Transcript Autistic Spectrum Disorder in a Dental Setting

Autistic Spectrum
Disorder in a Dental
Setting
Septian Borders, DMD
Meharry School of Dentistry
Objectives
What is Autism
Diagnosis
Professional/ Parent Interplay
Behavior Management
Dietary Concerns
Dental Materials
Dental Resources
What is Autism
Autism is a neurobiological disorder, not a mental illness, that appears
during the first three years of life and typically lasts throughout a person’s
lifetime. It is a pervasive developmental disorder (Autism Spectrum
Disorders) defined behaviorally as a syndrome consisting of abnormal
development of social skills, limitations in the use of interactive
language, and sensorimotor defects. Autism specifically affects brain
function in the areas responsible for the development of communication
and social interaction skills.
DIAGNOSIS OF
AUTISM
Experienced clinicians can reliably
diagnose autism in children younger
than three years of age. The typical
presenting symptoms of autistic
disorder are delayed speech, or
challenging behavior before the age
of three. There are 5 disorders that
are grouped under ASD (Autistic
Special Disorder/ Autistic Spectrum
Disorder) also known as Pervasive
Developmental Disorder (PDD).

Autistic Disorder= impairments in social
interaction, communication, and
imaginative play usually seen in a child by
the age of 3.

PDD-NOS (not otherwise
specified)=atypical autism when a specific
criteria for autism is not met but there is
severe pervasive impairment in the 3
areas.

Asperger’s syndrome=impairment in social
interactions and the presence of restricted
interests and activities, with no significant
delay in language and testing in the
average to above average range of
intelligence.

Rett’s Disorder- progressive disorder in
girls stating at age ranges 1-4. That show a
repetitive hand motions where there was
once previous normal development.

Childhood Disintegrative Disorder-normal
development for the first 2 years followed
by a loss of previous acquired skills.
Etiology
Unknown
Controversies
-Immunizations
-Genetics
-Neurotransmitters
-Infection/Inflammation
-Environments
-Metabolic errors/ Dietary deficiencies
-Diagnostic Tests
Diagnosing Autism
 · Two levels of evaluation are needed: First, a general screening for
developmental problems or risk factors. Second, another evaluation is
needed to actually establish the diagnosis of autism.
 · Metabolic and/or genetic testing to rule out other conditions with
manifestations similar to autism.
 · Serologic studies, to see if a child has been infected with herpes simplex,
intrauterine rubella, or cytomegalic inclusion disease.
 · Hearing tests, to determine if language delay is due to a hearing problem.
Two hearing tests are used: the behavioral audiometry test, and the
brainstem auditory evoked responses test.
 · Neuroimaging, such as MRI, is performed if a structural brain lesion is
suspected
Professional Interplay
Psychologist, Physicians, and
Dentists make up the inter
professional collaboration in the
special needs management of
patients.
* Parents*
Comorbidities
Medication
Behavior
Comorbidities
Multiple allergies, immune system
dysfunction, gastrointestinal (GI)
disturbances (celiac disease,
abdominal bloating, abdominal
discomfort, diarrhea, GERD),
seizure disorders, mood disorders,
bruxism, and aggressive or self injurious behaviors
Adverse Effects of Drug Therapy
Antipsychotic drugs
Anxiolytic drugs
Antiemetic drugs
Anticonvulsant
Vasoconstrictors
Dental Therapeutic Effects
Vitamins
Steroids
Hypertensive meds
Behavior Management
Tell-Show-Do
Trial Appointments
First Person Dialogue
Visual Aids: Dental Books
Voice Control
Parental Guidance
Reinforcement
Self injurious behavior
Rewards
Communication Strategies
Anesthesia
Barriers to communication
 Difficulty using non- verbal communication (eye
contact, gestures, facial expressions)
 Lack of initiation skills
 Obsession of topics
 Echolalia
 Lack of understanding reciprocity---interrupts, talks
out, talks over others
Treatment Planning incorporating
DIETARY CONCERNS
Gluten free
Casein free
Calcium Phosphate
Probiotics
Sulfation deficit
Folic acid Metabolism
Vitamin B12 Deficiency
Treatment Planning including Dental
Materials
 Nitrous oxide = methylene-tetrahydrofolate reductase
 Mercury
 Fluoride
 Treatment Planning options
Autism DENTAL RESOURCES
Americans with Disability Act
AwDA
Autism Society of America
autism-society.org
Disability Resources
Disabilityinfo.gov
First Signs
Firstsigns.org
National Institute of Health
Nih.gov
Wrights Law
Oasis (Asperger’s)
Dr. Gerald Davis
Dr. Daphne Ferguson-Young
Dr. Maureen Romer
wrightslaw.org
udel.edu.bkirby/asperger