Dentistry on Autistic Children
There are several theories regarding the cause of Autism, such as a theory that Autism has genetic or environmental links. This has led parents to seek traditional and alternative therapies for treatment. Many parents of these children have concerns regarding environmental toxins, and therefore toxins that may be 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 that could have dental implications. Due to concerns from parents and patients’ with 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 reducing fluoride exposure should be part of treatment. Also, Autistic children often time have trouble rinsing and thus 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.
Regular toothpaste may contain ingredients such as mint, which may cause irritations and even burning sensations. Flavored toothpaste such as berry is generally more acceptable to Autistic children, as long as the child is not swallowing it. If the child tends to swallow the toothpaste, use unflavored and fluoride-free versions to encourage the child to spit it out it. In addition, if a minimal amount of the toothpaste is swallowed, it will not be harmful.
Although western medicine suggests that fluoride is safe, some alternative ways of thinking suggest otherwise. Regardless, there is no dispute that Autistic children need more frequent cleaning and maintenance 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 the risk of GI problems as well as reducing the risk of decay.
Tooth brushing can lead to sensory overload to an Autistic child. Every attempt should be made to desensitize a child at a very young age. Try touching the child with the toothbrush and continue to the lips and mouth. It may take weeks before a child is ready for teeth brushing. It is important to proceed in small steps but with consistency. At first, try a soft or silicone bristled toothbrush. Autistic children do well when a routine is set. As long as that routine is started early in life and is consistent, Autistic children can do well with their dental hygiene. Same with flossing. At a young age, get the child desensitized and put them on a routine. Parents need to step in for children that cannot perform their own dental hygiene. Also, make it easier for an Autistic child to perform their own dental hygiene. Electric toothbrushes, a tennis ball around the handle of a toothbrush, floss aids, and water flossers can be used to aid a child as long as the child is not over sensitized by it.
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 ridding 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 altogether. 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 threat.
Nitrous Oxide is an anxiolytic (breaks anxiety) and is oftentimes 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, then to be safe nitrous oxide should not be administered.
Autistic children usually have a 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 the child is 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 well understood. There are two theories regarding its origin. One is genetic, and the other is environmental influence. Understandably, parents seek answers to help their children. Parents will often reject proper dental treatments because of concerns about 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. The use of mercury, in my opinion, should be outlawed altogether. By slowly adding routines to the child’s everyday activities, they can become accustomed to better dental hygiene. Also, with the 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.