Dentistry on children with Autism
A couple of weeks ago, I had a young patient with autism. The patient’s mom kept asking me questions about autism and her child’s dental care. I found myself without answers. Therefore, I became determined to find more information about the topic. I researched on the web, and found a couple of websites and articles that I found helpful. Below is a summary of what I came up with.
There are several theories regarding the cause of autism. This has led parents to seek traditional and alternative therapies for treatment. There are theories that autism has genetic or environmental links. Many parents of these children have concerns regarding environmental toxins, and therefore toxins that maybe introduced to them while seeking dental care. In addition, autistic children often have allergies, seizures, immune system and gastrointestinal problems. Because of these health conditions, autistic children are under several medications which could have dental implications. Due to of concerns from parents’ and patients altered health conditions, routine dental care and therapies may need to be altered.
There is literature that suggests fluoride lowers critical antioxidant enzymes in the brain. Therefore, some parents believe lowering fluoride exposure should be part of treatment. In addition, autistic children often time have trouble rinsing and therefore end up swallowing much of the toothpaste. This can lead to fluorosis and damaging of the gastrointestinal (GI) mucosa. On the other hand, autistic children are on several medications leading to higher incidents of plaque and dry mouth (xerostomia) which increases the risk of developing decay and gum disease. Therefore, patients who may swallow too much toothpaste should use fluoride-free toothpaste. These children need practice with the use of a toothbrush and floss. Parents need to seek out therapists to help aid the child in brushing and flossing techniques. If the child is unable to perform these procedures, parents need to step in and perform them for the child. For children without problems with rinsing and spitting out of the toothpaste, parents can make an informed decision on the use of fluoride.
Although western medicine suggests that fluoride is safe, some alterative ways of thinking suggests otherwise. Regardless, there is no dispute that autistic children need more frequent cleaning and maintainace appointments. In addition, during appointments fluoride varnishes can be applied. These varnishes are low fluoride exposure but a high fluoride to tooth surface contact, thus lowering risk of GI problems as well as reducing risk of decay.
Mercury is a neurotoxin. There are several countries that have outlawed the use of mercury fillings containing mercury. It is proven that autistic children can have trouble riding their bodies of mercury. There is merit for not using mercury on any child. In my opinion, mercury filled fillings should not be used on any child and should be outlawed all together. There are alternative filling materials, such as resin reinforced glass ionomers, that are much better for children with high plaque rates and xerostomia.
Some autistic children may be missing some enzymes that will metabolize Tylenol. In these children, byproducts of Tylenol can build up and become toxic. Ibuprofen is not metabolized the same way, and therefore does not pose a treat.
Nitrous Oxide is an anxietylitic, and is often times used to treat children who are uncooperative. Nitrous oxide can reduce cells’ ability to synthesis DNA. In rare cases, autistic children could have a genetic enzyme deficiency which could lead to further disable the ability of cells to synthesize DNA. All cells need to replicate DNA in order to reproduce. This includes red blood cells. Vitamin B12 deficiency can have the same effect and can lead to mortality of a child. In my opinion, autistic children should be tested for these genetic enzyme deficiencies. If they are not tested, nitrous oxide should not be administered.
Autistic children usually have very good memory and are good at following routines. They can benefit from repetitive behaviors such as flossing and brushing. Behaviors can be modified slowly with small changes to routine daily activity and repetition.
First dental visit and follow up appointment:
Have the child visit the office and familiarize them with the surroundings. Have them return and sit in the dental chair. It may take up to three visits for the child to become familiar with the office before he will be open to exams. Once the routine is in place, it will be easier to introduce small changes to the routine. If the child is uncooperative after these routine appointments, do not be afraid to see a pedodontist who specializes in seeing children. They may have specialized training that will better suit them for treating your child. If this does not work, options of sedation do exist.
Autism is not very understood. There are two theories regarding its origin. One is genetic, the other is environmental influence. It is understandable that parent seek answers to help their children. Parents will often reject acceptable dental treatments because of concerns for toxins. Unfortunately there are no easy answers. There are only informed decisions. Autistic children could benefit from fluoride; however it can lead to toxicity and GI problems. Nitrous oxide can be used to treat a non-cooperative child. On the other hand, if the child has an additional rare genetic enzyme disorder, it can lead to death. Use of mercury, in my opinion, should be outlawed all together. By slowly adding routines to the child’s everyday activities, he or she can become accustomed to better dental hygiene. In addition, with slow introduction of the child to a dental office, he or she will more likely accept routine dental care from which the child can greatly benefit.