autistic child will benefit from this method and will be able to receive dental care without sedation.To summarize a typical appointment with an autistic child it should be well organized, short with waiting time not exceeding 10, 15 min because of their limited attention span. A routine should be established by maintaining same days, times with same personnel and same quiet operatory for each dental visit. A music background could be beneficial. Personnel should limit movements because of child very distracted.
Tell-show-do, voice control with short, clear command and positive reinforcement are successful first-line management techniques for the autistic patient: explain the procedure before it occurs.Show the instruments that you will use. Provide frequent praise for acceptable behavior.
The use of a restraint board, immobilization techniques to protect patient and care providers from potential injury may be used only after explanation and parental consent. AD is a life-long disorder, generally with no regression. Early detection is important, because early therapy results in faster and greater improvement. Pediatric dentists are well suited to be primary health care providers for early screening of the risk group because pediatric dental care ideally starts by age 1.References 1.
http://student. ahc. umn. edu/dental/2010/Documents/Summer09/Autism%20Review%20for%20Pediatric%20DDS-Klein%20and%20Nowak-JPD-1998. pdf2.
http://www. casereports. in/articles/1/1/dental-management-of-autistic-child. html 3. http://nlmfoundation. org/media.
htm 4. http://www. youtube.
com/watch? v=artQFqd6osQ 5. http://dentalresource. org/topic55autistic. html 6. http://illinoisaap. org/wp-content/uploads/Autism-Providers.