Autism and the Necessity of Dental Hygiene

Performing dental hygiene on some children with Autism is not an easy task, however, it is a necessary one.
If you want to prevent any problems later on, prevention is certainly better than a cure.

It is presumed that children with Autism have a high threshold for pain, and what pain is much worse than a toothache.
It is not an area that is easy to inspect and if the Autistic child has no speech as 50% of them do, then they may not have a way to tell you and may be in some considerable amount of pain for some time before you suspect anything is wrong.

It is best that dental care is started as early as possible so that they can get accustomed to it.

Start simple by sweeping around the teeth with a flannel or a fingerstall type toothbrush.
It is much better to break the task down into many simple steps and keep to the same routine. This will help the Autistic child feel more comfortable with doing it.

For those whose child with Autism has a tendency to chomp down on fingers that are placed in their mouth, I would suggest holding the child's hand and using their finger to perform the task.
If they do chomp down, they will soon realize their error and your fingers will be out of harm's way.
Also handing them a toothpaste with a bit of water on it while you are brushing their teeth will give them an idea of how it is meant to be used and can act as a prelude to them using it on their teeth.

Children's toothpaste comes in many different flavours and it should be possible to come up with one that your child likes.
Always use just a wee bit of toothpaste as initially it is going to be next to impossible to get the Autistic child to rinse and spit, but that should be a goal to work towards.
Sometimes, after brushing, putting a dash of mouth rinse on a wipe and getting the child to wipe his mouth and front of his teeth can have the dual benefits of keeping their breath fresh and wiping off the excess toothpaste so that it doesn't get swallowed.

There are dentists who specialize in dealing with children with disabilities and it may be an idea to use one of those for your Autistic child.
They will have experience in dealing with many types of disabilities and have plans in place for treating the Autistic child.
Sometimes a visit before treatment is initiated is helpful for the child with Autism to get them used to the setting. Make sure that you are not stressed before or during the visit as the Autistic child seems to pick this up from you and will react accordingly.
If you remain calm and positive throughout the visit, they are also likely to be more manageable.

An ounce of prevention is worth a pound of cure and a smidgen of toothpaste and a toothbrush is definitely more preferable to a visit to the dentist with an Autistic child.

Donna Mason has been a Registered Nurse for the past 16 years. She is the mother of 6 children, 3 of whom have varying degrees of Autism. For more information on Autism signs and symptoms, and to learn more about this mother's battle in the fight against this misunderstood condition, visit us on the web at: http://www.autisticadventures.blogspot.com

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Dental Sedation and Autism

Oral health care for a child with the diagnosis of autism is not much different from the oral health care of other children. However, children with autism often have difficulty in communication skills, so cooperation from your child might be a difficult challenge when visiting the dentist. For parents of children with autism, a visit to the dentist is more than a child opening his or her mouth and getting a reward after. If your child is too difficult to work with and the need for a dental procedure is urgent enough, a dentist may have no choice but to use dental sedation in order to perform his job.

What is dental sedation? Is it necessary? Is it safe?

Sedation is the utilization of medications called "sedatives" to create a state of relaxation. It is usually done to facilitate a medical, or in this case, dental procedure. There are three levels of sedation that may be used with pediatric patients that require extensive dental care:

-Conscious sedation is inducing a minimally depressed level of consciousness that retains the patient's ability to maintain an open airway independently and continuously and respond appropriately to physical stimulation or verbal commands.

-Deep sedation is a type of sedation in which the patient is not easily aroused and which may be accompanied by a partial loss of protective reflexes, including the ability to maintain an airway or to respond properly to physical stimulation or verbal commands.

-General anesthesia is an induced state of unconsciousness. The patient cannot respond to physical or verbal stimulation of any kind and it will be up to the dentist to insure that an airway is maintained.

Most people immediately associate sedation with general anesthesia, in which the patient is put to sleep during the whole procedure and awakens afterward in a recovery room. However this is normally the last possible choice for a pediatric dentist. He will recommend a lower level of sedation instead if he can, trying to use whichever form of anesthesia has the lowest risk while being effective. To make his decision he will take the child's age, cognitive level, coping and communication skills, physical health, the attitude of the parents toward anesthesia and the urgency of the procedure into consideration.

Although the decision regarding which level of sedation to be used on your child must ultimately be made by the dentist, you as the parent should always have a say in the matter. If you are not comfortable with the suggestion of your dentist, make sure that your concerns about it are heard. To help you further understand the decision the dentist will be making, here are some guidelines from the American Academy of Pediatrics (AAPD) that the dentist will be using in making his recommendation: (American Academy of Pediatric Dentistry, 2010)

The AAPD recommends conscious sedation for:

-Preschool children who cannot understand or cooperate for definitive treatment

-Patients requiring dental care who cannot cooperate due to lack of psychological or emotional maturity

-Patients requiring dental treatment who cannot cooperate due to a cognitive, physical or medical disability

-Patients who require dental care but are fearful and anxious and cannot cooperate for Treatment

The AAPD recommends deep sedation or general anesthesia for:

-Patients with certain physical, mental or medically compromising conditions

-Patients with dental restorative or surgical needs for whom local anesthesia is ineffective

-The extremely uncooperative, fearful, anxious or physically resistant child or adolescent with substantial dental needs and no expectation that the behavior will improve soon

-Patients who have sustained extensive orofacial or dental trauma Patients with dental needs who otherwise would not receive comprehensive dental care

Sedation Procedure

Dental Sedations are usually done in an outpatient dental clinic that is well-equipped. The whole procedure usually won't take more than 90 minutes for most procedures. Although some details vary depending on the dentist's practice among other things, in general the process will go like this:

-Initial assessment of the pediatric dentist and scheduling of the actual procedure.

-Consent signing by the parents

-Guidelines are given prior to the procedure - your child will be asked to go on a NPO (nothing per orem or mouth) diet 6-8 hours before the procedure. This is a standard operating procedure for any sedation process. It will aid in the proper ventilation of your child and will avoid any episodes of vomiting after the procedure is done.

-Sedation medication is introduced via injection, an IV line, rectal line (just like when you give suppositories for fever), orally or thru inhalation.

-Dental procedures are done. Your child may or may not be strapped onto a papoose board. Papoose boards restrain the child's limbs and help in stabilizing your child during the procedure. Oxygen and pulse oximeters should be available and used if the need arises.

-Monitoring of the patient until sedative wears off.

Safety of Sedation

Sedation is an accepted standard of care. The 3 levels of sedation are all accepted and supported by the American Academy of Pediatric Dentistry, the American Dental Association, the American Medical Association, and the U.S. Department of Health and Human Services.

Pediatrics dentists are also trained and certified to perform sedation as part of their profession. Usually, dentists who specialize in treating pediatric patients are also well equipped to handle children with Autism Spectrum Disorder.

Reference:

American Academy of Pediatric Dentistry. (2010). Reference Manual 2010-2011. Chicago, IL: American Academy of Pediatric Dentistry.

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