Monday, March 15, 2010

The Autistic Dental Patient

Patients presenting with Autism can be a challenge for dental professionals. We as Pediatric Dentists see patients with all kinds of special needs, developmental conditions and disabilities. Autism is a relatively common condition affecting children throughout the country.

These children need dental care just like every other child. Children with Autism usually present with a spectrum of disorders and often have difficulty communicating or interacting with others. Loud sounds, lights, smells and sometimes touching can overwhelm a patient with Autism. This presents a special challenge for dental treatment because pretty much anything about dentistry involves these things. Other than these sensitivities and the patient's reaction to them, the dental problems are pretty much like every other patient. Special attention to oral hygiene is helpful along with a measured approach to dental examinations and cleanings.

When fillings or other treatment is needed, sedative medications can often help patients more easily cope with the stimulus and stress of their environment during treatment. In a few cases where extensive procedures are required, general anesthesia might be considered. Each child is different. Treatment modalitites for one may differ for the next. As patients with autism may present reactions and symptoms in varying degrees, many can be treated in a similar manner to other children.

I see Autistic patients almost every day and they do quite well for most things. Sometimes just doing an exam can cause a loud commotion, but the kids are sweet and none the worse for it. Most parents are well versed in their child's condition and special needs. Although, like most parents, I think they are more stressed out by any dental appointment than their child.

*Interestingly, patients with ASD (Autism Spectrum Disorder), seem to have fewer cavities than non-affected patients: J Am Dent Assoc, Vol 139, No 11, 1518-1524.© 2008

30 comments:

JPManuel said...

Dr. Brandon, though I don't have a child with autism, I'd like to thank you for posting this entry. I can imagine how helpful this is for parents with children with special needs who have not brought their children to a dentist and are at a loss as to how the treatments are done. Thank you for this informative blog! With your permission, may I post a link of this entry on my blog (since mine is also about parenting, among other things)? --- http://joypagemanuel.com

Dr. Dean Brandon said...

Thanks JP. Link away. Links are one way blogging has become so informative.

Marketing for Dental Specialists said...

This can be a very challenging area to get involved in but it comes with the job. I think speaking with the parent well in advance can prevent any mishaps in the office.

Bayside, NY said...

You are right that autistic children can be lovely. Light sedation would seem to be a solution for the dental chair.

Thank you for your informative blog.

Melina said...

My autistic son had his 6 month cleaning appointment at the Huntsville office yesterday. He really enjoys going. This was not always the case. We went through 4 different dentists before we found APDA...our son was not comfortable at any of the 4...either it was something to do with the office itself or the dentist did not seem comfortable with our son. The first time we brought him to APDA (referred by a teacher at his school) he loved it. He goes back now with no problems, by himself. All the staff are wonderful with him.
APDA has been a God send for our family! :) Thank you SO MUCH for all that you do. Words cannot express how grateful we are for APDA!

Health Staff Connect, Inc. said...

Hey Dr. Brandon:

I work with Healthstaffconnect.com. This is new "healthcare professionals only" networking and staffing site which was launched (in beta form) April 1, 2010. We do not yet have staff writers but wanted to see if we could repost your Autistic Dental Patient blog in our dental blog area? It is one of the best I've seen on the web thus far. Please contact me at admin@healthstaffconnect.com if we can repost. Also, come check out the site and join as a user, it's free!

Dr. Dean Brandon said...

HSC--Certainly you may repost.

Cosmetic Dentists Chandler said...

You are very magnanimous to have shared your story. I treat some kids with autism and other disabilities and I can tell you that they are one of the most difficult patients to treat, but I also feel that they give me the most rewarding experience ever.

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Teeth Whitening said...

This is very challenging situation. The autistic dental children can be lovely ever. Thanks

website promotion company said...

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Edward Logan, DDS said...

I recently asked TouchPoint Autism Services for some tips on treating dental patients with autism. I linked to an article summary of what they told me in my signature here.

Dentist in Orange said...

Special needs patients need extra care when it comes to dentistry, and not a lot of dentists take the time to train for them. Thanks for bringing this topic to light; I'm sure it will be a lot of help not only to dentists but to parents of autistic children as well.

Michelle said...

My 7 year old son is severely autistic and just endured his 3rd dental exam and cleaning yesterday. We got a late start because frankly I was scared to death of the process. He see's a very patient pedo dentist, and requires oral sedation medication to even get an exam and cleaning done. We are nearing the maximum amount he can receive and not sure what we will do when that doesn't work. I can't thank them enough for the lengths they go to for my son to get a simple cleaning. Thankfully no restorative work has been needed yet. I hope none ever is because he won't let anyone touch him at all. We have to have 3 people holding him down, plus a papoose board and versed :( I hope that we grow out of this, because it's getting harder and harder the bigger he gets.

I See You said...

We have twin recently turned three years old twins. Both are ASD. One has very healthy teeth while the other's teeth have simply disingrated before they would leave the gumline. By barely two years old he had received there flouride treatments to "buy time" which made him very ill; each time moreso for two days vomiting and stomach pains afterwards. His teeth are cleaned well daily and no milk at night etc. but now at barely there years old it seems as though all of his teeth are turning color and there is a new discolored groove at the top of his canine tooth which I know will need to be treated again. Literally the decay/condition seems to have quadrulpled in the last year no matter what efforts have been taken by dentist/pediatric dentist and parents. The only alternative we get now is to pull several teeth; porcelain crown several more ... and composite the rest. This will have to be done in a hospital setting under long term general anesthesia and we are just scared to death not to mention that it will cost upwards of 25K! (after insurance! since "cosmetic dentistry" is not covered under our/most plans. Any advise or remarks? Any alternatives? It would certainly be worth the money if we can come up with it but in three years or so the mature teeth will start coming in as the baby teeth progressively start coming out .. along with the dental crowns. :-( So far he is not seeming to hurt but know his mouth is sensitive and something has to be done soon and obviously the flouride treatments seemed to have made worse! I almost wonder if what we are seeing now is flourosis. thank you so very much!!

Dr. Dean Brandon said...

I see children every week with rampant (a lot of) cavities. It's also called early childhood caries. I also treat many of these young children with extensive needs under general anesthesia. So, unfortunately this is not uncommon. Fluoride helps, but once a cavity starts, you do have to fix it one way or another. Please read my other posts on cavities, hospital dentistry, etc. There is a lot here that I think might help.

Hospitals charge varying fees which are many times covered by insurance. Most cases I see which are two hours or less run about two to four thousand dollars before insurance for the hospital part. Dental treatment us usually the same whether it is done in the hospital or office. I have never heard of a $25,000 case. The dental fee for most the typical case of extensive cavities/restorations on a preschooler usually runs from a few hundred dollars up to 2 or 3 thousand dollars for a large case.

Donna Jo said...

Dr. Brandon, can you recommend a dentist in my area who is good with autistic children? Specifically for removing some baby teeth. My son is 12 and has mild autism (Asperger's syndrome). He needs to get 6 baby teeth removed as per orthodontist instructions because the permanent teeth under them are coming in the wrong way and can't push out the baby teeth. He will get braces in about a year. Thank you.

Dr. Dean Brandon said...

Donna Jo,

Well, I kind of need to know about where you are talking about-you didn't say. What city or area? If I know someone personally I can let you know, but normally, I would suggest going to the American Academy of Pediatric Dentistry web site and searching for a member in your area. The link is on the sidebar.

Dental Care Michigan said...

You have a great blog, and very educational for someone like me (I'm not a dentist, but I do love everything dental care) that isn’t as knowledgeable about the technical side of dentistry. The fact is, your blog could have probably trumped a few that were on my list. I’ll probably tweet this post soon…so stay tuned for that…hint hint…

Kelly said...

Thank you for this post. I have an autistic child (he's 6 years old), we just went to the dentist for a cleaning today. It's a large dental practice. I gave the hygenist some tips on what to do and what not to do but she didn't seem to care. My son was upset about the cleaning, but I finally talked him in to agreeing to it. (usually once he agrees, he'll at least give it a try). At that point she refused to do the cleaning, even though it would be the best time to give it a try! No one there seemed to know anything about working with autistic children, and they were annoyed at the advice I tried to give them (she even said she was uncomfortable with me "not allowing" them to do certain things, even though I was trying to help her do her job with minimal problems) Is it common practice these days for even large dental practices to have absolutely no knowledge or training about working with autistic children?

Dr. Dean Brandon said...

It is my experience that no two Autistic patients are exactly the same in their response to dental treatment. Some cases are severe and some are quite mild. We have a large pediatric practice and do see many autistic patients. We handle most of them quite well I think, but I am sure there are a few where we do not do things just right, just the way an (experienced with her child) parent is trying to communicate. It can be frustrating for staff who know what they are trying to accomplish and the most efficient way to do so. They are trying to figure out how to get the job done but adapt it to that specific child.

I suppose I'd try to explain or let them know as much as possible before you get started so they will know any special needs or reactions. Sometimes even with the best of care, just getting teeth cleaned or examined can be a difficult proposition even if you do everything "right". It's hard to get in there and even see anything. Good luck and God Bless.

Anonymous said...

Dr. Brandon, my daughter is not autistic, she 5 3/4 and has Tourette's plus OCD Characteristics and ADHD characteristics. I do agree that dental work on our children is much harder for the parent than the child. However, do you have any experience with, or know anyone that has experience with performing dental work on a child with Tourette's? Her symptoms actually appeared and have never improved since her last dental visit where they used laughing gas. I've already decided I won't risk using the laughing gas again. Do you think the alternatives to nitrous are just as effective? I won't be harming her by opting not to use it will I? She has slow progressing dark cavities are her top two teeth that they have finally decided to cap after keeping an eye on them since she was 2. She repeats the phrase "one more time" and the pediatric dentist told me they would just try their best.

Dr. Dean Brandon said...

I have seen a few patients with Tourette's. Laughing gas (Nitrous Oxide) is very very safe as used in dental offices. It can be kind of wimpy in children who need more pharmacologic intervention. As I recall we have used everything from general anesthesia, conscious sedation or just nitrous oxide for restorative dentistry. Each case is different and most pediatric dentists have a pretty good idea what works.

Steve said...

We have 3 children. Our 11 yr old daughter is migrating from expander to braces. Our 7yr old son, non verbal autistic adores and mimics his older sister. This is a blessing. She will teach him to accept and care for his impending braces. Our 4 yrold autistic son will observe both of these as a point of passage and hopefully will be accepting too! Our thanks to the staff at the special needs dental clinic inhouse at Children's Hospital,Ottawa, Canada They have tolerated the banshee screams from a 7 yr old who can't speak but lets you know when something is uncomfortable. We endured gen anast for an MRI and it took 1 month for Ryan to forgive me for holding him down while nurses put a mask to his face. NOw, all we have to do is find volume purchase for braces...buy 2 get 3 rd half price? Hand me down braces? Good blog.No knuckle draggers here.

thats me said...

hi doc. thanks for the blog.my 3 yr old son is autistic and the pediatric dentist says that he will be needing root canal treatment on two teeth.i am very concerned about this because my son is extremely sensitive to touch by doctors!!it becomes difficult to control him which is why the doc suggested general anesthesia.is it the correct option or will sedation work too?my insurance doesn't cover anesthesia which is why i am in two minds.

Dr. Dean Brandon said...

I see a lot of three year olds, but each one is different as far as cooperation for surgical procedures. A wiggly or fusy three year is often best managed in the hospital under genenral anesthesia for longer or more complex procedures. There are some that we premedicate, that is "sedation", however, you should read more about that here on the blog. Sometimes it is great esxpecially for shorter appointments other times it is just not enough. That is the judgement call the dentist and parent have to make.

Zachary Ikkanda said...

Applied Behavior Analysis is an empirically validated methodology for treating children with Autism Spectrum Disorder in a host of environments. Could work for dentistry too.
http://jada.ada.org/content/142/3/281.short

Anonymous said...

Thank you Dr. B for this section of your blog. I, as a parent of a child on the spectrum, am very aprehensive about my child's app't tomorrow morning. She needs to have 14 teeth treated, most of her molars need stainless steel crowns. Her first app't will start with the lower left side. We are going to try her with conscious sedation, in office first, and if she is unable to comply or withstand the treatment, we will have no other choice but to have her treatment done in hospital with general anesthesia. Although it is frightening for us as parents to imagine "electing" to have the treatment done, we feel it would be a disservice to our child NOT to have it done. Interestingly enough, the nurse told us, they wouldn't have even known she had autism, because she did so well on her consult. I guess we as parents also can negatively anticipate our children's behavior even before they display it. They said she did better than most typical kids.

Nicole Born said...

Hi
My 9 year old autistic son is having dental work done this week. I am supposed to give him 10 MG of Valium the night before the procedure. I have searched online and looked in the drug books - being a nurse I just want to know that 10 MG is a safe dose to give a 60lb child? Thanks for your time.

Dr. Dean Brandon said...

I cannot say if something like that is too much or not. I am not his physician. Generally, Valium is a pretty safe drug. Larger doses can make people pretty sleepy--of course sometimes that is what you want. It seems the effect is greater on teenagers and adults than on very young children. Medical conditions and behavior can affect dosing as well. It's a lot an art really. You can give a larger dose of something, and not get much of a response--they can still be quite fussy, etc. Other kids, are much more sedated.

Read more on my posts on sedative medications used in pediatric dentistry and other related posts. The Bell curve states that in a given population, most will respond a certain way, some will have a greater effect, and some will have a lesser effect. Also, usually with oral medications, you have to give more per weight--so you can't rely on IV or even IM dosage charts. fyi, I have read that 60 pounds (27 kg) are often considered an adult weight as far as medications. In addition, although oral Valium stays around a long time, it can pretty much be worn off by about 6 hours or so. It is not uncommon to give it the night before to reduce anxiety. It does seem to have a slight residual effect in the morning.