Management of Autistic Children at The Dentist

Children with an Autism Spectrum Disorder have impaired social interaction and limited communication abilities, combined with a restricted amount of activities and interests. While parents are often able to manage them in familiar places and situations like the home, it becomes difficult to do the same outside, especially when visiting specialized healthcare providers including dentists.

Considering that 1 in ever 30 Indian children displays signs of ASD, pediatric dentists are very sensitive to their dental needs and specialized management. Even so, parents have a large role to play in ensuring all procedures go smoothly, and children come away with the least amount of stress and mental trauma.

Dentists managing autistic children are aware of them exhibiting specific observable behavior;

IMPAIRED SOCIAL RESPONSE - Children are unable to read and respond to feelings and experiences, with absolute no understanding most times

IMPAIRED COMMUNICATION - Children are unable to use and understand gestures, repetition of words (echolalia) and a rigid body stance is often displayed

Besides the atypical behavioral and impaired communication skills that are observed and need careful handling, below are often the main dental problems that such children exhibit;

* Bruxism or teeth grinding, often when asleep or the child isn't aware of it

* Tongue thrusting or repeated tongue movements

* Chewing at all odd times without presence of food

* Self-injury, where pinching gums, biting lips and creating wounds is common

* Erosion of teeth

* Caries, when teeth aren't brushed thoroughly because the child finds it unpleasant

* Poor oral care at home, because of difficulty in managing the child

* Limited dietary preferences. Autistic children have very strong likes and dislikes (Only pureed food, no vegetables, dislike of particular vegetable color, etc.)

Management of an Autistic Child at the dentist, can be divided into two phases;

PRE MANAGEMENT or BEFORE CHILD MEETS THE DENTIST

• It is important to plan a desensitizing appointment with the dentist to help the child familiarize themselves with the doctor and the staff
• Allow the child to bring things that can comfort them, a favorite blanket, stuffed toy or even hold the parent's hand
• Parents need to discuss with the doctor about the child's tolerance to pain and discomfort, and their threshold
• Share the child's intellectual and understanding abilities with the doctor, so that they can phrase sentences or relate with the child accordingly

POST MANAGEMENT or AFTER THE CHILD MEETS THE DENTIST

• The dentist will communicate with the child at a level he/she can understand. They use phrases such as 'Tell', 'Do', 'Show' when explaining any procedures or methods, always speaking in clear, precise tones
• Oral examination is begun with only fingers first, while the hard feel of dental instruments is brought in later
• Dental instruments are only shown later. Suddeness of movements by the dentist is kept to a minimum and light is kept away from the child's face. Sensory input of any kind is kept as less as possible to avoid distraction
• Dentists place same staff at all examinations and interruptions are kept minimal
• Child's co-operative behavior is always encouraged with positive words and nods
• The child's unusual body movements are always observed and pre-empted

Most pediatric dentists are aware of the extra care and effort it takes to manage autistic children, and are extra cautious while carrying out any kind of dental procedures. As a parent, it is important to know what to expect, understand how the process can be made easy and prepare the child for any kind of dental visit.

Does a mother's dental health affect her baby?

When should we start thinking about our children's oral health?

Newborn babies do not yet have teeth - surely this is too early to worry about cavities or gum problems? 

What about during pregnancy?

Expectant mothers are keen to do everything they can for the health of their baby. However, many are unaware that  their own dental health problems can have effects on their general health and their unborn child. 

Research has shown that mothers with gum disease have a three times greater risk of poor and pregnancy and birth outcomes such as pre-term deliveries and low birth weight. This can occur as bacteria from the mouth and their by-products have the ability to cross the placenta to the developing baby and trigger inflammatory responses. Another study has shown a link between gum disease and pregnancy (gestational) diabetes.

Also, mothers with poor oral health and high levels of the bacteria which cause dental decay are at greater risk of passing these bacteria to their newborn babies, putting them at an increased risk of developing dental cavities at an early age. For more information on this, click for the previous blog post.

Problems with oral health in pregnancy

Unfortunately, due to pregnancy hormones, some women can be more susceptible to gum problems during pregnancy. Warning signs of periodontal (gum) disease include swelling, redness, bleeding and sensitivity.

Nausea and vomiting and extreme tiredness can also cause problems and lead to dental hygiene being neglected. Pregnancy cravings and the need to each more frequently may increase the risk of dental decay if sugary snacks are consumed often. 

Many women are concerned about the safety of dental treatment during pregnancy. However, treatment should not be unnecessarily delayed if appropriate safety precautions are taken. Active decay should be removed and the cavity filled. Pain and infection should not be left untreated, as these can cause stress and danger to both the mother and her developing baby. 

Guidance for expectant and new mothers

• Remember that your own dental health can have an effect on your baby, both during pregnancy and after birth.
• See a dentist for a consultation as soon as possible. Be sure to tell your dentist if you are pregnant as this may affect the treatment or medication prescribed. 
• Cleaning (scaling and polishing) and many other treatments are safe during pregnancy, you can discuss the best options with your dentist. 
• The second trimester (14th to 20th week) of pregnancy is usually the best time to get treatment done if required.
• X-rays are generally avoided during pregnancy but if they are required for urgent treatment then small x-rays using a lead apron to protect the rest of your body can be taken.  
• Maintain your oral health during pregnancy to prevent gum disease and decay. Try not to neglect brushing and flossing.
• If you are having gum problems, in addition to regular professional cleaning, using a chlorhexidine (antibacterial) mouthwash may help.
• Diet and nutrition is especially important during pregnancy. Although you will need to eat more frequently, try to choose snacks that are sugar free between meals.
• Take your new baby to see a dentist when they are 1 year old. An early check-up enables the dentist to assess the risk factors for your child developing dental decay and give personalised preventive advice.