The Tribune

By Dr Andre Clarke

THE conference entitled, "Combating Autism Spectrum Disorders and Developmental Disabilities in The Bahamas" was presented by the Autism Speaks' Global Autism Public Health Initiative; the Caribbean Centre for Child Development; the Resources and Education for Autism and Related Challenges, and the US Embassy in The Bahamas.

It was a three-day initiative to educate and to decrease the stigma associated with autism and developmental disabilities. It is universally accepted that the care of individuals with autism and developmental disabilities must not only be medical, but dental also.

Pervasive development disorders are characterised by delays in the development of multiple basic functions including socialisation and communication, such as a persistent lack of interpersonal skills, abnormal speech and language and ritualistic or compulsive behaviour with repetitive activities.

Autism spectrum disorder includes a range of pervasive developmental disorders that usually begin in the first 30 months of life. Persons with autism have no particular distinguishing physical feature, but may appear indifferent and unable to form emotional bonds.

Epilepsy may develop in about 30 per cent of the persons in the autism spectrum disorder. They often avoid eye contact, appear deaf, act unaware of the coming and going of others, prefer unchanging environments, and practice repetitive actions (for example hand-flapping and rocking).

Many caregivers give persons with autism sweet foods as rewards and this may lead to poor oral hygiene. Anecdotally, the risk for dental cavities and periodontal (gum and supporting structures) disease will increase with such a practice. The use of stringent oral hygiene practices will be needed to avoid this, but are often times difficult as many persons with autism have an aversion to mouth cleaning techniques. The caregiver will require much patience.

It is worth noting that many electric toothbrushes are not well tolerated by persons with autism due to the erratic bristle movement and the rotor sound. A caregiver may often times need to use pictures to explain oral hygiene instructions before performing them.

In addition, many persons with autism show signs of bruxism (non-functional grinding, clenching, and rubbing of teeth); bite foreign objects (resulting in traumatic mouth injuries), and indulge in self-aggression (very often damaging the mouth). Convulsions may also be a factor in mouth injuries in an autistic person.

Please remember that persons with autism have a right, like any other, to good dental care. Dental treatment can be very exhausting to any dentist and a very empathetic approach is mandatory. This is because patients with autism can sometimes show inappropriate behaviour, with uncontrolled movements in the dental operatory. They may even exhibit self-aggression during the dental treatment.

The experienced dental healthcare professional will use visual aids and familiar (to the patient) movements and gestures, to reassure the patient with autism. Simple step-by-step instructions should also be included, with no stress inducing questions posed to patient.

Many patients with autism will only allow mouth examination and preventative oral care, even after progressive desensitisation and more invasive procedures may need some form of sedation (calming drug). However the success of sedation is unpredictable and general anesthesia may be necessary.

It is essential in The Bahamas that dental healthcare professionals seek to improve the access of dental care to persons with autism. There must be training in the homes and in the schools of persons with autism, with visual aids (pictures and instruments) and simulation of dental procedures.

The dental officer must create a dental visit routine, in which the patient with autism is not kept waiting and has a short quiet visit. The same dental staff should be used repeatedly and a step by step process followed each visit. This will assist in creating the routine and can be even converted to pictures for the patient to take home.

It is advisable that a family member or caregiver is present for all dental visits.

Please contact your dental healthcare provider about autism and its mouth impact. Oral healthcare is for everyone.

• This article is for informational purposes only. It is not intended and may not be treated as, a substitute for professional medical/dental advice, diagnosis, or treatment. Always seek the advice of a physician or dental

professional with any questions you may have regarding a medical/dental condition. Never disregard professional medical/dental advice or delay in seeking it because of a purely informational publication. If you have questions, please send e-mail to dr_andreclarke@hotmail.com.