The Tribune

By DR ANDRE CLARKE

Autism Spectrum Disorder is a range of pervasive developmental disorders that usually begin in the first 30 months of life. Pervasive development disorders are characterized 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.

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 percent 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 (e.g. hand-flapping and rocking).

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 the autistic community.

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 aversions to mouth cleaning techniques. The caregiver will require much patience.

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.

The tell-show-do technique is not appropriate in persons with autism because they do not hold eye contact. Many patients with autism will only allow mouth examination and preventative oral care, even after progressive desensitization and more invasive procedures may need some form of sedation (calming drug). However the success of sedation is unpredictable and general anaesthesia 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 too is advisable that a family member or caregiver is present for all dental visits.

Please seek advice from your dental healthcare provider concerning care for anyone you may know who has autism.

• 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 email to dr_andreclarke@hotmail.com.