dental management of autism patients is very important to understand how we can treat those children in our clinic, cause they need special care from us not like the other normal children. we must understand everything associted with them in order to treat them. if we understand how to deal with autistic patient so we can treat other handicapped children in our dental clinic like Mongolism, mental retarded child and others. we must know the classification of autism and types of them, social skills, communication, behavioral problems.

2.  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.  Not responding to their own name
 Avoiding eye contact
 A strong preference to play by themselves
 Has flat facial expressions
 Avoids or resists physical contact
 Isn’t comforted by their parents during times of
distress
 A lack of interest in the world around them
 Failure to copy words and actions
 Not clapping or waving goodbye

5.  It’s important to understand that each person with autism
has different communication skills. While some can speak
fine, others can’t speak at all. It’s also quite common for
children with autism to have some words by the time
they’re 18-months-old then lose them. Other signs may
have autism include:
 continued repetition of words or phrases
 Not pointing at anything or responding when you point to
something
 Having few, if any, gestures: Not waving goodbye
 Not engaging in pretend play like feeding their doll

6.  Lining up their toys
 Playing with their toys in the exact same way
every time
 Preferring to play with a specific part of a toy
like its wheel
 Getting upset by minor changes to their
routine
 Flapping their hands, rocking their body, or
spinning in circles

7.  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.

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

9.  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.

10.  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.

11.  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

12.  Practical oral care for people with autism
 Health Challenges in Autism and Strategies for Care
 Behavior Problems
 Communication Problems and Mental Capabilities
 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

13.  which may include hyperactivity and quick
frustration—can complicate oral health care
for patients with autism.

14.  Talk with the parent or caregiver to
determine your patient’s intellectual and
functional abilities, and then communicate
with the patient at a level he or she can
understand.

15.  Use a “tell-show-do” approach to providing
care. Start by explaining each procedure
before it occurs. Take the time to show what
you have explained, such as the instruments
you will use and how they work.
Demonstrations can encourage some
patients to be more cooperative.

16.  Plan a desensitization appointment to help
the patient become familiar with the office,
staff, and equipment through a step-by-step
process. These steps may take several visits
to accomplish.

17.  Have the patient sit alone in the dental chair
to become familiar with the treatment setting.
Some patients may refuse to sit in the chair
and choose instead to sit on the operator’s
stool.
 Once your patient is seated, begin a cursory
examination using your fingers.

18.  Next, use a toothbrush to brush the teeth
and gain additional access to the patient’s
mouth. The familiarity of a toothbrush will
help your patient feel comfortable and
provide you with an opportunity to further
examine the mouth.

19.  When the patient is prepared for treatment,
make the appointment short and positive.
 Pay special attention to the treatment
setting. Keep dental instruments out of sight
and light out of your patient’s eyes.
 Praise and reinforce good behavior after
each step of a procedure. Ignore inap-
propriate behavior as much as you can.

20.  Try to gain cooperation in the least restrictive
manner. Some patients’ behavior may
improve if they bring comfort items such as a
stuffed animal or a blanket. Asking the
caregiver to sit nearby or hold the patient’s
hand may be helpful as well.

21.  Use immobilization techniques only when absolutely necessary
to protect the patient and staff during dental treatment—not as a
convenience. There are no universal guidelines on
immobilization that apply to all treatment settings. Before
employing any kind of immobilization, it may help to consult
available guidelines on federally funded care, your State
department of mental health/disabilities, and your State Dental
Practice Act. Guidelines on behavior management published by
the American Academy of Pediatric Dentistry (www.aapd.org)
may also be useful. Obtain consent from your patient’s legal
guardian and choose the least restrictive technique that will
allow you to provide care safely. Immobilization should not
cause physical injury or undue discomfort.

22.  If all other strategies fail, pharmacological
options are useful in managing some
patients. Others need to be treated under
general anesthesia. However, caution is
necessary because some patients with
developmental disabilities can have
unpredictable reactions to medications.

23.  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

24.  ORAL HABITS:
 bruxism; tongue thrusting; self-injurious
behavior such as picking at the gingiva or
biting the lips.

25.  Children with ASD prefer soft and sweetened
foods.
 They tend to pouch food inside the mouth
instead of swallowing it.
 Poor tongue coordination. Psychoactive
drugs or anticonvulsants, which can cause
xerostomia and delayed tooth eruption

26.  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.

27.  Majority of ASD children had poor oral
hygiene .
 Irregular brushing habits.
 Lack of the necessary manual dexterity of
ASD children.
 Side effects of medications which were used
to control the manifestations of autism, such
as psychoactive drugs or anticonvulsants.

28.  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.