1. Managing Tourettes Syndrome in the Dental Office
Hannah Campbell
Van Tran

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

3. 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.

4. 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.

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

6. 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)

7. Oral Manifestations
Attrition
TMJ dysfunction
Cheek biting

8. 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

9. 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

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

11. QUESTIONS??