Autism is a group of complex disorders of brain development, which is characterized by social interaction difficulties, repetitive behaviors and social communication challenges. Symptoms vary in severity and they range from mild to severe.  Patients with Autism Spectrum Disorder have a reported lower rate of dental caries but are at higher risk for other oral conditions. These patients have higher risk of bruxism, tongue thrusting, self-injury with non-nutritive biting; erosion, xerostomia and they also may have a hyper gag reflex.

The biggest challenge with these patients is in the aspect of social interaction and communication. In the field of dentistry, the providers are in very close proximity to these patients and much of what we do in providing treatment and getting to know the patient involved verbal and non-verbal communication. According to the CDC, about 40% of individuals with ASD are non-verbal. This can pose as a challenge because we cannot get proper feedback through language and they may communicate in a different way that may disrupt dental treatment. These patients may also exhibit sensory processing issues, which cause them to be hyper or hyposensitive to sounds, smells, taste, sight and human touch.  For those who are hypersensitive, a dental office can be overwhelming due to the various instruments, sounds and smells of materials that are in an office. Due to this, some children with ASD may have significant anxiety about going to the dentist and we must adjust treatment and the environment to make the patient more comfortable.

As providers, we can take various steps to ensure that our patient with ASD is comfortable. The first step can be to use pictures and videos to get the patient familiar with a dental setting. We can work with the parents in learning what the patient is sensitive to and what triggers negative reactions by the patient. When the patient first comes in, we can have appointments to get the child familiar with the office and the instruments. We can do so when the office is not as busy and with any adjustment such as a dimly lit room, for example. We can have a few short visits like this to start to desensitize the patient. Knowing what the patient likes is very important for a successful visit with any pediatric patient but it is especially important for patients with ASD. Whether the patient has a favorite toy or likes to listen to music we cam have those items on hand with a set of awesome sunglasses to keep the patient distracted and relaxed. We can also implement a tell-show-do method of learning so the patient knows exactly what we are doing. Patients with ASD also may have unusual response to stimuli and unpredictable body movements so we must minimize distractions and start to become familiar with any patterns that the patients may have. All of these things must be documented so we can know what to do to have a smooth appointment.  The patient’s parents or caregiver can give the providers a sense of how tolerant the patient is with human contact. Just like any other pediatric patient, the providers must have all proper emergency protocol established and if necessary may have to refer to treatment in an OR if they cannot tolerate being in a general practice setting. As providers we must be prepared to treat any type of patient that comes through our door and patients with special needs are not an exception.