Practical Oral Care for People With Autism Health Challenges in Autism and Strategies for Care Communication Problems and Mental Capabilities Behavior Problems Unusual Responses to Stimuli Unusual and Unpredictable Body Movements Seizures Oral Health Problems in Autism and Strategies for Care Damaging Oral Habits Dental Caries Periodontal Disease Tooth Eruption Trauma and Injury 

1. By: Dr. Faisal M Alzahrani
Autism and oral health

2. What Is Autism?
 a mental condition, present from early
childhood, characterized by difficulty in
communicating and forming
relationships with other people and in
using language and abstract concepts.

3.  Children with autism have trouble
communicating. They have trouble
understanding what other people think and
feel. This makes it very hard for them to
express themselves either with words or
through gestures, facial expressions, and
touch.
 Children who are autistic may have
repetitive, stereotyped body movements
such as rocking, pacing, or hand flapping.

4.  Symptoms of autism :
 typically appears during the first three
years of life.
 it is now recognized that some
individuals may not show symptoms of a
communication disorder until demands
of the environment exceed their
capabilities.

5.  These disorders may now be diagnosed
as either:
 a social communication disorder or
 autism spectrum disorder
based on the primary impairments.

6. Type of autism :
 Asperger's syndrome. These children
don't have a problem with language -- in
fact, they tend to score in the average or
above-average range on intelligence tests.
But they have the same social problems
and limited scope of interests as children
with autistic disorder.
 Pervasive developmental disorder or
PDD -- also known as atypical autism.
This is a kind of catch-all category for
children who have some autistic behaviors
but who don't fit into other categories.

7.  Rett syndrome. Children with Rett
syndrome, primarily girls, start
developing normally but then begin
losing their communication and social
skills. Beginning at the age of 1 to 4
years, repetitive hand movements
replace purposeful use of the hands.
Children with Rett syndrome are usually
severely cognitively impaired.

8.  Childhood disintegrative disorder:
These children develop normally for at
least two years and then lose some or
most of their communication and social
skills. This is an extremely rare disorder
and its existence as a separate
condition is a matter of debate among
many mental health professionals.

9. SOURCE:
 American Academy of Pediatrics:
Pediatrics 2010.
 Parker, S., Zuckerman, B., and
Augustyn, M. (editors). Developmental
and Behavioral Pediatrics: A Handbook
for Primary Care, Lippincott, 2005.
 American Psychiatric Association:
Diagnostic and Statistical Manual of
Mental Disorders version 5 (DSM-5

10. Autism and oral health
 Practical Oral Care for People With Autism
 Health Challenges in Autism and Strategies for Care
 Communication Problems and Mental Capabilities
 Behavior Problems
 Unusual Responses to Stimuli
 Unusual and Unpredictable Body Movements
 Seizures
 Oral Health Problems in Autism and Strategies for Care
 Damaging Oral Habits
 Dental Caries
 Periodontal Disease
 Tooth Eruption
 Trauma and Injury

11. COMMUNICATION
PROBLEMS and MENTAL
CAPABILITIES
 Talk with the parent or caregiver to
determine your patient's intellectual and
functional abilities
 Use a "tell-show-do" approach to
providing care.

13. BEHAVIOR PROBLEMS
 hyperactivity and quick frustration--can
complicate oral health care for patients
with autism.
 Plan a desensitization appointment
 Use immobilization techniques only
when absolutely necessary
 If all other strategies fail,
pharmacological options are useful in
managing some patients.

14.  UNUSUAL AND UNPREDICTABLE
BODY MOVEMENTS are sometimes
observed in people with autism. These
movements can jeopardize safety as
well as your ability to deliver oral health
care.

16.  UNUSUAL RESPONSES TO STIMULI can
create distractions and interrupt treatment.
 SEIZURES may accompany autism but
can usually be controlled with
anticonvulsant medications. The mouth is
always at risk during a seizure: Patients
may chip teeth or bite the tongue or
cheeks. People with controlled seizure
disorders can easily be treated in the
general dental office.

17. Oral Health Problems in
Autism and Strategies for
Care
 ORAL HABITS:
 bruxism; tongue thrusting; self-injurious
behavior such as picking at the gingiva
or biting the lips; and pica--eating
objects and substances such as gravel,
cigarette butts, or pens. If a mouth guard
can be tolerated, prescribe one for
patients who have problems with self-
injurious behavior or bruxism.

18. DENTAL CARIES:
 Recommend preventive measures such as
fluorides and sealants.
 Caution patients or their caregivers about
medicines that reduce saliva or contain
sugar. Suggest that patients drink water
often, take sugar-free medicines when
available, and rinse with water after taking
any medicine.
 Encourage independence in daily oral
hygiene. Ask patients to show you how
they brush, and follow up with specific
recommendations.

19.  Perform hands-on demonstrations
 Some patients cannot brush and floss
independently. Talk to caregivers about
daily oral hygiene and do not assume that
they know the basics. Use your
experiences with each patient to
demonstrate oral hygiene techniques and
sitting or standing positions for the
caregiver. Emphasize that a consistent
approach to oral hygiene is important--
caregivers should try to use the same
location, timing, and positioning.

20.  PERIODONTAL DISEASE occurs in
people with autism in much the same way
it does in persons without developmental
disabilities.
 TOOTH ERUPTION may be delayed due
to phenytoin-induced gingival hyperplasia.
Phenytoin is commonly prescribed for
people with autism.
 TRAUMA and INJURY to the mouth from
falls or accidents occur in people with
seizure disorders.

22. SOURCE:
 http://www.nidcr.nih.gov/oralhealth/Topic
s/DevelopmentalDisabilities/PracticalOra
lCarePeopleAutism.htm

23. Thank
you