fixation, which is very typical of this disorder as the child moves into puberty. Of special concern to dental health professionals are the problems of bruxism, which occurs as a result of uncontrollable movements; esophageal reflux, which exposes the teeth to gastric acid; and drooling— although some of the medications for Rett syndrome can cause xerostomia. Children with Rett syndrome also tend to clench their mouths shut, which can make dental examination and treatment a challenge (Sandweiss et al., 2020). Childhood disintegrative disorder , like Asperger’s syndrome, now falls under the umbrella of autism spectrum disorders in the DSM-5. This disorder is much more common in boys than it is in girls (Mehra et al., 2019). The patient develops age appropriately until about age 3 or 4, when developmental regression begins. A genetic component has been identified in both Rett syndrome and childhood disintegrative disorder. In the absence of known genetic causes, the exact etiology of autism spectrum disorder is unknown, though there has been much speculation and controversy. Data from 2020 indicate that autism occurs in roughly 1 in 36 live births in the United Sates, which is an increase of 20% since 2018 (Harris, 2023). Patients with autism display a wide range of verbal and nonverbal cues and may display a wide range of behaviors or emotions. A patient may have a tantrum, use inappropriate language, speak at inappropriate times, or engage in self-injurious behavior. Head banging, echolalia (repetition of speech), and biting themselves are some of the characteristics that many, but not all, patients with autism display. Several key points enable a successful interaction with and treatment of a patient with autism: ● Interview caregivers carefully about what frustrates or calms the patient. ● Ask how the patient reacts when they experience pain or fear. ● Establish trust and develop a positive relationship at the earliest possible moment. ● Find out when is the best time of day for the patient’s appointment. ● Familiarize the patient with photos of the office and staff beforehand. ● Be aware that short and frequent visits may help the patient develop trust and confidence in the dental office. ● Ask the caregiver to bring a comfort item or coping device, along with a reward device, for each appointment. ● Many patients with autism become agitated at the sight of dental instruments; do not bring them out until needed, and then introduce them slowly and carefully. ● Avoid shining direct light into the patient’s eyes. ● Consider the use of weighted vests or a lead apron as a comfort tool for the patient. ● Remember that tell–show–do and being consistent with praise is helpful as with all small children. Following these simple steps will help to make the dental experience a positive one for many patients with autism and will foster a lifetime of regular dental visits.
single spectrum disorder (National Institute of Mental Health, 2023). Autism spectrum disorder is a neurodevelopmental disorder. Individuals with the disorder have persistent deficits in social communication and interaction, as well as severely restricted and repetitive behaviors, interests, and activities. Persons with autism spectrum disorder commonly display varied ways of learning, diminished attention span, attachment to certain everyday objects, intense and inflexible adherence to routines, and a heightened reaction to sensory stimuli. Although no longer categorically distinct according to the DSM-5, Asperger’s syndrome is commonly considered a very mild form of autism, and many people who have historically been diagnosed with Asperger’s syndrome find this label more useful than autism spectrum disorder. These people typically have less severe communication impairments and often display average or above-average intelligence. Social interactions and relationships are possible given the right circumstances (Autism Society, n.d.). Rett syndrome is a very rare genetic disorder that generally affects only girls. Boys with the condition usually die either in utero or very early in life. Normal development of the infant is followed, at around 18 months, with the beginnings of autistic-like symptoms. Eventually, the child loses control of their limbs and demonstrates hand ringing and an oral Dental treatment implications Because of the apparently increasing prevalence of autism in today, it is likely that oral healthcare providers will come into contact with a person who has autism spectrum disorder. To facilitate optimal care, the dental team should discuss the condition with the patient’s physician and/or autism specialist and, more importantly, create a family-centered approach based on parental preferences and concerns to improve treatment planning and oral health management of these patients (Pimentel et al., 2023). It is common for patients with autism to have specific oral habits, including food or object obsessions or aversions, increased intake of foods high in sugar, or increased incidence of sensory chewing to relieve stress. Pica, for example, is an eating disorder most often observed in individuals with developmental disabilities (Schnitzler, 2022). This condition is characterized by the ongoing ingestion of nonnutritive substances such as paper, glue, or cigarette butts at an age at which this behavior is considered developmentally inappropriate and in a setting in which the practice is not culturally sanctioned. Sensory stimuli may be desirable or undesirable depending on the specific patient. It is important to discuss sensory stimuli with the caregiver prior to the patient’s first visit. This conversation can prepare the dental team and patient for a positive dental experience. The dental team should be patient in the desensitization process and allow the patient to experience the operatory and office with all of their senses instead of jumping straight into an examination or treatment. Consider the patient’s visual response to light and their comfort with proximity to people. Make chair movements slowly so the patient can become accustomed to the sounds and feel of the dental chair.
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