Autism and Oral Care
Children with developmental disabilities are at a high risk for enamel irregularities, gum infections, delays in
tooth eruption, moderate to severe misalignment between the upper and lower teeth when the jaw is closed,
resulting in a faulty bite poor bite, and oral infection. To achieve and maintain good oral health, people with
developmental disabilities often require a special approach to dental care. Proper diagnosis and treatment of
the dental patient presenting with autism may be challenging to the knowledgeable dental practitioner. The
initial examination may be very difficult to perform, and the medical history may present a variety of issues
that can impact on the materials that can be used. It is important to find a dentist who has experience in
treating children with special needs. With some adaptation of the skills dental professionals use every day,
most people with special needs can be treated successfully in the general practice setting.

Obsessive routines, repetitive behaviors, unpredictable body movements, and self-injurious behavior may all
be symptoms that complicate dental care. Communication and behavioral problems pose the most significant
challenges in providing oral care. The assessment of the patient’s diet may also present a complex resolution
between adequate nutrition, medical complications, and prevention of tooth decay. Above all people with
autism experience few unusual oral health conditions.

Sensory Triggers

The dental office probably is one of the main areas that may trigger a large amount of anxiety for a child
with an autism spectrum disorder. One of the areas being tactile (sensitivity to touch) and auditory (heighten
sense to noise). Mouths are extremely sensitive places and for a person with an ASD someone putting cold
instruments into their mouth could be very painful. In addition the noise of the drills and the cleaning of the
instruments could also be a problem. Sometimes the taste of the mouthwash or the paste used may be an
issue.

Dentists are one of the few professionals who invade everyone's personal space. Most people find this
uncomfortable but are aware of why the dentist has to be so close, to examine your teeth. For individuals
with an ASD they may find this close proximity extremely distressing. A common issue for many children
with autism is oral sensitivity around the face and the mouth. This sensitivity can affect eating, nutrition,
speech, tooth brushing, dental check-ups and oral health. Some children with special needs, especially those
with autism, have an oral sensitivity that makes tooth brushing difficult. They may resist having their teeth
brushed by a parent or caregiver and refuse to brush their own teeth.

Children with autism have greater difficulty accessing dental care. Some of the risk factor for
children with autism includes
:

•        Sensitivity around the face and mouth which can make tooth brushing and dental check-ups more
challenging.
•        Use of candy as reinforces or feeding issues which may lead to more frequent consumption of sticky
and sweet foods.
•        Sensitivity to light and sound common in the dental office and sensitivity to touch that may make
obtaining regular dental care more difficult.

Autistic children requiring anesthesia for dental procedures

There is no evidence that anesthetic drugs have cause or worsen autism, nor is there any published data on
preferred drugs for anesthetizing autistic children. Dental anesthesia is usually performed in the dentist’s
office. The mandatory requirement is that an anesthesiologist experienced in dental and in pediatric
anesthesia does the anesthesia care, and that standard hospital operating room monitoring instruments (e.g.,
pulse ,ECG, and blood pressure), and resuscitation equipment (including a defibrillator) are present in the
dental suite.

If the child has serious medical problems (e.g., heart problems, breathing problems, seizures, or airway
problems) it is sometimes unsafe to give anesthesia care in the dental office, and the dentist will need to do
the procedure in a hospital room setting. This decision is made by the anesthesiologist. When the dental
procedure is finished, the child stays at the facility until safely aware. This usually requires a minimum of 30
minutes. Post-anesthesia side effects are sleepiness, sometimes nausea, and in some children, aggressive
behavior or agitation. When dental sedation is done by an experienced anesthesiologist with modern
monitoring equipment and medications, the rate of major complications should be low.

Mercury in Dental Fillings

Amalgam fillings, also called silver fillings, are made of mercury, silver, and other metals and have been used
by dentists for more than a century. But their use has dropped in recent years as more and more doctors
switch to resin composite fillings, which are considered more appealing because they are white. Some
advocacy groups and dentists have long contended that the mercury in fillings can leach into the body and
cause harmful neurological effects, including autism.

American Dental Association (ADA) supports the use of such fillings and assures the American people that
dental amalgam is safe. The ADA claims that since mercury amalgam has been used for over 150 years, its
safety should not be disputed. While its position remains largely unsupported by scientific evidence, the
ADA challenges those opposed to the use of amalgam fillings to produce scientific evidence that its use is
harmful to humans.

This challenge has been accepted. The anti-amalgam movement has been given new life by the widespread
claims associating mercury with autism. Those involved with anti-amalgam have countered by challenging
the ADA to demonstrate that safe levels of mercury in human tissues exist before endorsing its use. The
ADA has yet to respond. Both sides do, however, agree that mercury is one of the most poisonous elements
known to man, and mercury amalgam may cause ill effects in those people who are mercury sensitive.

Mercury Contamination

Infants and young children that are not autistic, normally and commonly exhibit a degree of mercury
contamination that is directly related to the number of mercury amalgam fillings in their mother’s mouth.
The more amalgams mom has, the higher the mercury in the infant.  Mom's blood and breast-milk carry
mercury to the baby.  The more she has, the more baby gets.  Whether this is viewed as good, bad, or
insignificant, it's a fact to be kept in mind. Root canals, metal crowns, implants and fluoride may be doing
more harm than good. Another source of mercury for children is the mercurial preservatives that have been
used in vaccinations for many years; third major source of mercury is diet, especially fish.

Children with amalgam fillings were no more likely than other youngsters to suffer neurological problems,
researchers said. Autistic children somehow lack the normal mechanisms to rid the mercury of their bodies.
That strongly suggests that autistic children are unable to detoxify their mercury, build up higher body tissue
levels of mercury than the non-autistic children population. The higher tissue levels of mercury toxicity may
then result in neurological changes seen as symptoms of autism.

Visiting the Dentist

Finding a dentist can be a challenge. It is often difficult to find one that has experience in treating children
with special needs, try to searching for a pediatric dentist.  Many children with autism are resistant to
visiting the dentist. Some amount of preparation is recommended for your child to have a positive
experience with the dentist. The amount of preparation depends on your child's particular emotional and
physical needs.

•        When you call for a dental appointment, ask for an appointment time when the child is most rested.
•        Go at a time when the office is least crowded.
•        Inform the dental office of your child’s special needs.
•        Describe any behavior problems.
•        Develop a social story about visiting the dentist.
•        Take favorite toys, music or books.
•        Daily brushing helps prepare the child for the dental visit.

When making your dental visit try asking that the appointment is the first of the day. Ask if you could visit
the office prior to the appointment. This way your child can get meet the staff and get familiar with the
equipment. For some the experience is so distressing that sedation may need to be considered. If you feel
this is the case you need to talk this through with your dentist and a medical professional to discuss the
options.Tell dentist about any problems with chewing or any pain observed in the child. Talk to the dentist
about any problems with oral hygiene.
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