Special children often have problems accessing dental care due to their physical, emotional and behavioral difficulties. Family factors and social pressures cause these groups of patients to have less access to services than normal children(1,2). Patients with autism usually have a habit to eat soft and sweet food and always eat the same food. (3) They also have poor masticatory muscles and cognitive limitations that hinder self-cleaning. With isolating behaviors, it would also be difficult for a caregiver to help a child clean the oral cavity (3-5). As a result, patients with autism have a high risk of periodontal disease and tooth decay (6, 7). However, some studies turned out that patients with autism had lower prevalence of dental decay than normal children (8, 9). In addition, patients with autism have more chances to have their front teeth trauma than normal children since they are still restless and often experience the incidents of hitting their faces (10).
Since the patients with autism have difficulty in communicating, are often associated with mental retardation, do not like changes, and are sensitive to stimuli, consequently, they always have behavioral problems during dental treatment. Prevention of dental caries and periodontal disease should be focused in order to solve the dental problems of children with autism by providing dental health education to enable them taking care of themselves (11). Since the number of this group of patients is increasing, dentists should have knowledge and skills to manage their behaviors. According to a survey, it was found that 32 percent of general dentists and 89 percent of pedodontists had ever provided dental treatments for patients with autism. They had an attitude that they would have more confident and could give better treatments if they had received more knowledge and experience or had been familiar with the behaviors of patients (12).
Behaviors of patients with autism that cause problems when they come to receive dental treatments and the management of their behavior are as follows (13-14).
- Fears: they might fear of what is not scary such as mouth mirror handle, dental instruments, blowers, while they dont feel afraid of dangerous things such as climbing high places, running across the running cars.
- - Failures to communicate: some kids do not show eye contact or interest in what the dentist says. Some kids repeat what others say without understanding, or talk in the topics that the dentist does not talk about. Sometimes, they speak in their languages which other people dont understand.
- Children with autism like to do the same thing. Some kids cooperate with the dentist in the same dental room. If the rooms are changed, they may resist the change without reasons. The resistance is manifested in the act of writhing and rolling on the floor, screaming and self-bashing.
- Short attention makes children to reject dental treatment that takes a long time. They are distracted easily. They may also pick up some dental instruments to play.
- Imitation impairments and lack of imagination: Children do not understand the abstract and assumption, thus the way to introduce them with dental treatments is to make them familiar with things and environment in dental room that the children can touch. Children with autism do not understand the meaning of similar sounds like ROS for taste and ROD for car.
Basic behavioral modifications such as Tell Show Do, positive reinforcement could make the children cooperate. (13) These methods can be performed in patients with fair communication skills, but require a lot of time (1, 14). It is recommended that behavioral analysis of individual patient should be performed (14). The data obtained can be used for behavioral modification. The dentists should allow parents to be engaged in behavioral modification. For example, parents should be informed to understand the process of dental treatment at home and prepare the children before taking them to dental treatments. The parents can train the children to be accustomed to the dental treatment (Desensitization) by taking them to the dental clinic before the appointment.
The dental appointment makes a change in a childs routine activities. Parents must tell children in advance for several days and repeatedly do it till they get to know the routine changes.
Children with autism have communication defect, using hands over mouth exercise to control their behavior is inappropriate. Using physical restraint is arguable whether it is appropriate or not. However, physical restraint used in patients with severe mental retardation or small children who do not cooperate in treatment, is currently accepted for the purpose of improving the patient's quality of life. Anyway the consent from the parents must be obtained in advance.
It is necessary for children with autism who have severe cognitive impairments and high tooth decay to be treated under general anesthesia management which is approximately 37 percent of patients with autism. (10
References
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