Providing Dental Care for the Patient with Autism

By H. Barry Waldman, DDS, MPH, PHD; Steven P. Perlman, DDS, MSCD, DHL (HON); and, Karen A. Raposa, RDH, MBA

Autism spectrum disorders (ASDs) are a group of developmental disorders defined by a significant impairment in social interaction and communication and the presence of unusual behaviors and interests. Many individuals with ASDs have atypical ways of learning, paying attention or reacting to different sensations and stimuli. The assessment and learning abilities of youngsters and adults with ASDs can vary from gifted to severely challenged. ASDs begin before the age of 3 and last throughout a person’s life. It occurs in all racial, ethnic and socioeconomic groups.

The Centers for Disease Control and Prevention (CDC) estimated in 2018 that one in 37 boys and one in 51 girls have some form of autism. It is unclear if the increase is due to changes in how one identifies people with ASDs or whether it is an increase in prevalence.

General Symptoms

People with ASDs differ greatly in the way they act and their capabilities.

Social skills: They have limited or no interaction with other people, might not make eye contact and just want to be alone. They may have difficulty understanding other people’s feelings or talking about their own feelings. Children might not like to be held or cuddled. They may not know how to talk, play or relate to other people.

Speech, language and communication: About 40% of ASD children do not talk at all. Others repeat words or questions directed to them, rather than responding. They may not understand gestures. Some can speak well, but have a hard time listening to others.

Repeated behaviors and routines: Individuals with ASDs may repeat actions. They may want to maintain routines and have trouble with changes. Children with ASDs may have significant delays in language, social and cognitive skills, but may be great at solving puzzles or computer problems.

Causes and Treatment

It is suspected that there are numerous causes for ASDs due to complex interactions of genetic and environmental factors. Studies of twins have shown that in identical twins, there is about a 75% rate of both twins having autism, while in fraternal twins this occurs about 3% of the time. The cause of ASDs in most people is unknown, however, it tends to occur more frequently than expected among individuals who have other particular medical conditions, including Fragile X syndrome, tuberous sclerosis, congenital rubella syndrome and untreated phenylketonuria.

Although there is no known cure for ASDs, early and intensive education can help children develop and learn new skills. The goal of these efforts is to help the child to talk, interact, plan, learn and care for his/her needs. While some medications can relieve some of the symptoms, structured teaching of skills (often called behavioral intervention) is currently the most effective treatment.

Associated Oral Conditions

The complex neuro/developmental disabilities compound and exacerbate the all too frequent oral health disorders in the general child and adult populations, including: poor oral hygiene, increased risk for caries, generalized periodontal problems, oral-facial pain, xerostomia, poor nutrition and poor diet.

Dental Services in a Private Practice

The actual technical aspects of care are similar to the delivery of services for the general population of patients. Modifications in practitioner-patient-staff-parent or guardian interactions, however, may be necessary. Providing dental care and ensuring follow-up home care for individuals with ASDs will vary by patient age, type and level of the particular disorder, as well as an appreciation of family/living arrangements. An underlying understanding of patients with ASDs will facilitate the actual provision of care.

  • Not all patients with ASDs are alike.
  • They may be hypo- or hypersensitive to sight, sounds and smells.
  • Nonverbal patients may carry out self-abusive behavioral acts as their only means of expression for pain.
  • You may need to attempt different modalities of behavioral guidance.
  • Additional time may be necessary.
  • Schedule appointments in line with behavioral medication.
  • Keep wait times to a minimum to help reduce anxiety.
  • With proper consent, medical immobilization/protective stabilization may be a necessary behavioral guidance technique.
  • Use simple verbal and nonverbal communication.
  • Use adequate pain control for both restorative and surgical procedures

H. Barry Waldman, DDS, MPH, PhD, SUNY Distinguished Teaching Professor, Department of General Dentistry, Stony Brook University, NY.

Steven P. Perlman, DDS, MScD, DHL (Hon), Global Clinical Director, Special Olympics, Special Smiles; Clinical Professor of Pediatric Dentistry, Boston University Goldman School of Dental Medicine.

Karen A. Raposa, RDH, MBA, Published Author and International Speaker, Clinical Education Manager, Hu-Friedy Mfg. Co., Raynham, Massachusetts

Reprinted from Today’s FDA, Jan/Feb 2020. Visit floridadental.org/publications to view Today’s FDA archives.

I Need a Hero

By Dr. John Paul, FDA Editor

I was wearing a long face and being generally disgruntled by all the goings on in this great country when I walked into the room with one of my favorite patients and longtime advisors, Ima Mae Gruntbuns, a great American. Not being one to let me rest on my laurels or rain on any parade she is enjoying, she questioned my lack of enthusiasm for being alive one more day. I complained that people just seem to being sliding back into the slime. Folks I know and like are being nasty to one another. Others think they can run amok, spouting hate and destroying things that don’t belong to them. When one side behaves badly, the other side tries to top them and then the “news” tells you about the worst of us every hour on the hour in gory detail with plenty of video from every angle.

Mrs. Gruntbuns pulled me up short. She said, “Son, you are looking in the wrong place for inspiration. Just because you get elected or you are famous or someone points a camera your way, doesn’t make you a leader or a hero. All those pictures on your Marvel comics scrub top are fiction.”

That was a little disheartening because my wife thinks I look like Thor now that I wear a beard, but Mrs. Gruntbuns wasn’t slowing down.

“Turn off the TV and put down the phone. Last April when no one knew who had or who might die from the coronavirus, who opened his office and removed that fish bone stuck between Mr. Gruntbuns’ teeth?” she continued.

I replied, “Well, I did Mrs. Gruntbuns, but he’s a friend and I was just doing what I know how to do with the tools I have on hand …”

“Yes, Doc — but you did it. You came in and got him out of pain. He carries that bone around in his wallet and he’s still telling people about it.

“Who grabs people’s tongues with a piece of cotton, pulls it out past their nose and stares at that hangy-down thing and whatever else is in the back of our mouths to make sure we don’t have cancer, or at least catch it early so we can cure it?”

“Well, we dentists do, Mrs. Gruntbuns, but it’s just what we were taught to do in school and it’s the right thing to do,” I responded.

She went on. “Have you counted up the lives you’ve saved, the suffering you prevented? There is a hero or two in every dental office. Every once in a while, an ‘Atta-girl/boy’ and a pat on the back goes a long way, but you don’t need the satellite truck and the pretty newsreader to verify what you do. Just keep doing it for all of us regular folks who may not be famous either but deserve your best effort every day.”

It’s hard to argue with someone who is so right.


Reprinted from Today’s FDA, Jan/Feb 2021. Visit floridadental.org/publications to view Today’s FDA archives.

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