Download Autism and Dentistry

Autism and Dentistry
Diana Zschaschel DDS
,
Diana Zschaschel, DDS
 UCLA BA Psychology 1992
 Behavioral Therapist for
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Autism
UCLA DDS 1997
UCLA GPR 1999
Dental Consultant
California Regional Centers
Hospital Priveleges, UCLA
St. Vincents
Started Angels’Smiles NPO
2007
ADA Diversity in
Leadership Class 2008
History of Autism
 First “diagnosed” 1943 by Leo Kanner
 “Autism” from Latin “auto” meaning “self
absorbed”
 Prevalence debatable as frequent as 1/150 births
 Neuropsychiatric disorder
 Spectrum disorder
 Other related disorders
 Diagnosis by 3 years of old
 No known cause or cure
Characteristics of Autism
What we see
 Physical
 Cognitive
 Behavioral
 Emotional
 Dental
Autistic Children
Cognition
Cognitive Skills
 IQ
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Can be within normal limits
Unable to test appropriately
Savant Skills: 10%Savant Syndrome, a
disorder in which individuals with
neurological developmental delays
in socialization and
communication (3) possess
"astonishing islands of brilliance
that stand in stark, markedly
incongruous contrast to the overall handicap" (
Stimulus Overselectivity
Savant Skill S.Wiltshire
Behavioral
 Perseverative Behaviors: Repetitive acts,
routines
 Self Stimulatory Behaviors
 Self Injurious Behaviors-Self-injurious behavior is
one of the most devastating behaviors exhibited
by people with developmental disabilities. The
most common forms of these behaviors include:
head-banging, hand-biting, and excessive self-
rubbing and scratching. There are many possible
reasons why a person may engage in selfinjurious behavior, ranging from biochemical to
the social environment.
Possible reasons for SI
Behaviors
 Biochemical
 Seizures
 Genetic
 Arousal
 Pain
 Sensory
 Frustration
Research of S-I Behavior
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Some researchers have suggested that the levels of certain neurotransmitters are associated with
self-injurious behavior. Beta-endorphins are endogenous opiate-like substances in the brain, and
self-injury may increase the production and/or the release of endorphins. As a result, the individual
experiences an anesthesia-like effect and, ostensibly, he/she does not feel any pain while
engaging in the behavior (Sandman et al., 1983). Furthermore, the release of endorphins may
provide the individual with a euphoric-like feeling. Support for this explanation comes from
studies in which drugs that block the binding at opiate receptor sites (e.g., naltrexone and
naloxone) can successfully reduce self-injury (Herman et al., 1989).
Research on laboratory animals as well as research on administering drugs to human subjects
have indicated that low levels of serotonin or high levels of dopamine are associated with selfinjury (DiChiara et al., 1971; Mueller & Nyhan, 1982). In a study on a heterogeneous population of
mentally retarded individuals, Greenberg and Coleman (1976) administered drugs, such as
reserpine and chlorpromazine, to reduce serotonin levels. These researchers observed a dramatic
increase in both aggressive and self-aggressive behavior. Drugs that elevate dopamine levels, such
as amphetamines and apomorphine, have been shown to initiate self-injurious behavior (Mueller
& Nyhan, 1982; Mueller et al., 1982).
Interestingly, Coleman (1994) studied a group of autistic children who had low levels of calcium
(i.e., hypocalcinuria). These individuals often exhibited eye-poking behavior. When given calcium
supplements, the eye-poking decreased substantially. In addition, language functioning improved.
Emotional Considerations
 Emotional Lability
 Emotionally Distant???
Dental Considerations
 Delayed eruption of primary and permanent
dentition
 Higher Pain tolerance
 Sensitivities to visual, sensory or auditory
stimulation
 Caries rate
Caries Rate
 Dependent on:
 High carbohydrate diet
 Candy as a reward
 Medication
 Elixirs
Behavioral Management
What can DDS do
 Pediatric standards
 Tell Show do
 Not excessive words
 Sounds may be distracting
 Touch sensitization
Possible Non Compliance
Behavioral Management
 Desensitization-a systematic series of
appointments that help “desensitize” autistic
individuals to the dental
appointment/procedures
 Multiple appointment s
 At home parents practice with child with
instruments like a dental office
 May take several visits
Medical History
 Allergies
 Gluten allergies
 Milk allergies
 Seizures
 Immune system dysfunction
 GI disturbances
 Mood disorders
Behavioral Assessment
 Ask questions
 First appointment may not be able to open
mouth of patient; observe behavior
 Watch patient while asking parent/guardian
questions
 Are they fidgety, do they follow your command.
Are the parents intervening to help control child
Behavioral Issues
 Mood disorders/Emotional Lability
 Limited Attention Span
 Other psychological issues (OCD, bipolar
disorder)
 Asperger’s Disorder
 Self abusive behavior
 Aggressive behavior
Dentistry and Autism
 Use of Nitrous
 Use of Mercury
 Use of Fluoride
Treatment considerations
 Amalgam controversy
 Composite/ Fuji
 Vaccination controversy
 Fluoride consideration
 Topical/Varnish
 MI Paste
 Dependent if there are milk allergies
Mercury and dental Amalgam
 No causal relationship
 Unable to clear body of heavy metals
 Thimerosal- methyl mercury preservative
(removed from vaccines)
 Alternatives- Fuji glass ionomer, composite
Fluoride
 Fluoride inhibits critical antioxidant enzymes
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that have been linked to excitotoxic
reactions in the brain
Ask if autistic individual swallows toothpaste
GERD, GI disturbances
Seizure meds (are they more prone to caries)
Recommend MI Paste (check for milk
allergies)
Recommend quarterly cleanings
Nitrous Oxide
 Inhibits enzyme methionine synthase
 Children with genetic enzyme deficiency
(methylenetetrahydrofolate-MTHFR)- involved in
chemical pathways of the DNA during use of
nitrous.
 B12 deficiency also at risk
 Abnormalities in folic acid metabolism
Treatment Options
 Office
 Bite blocks-watch for gag reflex
 Molt
 Papoose/ parent/ guardian present
 Oral Sedation
 IV sedation
 General Anesthesia/ referral
Office Treatment
 Wheelchairs that can
lean back
 Mouth Molt
 Bite Block
 Papoose if needed with
parent in room
Hospital Setting
 Proper referral
 Complex medical history
 Behavior unmanageable
 Contact University
 Local Dental Society
for referrals
 AAHD-American
Association of Hospital
Dentists
Resources
 www.autismnow.com
 www.autismspeaks.org
 www.autism-pdd.net
 www.autismsociety.org
 www.autism.com
Thank you for your attention
 Diana Zschaschel
 (310) 854-6102
 www.angelssmiles.net
 Email:
[email protected]