Autism Flashcards
How would you prepare the dental surgery for an autistic patient before and during their visit?
- I would inform the parent that it can be very normal for children to be nervous of the dentist and not want to attend, and it can be worse for children with autism. I would let them know that we would try out best in the dental surgery to make her feel comfortable and would take things very slowly.
- I would probably not do anything in the first visit other than let her see the surgery and sit on the chair if she feels comfortable. But if she was happy to go ahead with a simple examination then I would carry that out
- Tell them they shouldn’t be worried to bring child
- Remain calm
- Explain that you will take your time in appointments
- You will build up trust with Taylor
- 1st visit
o Send out plastic mirror and pictures of dental visit to let her see what will happen
o Be on time
o De clutter surgery
o Leave more time for appointment
o Spend time just talking to Taylor and getting to know her introduce yourself
o Let her know you’re going to just count her teeth using the mirror she’s already seen
o Get a bit of a history and get them comfortable in this first visit - Fond out of there is a specific time of the day that would suit the patient best
- Ask them to bring in what they use at home to communicate so they feel more comfortable
- BSPD has a questionnaire ready – look at this later.
What is a preventative plan for a three year old with autism?
- Duraphat twice a year if possible
- Suggest oranurse if dislike the foam when brushing teeth
- Sugar free medication
- 1500ppm toothpaste
- In person tooth brushing demonstration at each visit
- Diet advice
- FS of all erupted first molars at age 6ish.
What are some ways you can use to motivate brushing?
- To motivate brushing
o Use charts to motivate them
o Two sided brushes
o Brush DJ app
o Anything that would make brushing teeth a bit fun
o Try and make a routine when you do it – always after a shower/bath etc, at same time everyday.
He attends for examination but his parents struggle to bring him into the surgery and he is unwilling to sit on the dental chair.
How would you establish a diagnosis?
-Toothbrush and 2 plastic mirrors, brush teeth to see in mouth as they are used to it
- Ask if he would like to just sit on his parents knee while I have a quick little look in his mouth
- Or if he prefers to stand get him to do that to have a little look
- Won’t manage any radiographs to confirm a diagnosis
- Need to assess best way to communicate with Craig, ask parents what is used best – preferably want to have established this before he attends the dentist so we can have things in place to be prepared
- Feel for caries as best as you can soft/hard to determine type of lesion
- TTP of tooth
- Sensibility testing if possible but probably won’t tolerate it
- This child will probably need some GA so just need to see if there is any justification to be able to warrant that
- Could be lying on the floor, on parents lap, on the floor in surgery, just anywhere they are comfortable just to do a quick examination to see roughly what’s going on
- Good to try and get them in at a time that is quiet
- Get parent to brush childs teeth as they would at home and you can stand to the side and have a little look
o Sometimes you can get the toothbrush out and if they see a brush they might associate that with opening their mouth and will now
- Can get parents trying to take a picture at home so you can see, if they refuse in surgery to open their mouth .
If you found he had gross caries affecting multiple deciduous teeth what immediate care might you provide? What would the longer term plan be?
- Immediate care would be to get rid of the pain – extraction or pulpotomy etc.
- Long-term would need to have his permanent teeth fissure sealed as soon as they erupt – ideally want resin FS but would possibly have to go with GI
- Try to get craig into the dentist more often to get him acclimatised before doing any procedures on him – take it slowly, first appointment may just be to have him sit on the chair
- Aim to relieve pain
o Remove gross debris from teeth
o Apply corticosteroid antibiotic paste under a temporary dressing
o If cooperative enough open the pulp chamber under LA and apply corticosteroid paste directly to the pulp, then place a dressing
o Prescribe pain relief
o Carry out a pulpotomy/extract tooth/teeth at a later date - Talk to the parents about pain relief
o Check exactly what is being taken and how often
o This child is non-verbal so can’t ask for painkillers so need to try and keep them going consistently
o Make sure they are getting the max amount of pain relief they can have
o If it’s only pain at the moment they don’t need antibiotics yet unless it turns into infection - Would want to get GA sorted ASAP.
Elaine is twelve years old who has high functioning autism and is able to attend main stream school. She is concerned about the appearance of her teeth and has asked if she can have orthodontic treatment to straighten them. On examination there are no visible plaque deposits but there is bleeding on probing which indicates recent vigorous brushing. She has fissure cares in 36 and a history of caries in her deciduous molars. She has upper and lower crowding which you feel could justify an orthodontic referral.
What would be your prevention plan for this patient?
- Go over OHI to make sure she is brushing the way we want her to
- Would want to treat her fissure caries in 36, and fissure seal her other molars to prevent them from getting caries
- Sugar free medicine if needed
- 2800ppm F and make sure she uses it regularly
- Toothbrushing instruction – interdental as well
- Fissure sealants
- Radiographs every 6-12 months
- Caries removal 36
- Do plaque and bleeding scores – especially if she wants ortho
o No plaque today but still bleeding suggests she’s brushed well for today but doesn’t brush well otherwise.
What is high functioning autism?
High functioning= a person that exhibits no intellectual disability but may exhibit deficits in communication, emotion, recognition, expression and social interaction.
What are the potential barriers for an autistic child?
- Access to dentist – they can be really scared as they don’t know what to expect
- May not be able to cooperate with the dentist and do what you need them to
- Often have more decay/untreated decay that children without an intellectual impairment
- Bright lights, lots of noise from machines, kept waiting a long time, smell of chemicals, being touched, taste of toothpaste etc
- Don’t like change, like things to be predictable so can struggle with coming to the dentist
- Might have pain but don’t know where its coming from as they can’t tell you
- Might have a bland diet so strong flavours won’t go well with them oronurse can be helpful.
Give examples of the potential resources available to facilitate the dental visit for an autistic child.
- Can use the ‘message to dentist’ form, use the MCDASf to assess level of anxiety for attending
- If patient is non-verbal can use storyboard/PECS to communicate
- Important to maintain a smiling face to make sure the patient feels at ease
- Can give patients a storyboard/PECS before they attend the dentist so they know what is going to happen when they get here
- Send home a plastic mirror so they can familiarise themselves with it
- De-clutter the surgery
- BSPD website really good to prepare for autistic patients
- National autism society website – gives tips on communication and what can help in the environment
- Storyboards – good to include pictures of staff so they know who to look for .
How would you structure an autistic child’s first dental visit?
- I would only do as much as they were comfortable with, if that was just sitting on the dental chair that is all I would do
- Not Kept Waiting
- Use simple language
- Use the boardmaker flash cards or booklet to tell the patient what is going to happen
- Repeat the flash cards while doing the exam
- Use the patients name before each phrase
- Might want to ask for two adults, an older sibling, come with someone so they someone can keep them entertained while the other can speak to the dentist
- Try to limit as much time they spend in the surgery as possible .
