Clinical Presentation, Dental Complications, and Autism Treatment

This essay provides a comprehensive overview of the challenges and considerations in providing dental care for individuals with Autism Spectrum Disorder (ASD). It begins by outlining the core symptoms of autism according to DSM-5 criteria, including impairments in social communication and repetitive behaviors, and discusses the importance of early diagnosis and parental education. The essay then delves into the specific challenges faced in dental management, such as uncooperative behavior, communication issues, and sensory sensitivities, and stresses the importance of a tailored approach, including gathering information from parents and caregivers and considering cultural factors. It highlights the increased risk of oral complications in autistic individuals, including caries, gingivitis, and periodontal problems, due to factors like poor oral hygiene and motor coordination issues. The essay emphasizes the need for preventive measures like fissure sealants and behavioral interventions, such as the tell-show-do approach and sensory adaptation, to improve patient cooperation and oral health outcomes. In conclusion, the essay underscores the importance of a holistic approach to dental care for individuals with autism, incorporating both preventive measures and behavioral strategies to address the unique challenges they face.

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Autism is a disabling neuro-developmental disorder that is most commonly seen in early
childhood. It is a heterogeneous disorder with two common features of social communication
impairment and repetitive behavioural patterns. History taking and observation of the affected
child is crucial for making a diagnosis on the disorder (2). The main aim of this essay is review
literature on clinical presentation of autism and find out treatment planning modifications in this
group of patient. The essay will also look at oral complications and preventive steps to control
such dental complications in individuals with autism.
According to the DSM-5 criteria, the core symptoms of autism include impairment in
social communication, repetitive patterns of behaviour and interest and impairment in social and
occupational areas of functioning. There are large varieties of clinical phenotypes of the
condition and some people present with intellectual disability, whereas other struggle to
communicate verbally (1). Children with autism have difficulty in communication with others
and they often show very restrictive pattern of behaviour. Speech delay is the first symptom that
is observed by parents. However, as deafness and developmental delay leads to speech delay too,
confirming the same through clinicians is necessary. There are many parents who fail to
recognize symptoms and characteristics features of autism in their children. This gives the
implication for education parents so that all their misconceptions and confusion related to autism
is addressed. During screening for autism, certain red flags of development are referred to
confirm that the child is suffering from autism. Some of the red flag symptoms include not
responding to name by 12 months age, avoiding eye contact, delayed speech, constant repeating
of words or phrases, obsessive interest and strange reactions to taste, look and smell. There are
many screening checklist available to screen for risk of autism such as the M-CHAT tool (7).
The etiology of the disorder is complex and both genetic and environmental factors are linked to
the risk of autism. The environmental causative factors included prenatal factors (such as
exposure to teratogen), perinatal factors (such as low birth weight and preterm delivery) and
postnatal proposed factors like autoimmune illness and mercury toxicity (2).
According to the principle of dental management, it is necessary to be aware of all
medical conditions of patient while planning any dental intervention in patient. In case of dental
treatment of patient with ASD, some of the challenges faced by dentist include uncooperative
behaviour of patient and cost associated with treatment. As children with autism show excessive

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social phobias, this factor also contributes to difficulty in dental management of patients. In this
scenario, the dentist must implement different approach to treat these patients. This may include
collecting data related to patterns of communication, medical history, oral hygiene behaviours,
dental history and inappropriate social behaviours of affected patient by discussing with parents
or caregivers. This approach may help to determine the barriers to dental intervention and
appropriate communication style needed to deal with such patients. Cultural considerations such
as use of general anaesthesia should be considered too (3). Hence, discussion with parents is
crucial to understand patterns of behaviour and know about patient’s reaction to previous dental
treatment. While choosing any intervention for patient, it is necessary that the dental care team
tailor it to suit individual characteristics. Thus, family involvement is the centre of care planning
for patients with autism and it enables deciding on key modifications needed to provide good
care experience to patients.
A systematic review revealed that children with autism have poor oral hygiene and so
they have high risk of dental problems like caries, gingivitis, increase in plaque and bleeding
indexe (3). Another research literature revealed that frequency of periodontal problem is high in
those autistic individuals who are institutionalized. Other oral complications in this patient
include decayed and missing teeth and high rate of caries due to poor tongue coordination and
long time presence of food within the oral cavity. Autistic patients are more prone to dental
injury because of harmful oral habits such as lip biting and gingival pricking. Another factor
contributing to high risk of caries include problem in brushing and flossing due to poor motor
coordination. In this scenario, diet modification can play a crucial role in lowering the incidence
of caries. Their oral health status deteriorates also because of many barriers in accessing dental
treatment. For example, communication issues and sensory issues affect their ability to
appropriately respond to the medical team (4). Thus, staffs caring for children with autism must
focus on oral health assessment and dental hygiene of autistic patients too so that oral
complications are prevented. While implementing treatment, it is crucial that the dental team
arrange a previsit meeting so that parents can prepared their child for the dental treatment. There
are certain dental treatment such as use of fluoride, gluten and amalgam that may worsen
symptom of the child with autism. Dentist should actively take part in explaining parent
regarding the need to provide quality care without causing any harm to the child (4).

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Past research literatures have discussed about various preventive measures to reduce risk
of dental complications in children with autism. Fissure sealant is one of the preventive approach
to prevent dental caries (5). Another preventive measure includes dental extraction and
preventive restoration under general anaesthesia. Tooth extraction, pulp-capping and restoration
treatment can reduce the problem of painful cavities. Moreover, as children with autism have
little interest in activity and they show a lack of motor coordination, it is necessary to implement
many behavioural interventions with them too. A study indicated that while planning treatment
for children with ASD, being aware of their basic behavioural pattern is crucial. This may
promoted oral care proceedings and help in understanding of variation in abilities, intelligence
and performance of staffs. Based on this form of action, dental practitioners can target
therapeutic interventions according to the unique characteristics of the child. This will help to
manage children who are less cooperative with their children. One example of this approach is
the tell-show-do approach that is beneficial in providing support to those children who have poor
focus and concentration. Another behavioural approach is the voice control technique by using
facial expression that can help to interpret emotional expression of others. Other approach that
has been found to be useful includes visual pedagogical approach, applied behaviour analyses
and sensory adaptation to the environment (6). Sensory adapted environment includes avoiding
anxiety provoking environment such as bright fluorescent lights, sharp noises like dental drills
and materials of unfamiliar texture. Environment can be changed by providing relaxing light and
rhythmic music in the dental setting. Such sensory modifications has the potential to reduce
adverse patient reaction and enhance patient’s cooperation during dental procedures (8) These
interventions have the potential to promote dental care in children with ASD.
To conclude, the essay gave a comprehensive insight into challenges in taking care of
people with autism from the dental care perspective. The essay revealed how poor coordination
and social communication impairment motor impedes autistic children ability to engage in self-
care routine. Dental complications like caries, periodontal problems, gingivitis and pain was
found to be common in these children and their ability to cooperate with dental staffs. The essay
gives the implication that apart from dental preventive measures, individual with autism also
need behavioural approach to engage in proper oral care.

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References:
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Frontiers in neurology. 2018 Aug 17;9:670.
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spectrum disorder in children. Current Medical Issues. 2017 Jan 1;15(1):6.
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spectrum disorder in the dental setting: concerns, behavioural approaches and
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