Managing Tourettes Syndrome in the Dental Office Hannah Campbell Van Tran

What is Tourettes Syndrome? (TS) A neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics.

Ages Symptoms may appear at any time up to the age of 18 years, the most typical age of onset is between 5 and 7 years. The incidence peaks around pre-adolescence, with one half of cases resolving in early adulthood. The disorder affects one child in every hundred children and more than 300,000 children and adults in the UK.

Genetic Study and Gender Genetic studies indicate that TS is inherited as an autosomal dominant gene A parent has a 50% chance of passing the gene to one of his or her children. Research indicates that boys are affected two to four times more than girls Girls with the gene have a 70% chance of displaying symptoms, while boys with the gene have a 99% chance of displaying symptoms.

Symptoms Simple Sounds: Throat clearing, yelping and other noises, and coughing. Movement: Eye blinking, shoulder shrugging, and facial grimacing

Complex Symptoms Cont… Sounds: Jumping, touching other people or things, and sometimes hitting or biting oneself. Movement: Uttering words or phrases out of context, coprolalia, and echolalia. coprolalia (saying socially unacceptable words) echolalia (repeating a sound, word, or phrase just heard)

Oral Manifestations Attrition TMJ dysfunction Cheek biting

Management In The Dental Office Parent/caregiver present at appointment Informed consent & Medical-Dental History Patient’s level of intellectual and functional abilities Cooperation techniques Speak directly to patient (parent if pt. to young) Short & clear explanation of procedure/instructions Ask what type of symptoms they have Ask how often their symptoms occur See if something might trigger their tics/movements Reduce sounds--Ultrasonic? Music? Positive verbal reinforcement

Management In The Dental Office Cont… Appointment planning If premed is needed then get a medical consult Early morning appointments Keep instruments out of reach or to close of patients More than 1 appointment may be needed for completion

Homecare Parent/Caregiver should help patient brush or floss Electric toothbrush Mouth guard

QUESTIONS??