Autism: Problems And Challenges
Approximately 1 in 66 children and youth are diagnosed with autism in Canada, which is also known as ASD. Autism is a range of conditions that challenge individuals with social skills, repetitive behaviors, and speech and nonverbal communication.
Autism was first recognized in 1942 by Dr. Leo Kanner at Johns Hopkins Hospital, but there are many historical accounts indicating that autism existed long before the 20th century. To this day the cause of autism is still not fully understood, and there are many myths connected to the cause of the autism like it is caused by bad parenting. In more recent studies research suggests that autism develops from a combination of genetic and nongenetic, or environmental, influences, but this is not a proven fact. There is no cure or medication that helps with autism, but there are some medications that people can take with autism that will help with related symptoms like depression, seizures, insomnia, and trouble focusing. It is also suggested by doctor that people with autism go to therapy to help them with issues they might face like their behaviour.
There are many oral manifestations related to autism. Studies have actually shown that some baby teeth give clues to autism organs ( https://www.webmd.com/brain/autism/news/20180530/baby-teeth-give-clues-to-autisms-origins#1)
Some examples of oral manifestations related to autism are tongue thrusting, not being able to chew, self injury like picking at the gingiva, erosion, caries, teeth grinding and poor oral hygiene. Most of the time people with autism can’t prevent these things from happening, so that is why it is very important that they have a good relationship with their dentist, and the oral health team, and do things like go for cleanings / checkups more often.
Patient who have autism have a have a lower hygiene level, then a regular patient. Most of the time you will find more carries on autism patients because of the amount of bacteria they would have built up on their teeth. They will also be a higher risk of gum diseases like pariontal diese, and gingivitis. It is very important at home that their parents understand how important brushing is for their child. Most of the time it is best if a parent helps a patient with autism brush their teeth at home, and if they don’t need their parents help to even watch them brush their teeth to be certain that no spots are getting missed. Children and adults with autism do much better with a clear plan that they can follow everyday. For example, they should always be provided with a clear outline when to brush their teeth and how long they should do it for. A good sechual would be as soon as they wake up, and right before they go to bed, and for about 2 minutes. A soft bristle toothbrush is always recommended with patients with autism and to explore several options before finding a toothpaste flavor that the child tolerates. When is comes to their diet Individuals with autism may have limited diets and strong likes or dislikes when it comes to food and drink. It is important to try to provide a diet that reduces the risk of cavities. This can be done by limiting sugary drinks, sticky/gummy foods (e.g., raisins, fruit snacks), and acidic foods that can break down the enamel. Parents with a autictic child should also talk with their dentist regarding fluoride and options for delivery (e.g., toothpaste, rinses, drops), to make the oral hygiene process with their child easier and better.
Visits to the dentist office have the potential to be very challenging when it comes to autism patients. Most autism patients don’t like going to the dentist office, mostly because it is a new surrounding for them, and there’s a lot going on that they don’t fully understand. The main challenge is the reduced ability autistic patients to communicate while in the dental chair. Some other problems are, lack of ability to control their emotions, repetitive body motions, attention deficiency, and them having frustration. All these things are minor, but they can turn into a dental emergency if it gets too out of hand. For example if the patient is showing signs of body motion and attention deficiency, and those signs are ignored and the dentist continues to keep on working on the patient, you would run the risk of the patient becoming aggressive and violent to the dental team, because that is their way of expressing that they don’t like what’s going on, our that they don’t want to be there anymore. The dental team should be organized and prepared for any responses, as these patients’ emotions change every minute. Some strategies that you can use if you are having problems are communicated with the child at a level that he or she can understand. Use a “tell, show, do” approach when explaining treatment and procedures, Reward cooperative behavior, If possible use the same staff and dental operatory for all services and visits, and in some serious cases Sedation may be used with appropriate precautions.
When it comes to the booking of the appointment there isn’t one specific time that would work better than another. It would be a good idea for the parents to let their child know that they are going to go to the dentist a week before their appointment and to remind them everyday, so they aren’t surprised when the day comes. Most of the time the dentist office suggests an initial appointment. The goal of the initial appointment is for the patient to build a relationship with the dental team. The appointment should be well organized and should be kept under 10 – 15 minutes, to avoid the patient getting upset, due to their low attention spend. Things that can be done at this initial appointment are letting the patient see all the tools, letting the patient go up and down on the examination chair, and showing the patient the different parts of the dentist office. By doing this it will release some of the stress of the patient might have, and creating a better relationship with the patient, which is ideal when treating a patient with autism.
Most of the time a patient with autism would be taking some kind of medication. So it is always very important to remember to ask the patient if any of their medical history has changed since the last appointment, and if so to always write it down in the patient’s record. There are three groups of medications that most doctors go with for autism patients which are used to treat co-occurring ADHD symptoms, antidepressants/anti-anxiety medications, and atypical antipsychotic medications. At one when a patient had autism they were automatically diagnosis with ADHD, but that has changed over the years, and doesn’t happen so much anymore, but nearly half of all kids with autism demonstrate ADHD symptoms that is why ADHD medications are so cominaily prescribed. There are two groups of medication currently used to treat ADHD, which are stimulants (such as Ritalin or Adderall) and non-stimulants (such as Strattera or Intuniv). These medications are proven to have the side effect of Xerostomia, and extensive dental caries. Some of the most common challenges for patients with autism is having obsessive behaviors, and depression. These behaviors, such as avoiding or running away from new or unknown situations, separation anxiety, or compulsive checking or washing behaviors, cause big problems in day-to-day life. Usually atypical antipsychotics medications are prescribed to the patient. These medications are the only group of medications specifically approved for children with autism. This is because studies show them to benefit autism-related irritability. However, atypical antipsychotics may also improve anxiety, impulsivity, or mood. The main side effect of this medication is Xerostomia, low blood pressure. If the patient you are working on is taking any of these medications you always want to make sure that you check their vitals and keep in mind they might get dizzy during prolonged dental work, leading to falls when they try to get up.
Each person that had autism are unique in their own ways. They should never be looked down upon for being different, and the ability to handle a patient with autism should always be guided by creativity, rather than by strict reasoning.
