Autistic Spectrum Disorder in a Dental Setting Septian Borders, DMD Meharry School of Dentistry

Objectives What is Autism Diagnosis Professional/ Parent Interplay Behavior Management Dietary Concerns Dental MaterialsDental Resources

What is Autism Autism is a neurobiological disorder, not a mental illness, that appearsduring the first three years of life and typically lasts throughout a person’slifetime. It is a pervasive developmental disorder (Autism SpectrumDisorders) defined behaviorally as a syndrome consisting of abnormaldevelopment of social skills, limitations in the use of interactivelanguage, and sensorimotor defects. Autism specifically affects brainfunction in the areas responsible for the development of communicationand social interaction skills.

DIAGNOSIS OF AUTISM  Autistic Disorder= impairments in social interaction, communication, and imaginative play usually seen in a child by the age of 3.  PDD-NOS (not otherwise specified)=atypical autism when a specific criteria for autism is not met but there is severe pervasive impairment in the 3 areas.  Asperger’s syndrome=impairment in social interactions and the presence of restricted interests and activities, with no significant delay in language and testing in the average to above average range of intelligence.  Rett’s Disorder- progressive disorder in girls stating at age ranges 1-4. That show a repetitive hand motions where there was once previous normal development.  Childhood Disintegrative Disorder-normal development for the first 2 years followed by a loss of previous acquired skills. Experienced clinicians can reliably diagnose autism in children younger than three years of age. The typical presenting symptoms of autistic disorder are delayed speech, or challenging behavior before the age of three. There are 5 disorders that are grouped under ASD (Autistic Special Disorder/ Autistic Spectrum Disorder) also known as Pervasive Developmental Disorder (PDD).

Etiology UnknownControversies-Immunizations-Genetics-Neurotransmitters-Infection/Inflammation-Environments-Metabolic errors/ Dietary deficiencies-Diagnostic Tests

Diagnosing Autism  · Two levels of evaluation are needed: First, a general screening fordevelopmental problems or risk factors. Second, another evaluation isneeded to actually establish the diagnosis of autism.  · Metabolic and/or genetic testing to rule out other conditions withmanifestations similar to autism.  · Serologic studies, to see if a child has been infected with herpes simplex,intrauterine rubella, or cytomegalic inclusion disease.  · Hearing tests, to determine if language delay is due to a hearing problem.Two hearing tests are used: the behavioral audiometry test, and thebrainstem auditory evoked responses test.  · Neuroimaging, such as MRI, is performed if a structural brain lesion issuspected

Professional Interplay Psychologist, Physicians, and Dentists make up the inter professional collaboration in the special needs management of patients. * Parents* Comorbidities Medication Behavior

Comorbidities Multiple allergies, immune system dysfunction, gastrointestinal (GI) disturbances (celiac disease, abdominal bloating, abdominal discomfort, diarrhea, GERD), seizure disorders, mood disorders, bruxism, and aggressive or self - injurious behaviors

Adverse Effects of Drug Therapy Antipsychotic drugs Anxiolytic drugs Antiemetic drugs Anticonvulsant Vasoconstrictors Dental Therapeutic Effects Vitamins Steroids Hypertensive meds

Behavior Management Tell-Show-DoTrial AppointmentsFirst Person DialogueVisual Aids: Dental BooksVoice ControlParental GuidanceReinforcementSelf injurious behaviorRewardsCommunication StrategiesAnesthesia

Barriers to communication  Difficulty using non- verbal communication (eyecontact, gestures, facial expressions)  Lack of initiation skills  Obsession of topics  Echolalia  Lack of understanding reciprocity---interrupts, talksout, talks over others

Treatment Planning incorporating DIETARY CONCERNS Gluten free Casein free Calcium Phosphate Probiotics Sulfation deficit Folic acid Metabolism Vitamin B12 Deficiency

Treatment Planning including Dental Materials  Nitrous oxide = methylene-tetrahydrofolate reductase  Mercury  Fluoride  Treatment Planning options

Autism DENTAL RESOURCES Americans with Disability Act AwDA Autism Society of America autism-society.org Disability ResourcesDisabilityinfo.gov First SignsFirstsigns.org National Institute of Health Nih.gov Wrights Law wrightslaw.org Oasis (Asperger’s) udel.edu.bkirby/asperger Dr. Gerald Davis Dr. Daphne Ferguson-Young Dr. Maureen Romer