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Autistic Spectrum Disorder in a Dental Setting

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 Materials Dental Resources. What is Autism.

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Autistic Spectrum Disorder in a Dental Setting

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

  2. Objectives What is Autism Diagnosis Professional/ Parent Interplay Behavior Management Dietary Concerns Dental Materials Dental Resources

  3. What is Autism Autism is a neurobiological disorder, not a mental illness, that appears during the first three years of life and typically lasts throughout a person’s lifetime. It is a pervasive developmental disorder (Autism Spectrum Disorders) defined behaviorally as a syndrome consisting of abnormal development of social skills, limitations in the use of interactive language, and sensorimotor defects. Autism specifically affects brain function in the areas responsible for the development of communication and social interaction skills.

  4. 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. DIAGNOSIS OF AUTISM 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).

  5. Etiology Unknown Controversies -Immunizations -Genetics -Neurotransmitters -Infection/Inflammation -Environments -Metabolic errors/ Dietary deficiencies -Diagnostic Tests

  6. Diagnosing Autism • · Two levels of evaluation are needed: First, a general screening for developmental problems or risk factors. Second, another evaluation is needed to actually establish the diagnosis of autism. • · Metabolic and/or genetic testing to rule out other conditions with manifestations 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 the brainstem auditory evoked responses test. • · Neuroimaging, such as MRI, is performed if a structural brain lesion is suspected

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

  8. 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

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

  10. Behavior Management Tell-Show-Do Trial Appointments First Person Dialogue Visual Aids: Dental Books Voice Control Parental Guidance Reinforcement Self injurious behavior Rewards Communication Strategies Anesthesia

  11. Barriers to communication • Difficulty using non- verbal communication (eye contact, gestures, facial expressions) • Lack of initiation skills • Obsession of topics • Echolalia • Lack of understanding reciprocity---interrupts, talks out, talks over others

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

  13. Treatment Planning including Dental Materials • Nitrous oxide = methylene-tetrahydrofolatereductase • Mercury • Fluoride • Treatment Planning options

  14. Autism DENTAL RESOURCES Americans with Disability Act AwDA Autism Society of America autism-society.org Disability Resources Disabilityinfo.gov First Signs Firstsigns.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

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