The caries experience and behavior of dental patients with autism spectrum disorder (ASD).

Resident: Roberts

Date: 5/18/11

Article title: The caries experience and behavior of dental patients with autism spectrum disorder (ASD).

Authors: Cheen Loo, Graham Richard, et al.

Journal: JADA

Volume #: 139

Year: 2008

Background: The authors conducted a study to evaluate ASD with those who were unaffected by the disorder in the areas of: behavior, and caries prevelance.

Methods: The authors reviewed the patient charts of 395 patients with ASD and 386 charts of patients who did not have ASD. They noted age, sex, residence(home or institutionalized), presence of a seizure disorder, other diagnosis, medications, caries prevalence, caries severity, and behavior.

Results: ASD Male:Female ration of 4:1, Sex distribution was equal to the unaffected group, which was younger and had higher rates of DMFT than did the ASD group. A significantly higher percentage of patients with ASD were uncooperative and required dental treatment to take place under general anesthesia. In the ASD group 55.2 percent of patients were uncooperative (that is they exhibited either negative or definitely negative behavior and only 9.2 percent exhibited definitely positive behavior). Caries prevalence and severity of decay was not associated with institutionalization, presence of seizure disorder or additional diagnosis. Regarding ASD patients with primary teeth, they were 83.4 percent less likely to have caries than were those unaffected. In the permanent dentition, they were 65.9 percent less likely to have caries than were those unaffected. No significant difference was noted in the amount of decay severity between male and female patients with ASD.

Conclusion: People with ASD were more likely to be caries free and had lower DMFT scores than those were unaffected. Significantly more ASD patients were uncooperative and required GA to treat decay than did others.

Dental Care in Children With Developmental Disabilities: Attention Deficit Disorder, Intellectual Disabilities, and Autism

Resident: Adam J. Bottrill
Date: 18MAY11
Region: Providence
Article title: Dental Care in Children With Developmental Disabilities: Attention Deficit Disorder, Intellectual Disabilities, and Autism
Journal: Journal of Dentistry for Children
Page #s: 84-91
Vol:No Date: 72:2, 2010
Major topic: Developmental disabilities, ADD, Autism, Dental care
Minor topic(s): None
Type of Article: Descriptive article

Main Purpose: The purpose of this article was to describe the characteristics of 3 common developmental disabilities and the challenges these issues present to the oral health care practitioner.

Key points in the article discussion:

I. General:

A. 13% of all children peat the MCHB definition of children with SCHN.
B. SHCN Children almost twice as likely to have unmet oral healthcare needs.
C. Considerations: speciale diet, medication, self-unjurious behavior, communication problems, orofacial malformations,

II. ADHD
A. Prevalence of 4-12% with persistence into adolescence of 60-80%
B. Impulsivity, inatention, hyperactivity... I'm sorry, but this paragraph makes me laugh. It describes almost every child with whom I've ever interacted.
C. Three types:
1. Hyperactivity/Impulsivity
2. Inattentive
3. Combined
D. Suggestions for Tx:
1. Frequent breaks
2. Reinforcement of positive behavior.
3. Those children on meds may be more behaved after taking them.

III. Intellectual Disability (mental retardation)
A. Sub-average functioning in 2 or more of the following areas: communication, self-help, home living, social and interpersonal skills, use of community resources, self-direction, health, safety, leisure, work
B. Prevalence: 1%
C. Mild/Moderate/Severe/Profound
D. ID children often have co-morbidities
E. Anxiety and uncooperative behavior in the dental setting.
F. Abnormal tooth eruption, maloclusions, missing/fused teeth, microdontia, abnormal jaw structure, macroglossia, perio disease.
G. Latex allergy, cardiac problems
H. knowing the child's mental age will help with behavior management. Manage to the "mental age".
I. Communicate to the patient's level: reward behavior, verbal reinforcement.
J. Communicate with the parents in order to gain useful tips on how to control behavior.
K. "Desensitization visits", picture books, "blanky/bobo"

IV. ASDS
A. Autism, Asperger S, PDD
B. Prevalence: 6.5/1000
C. Common deficits include: language, social skills, restricted stereotyped patterns of behavior
D. Prevalence of ID in those with ASD: 50-60%
E. Unusual responses to common smells, tastes, textures
1. Can interfere with hygiene and nutrition
F. Higher prev of obesity
G. Challenging behaviors more prev during childhood than adolescence... ALTHOUGH rapid increases in size and strength make any of these behaviors more dangerous.
H. Sources of discomfort can always bring about behavior changes... Important to take thorough med history.
I. Generally, ASD kids have good oral health and average caries and perio rates.
J. Encourage parents and teachers to use NON food rewards.
H. Some medications have side effects including weight gain, abnormal movements and increased risk of diabetes.
I. Visual supports to increase chances of succesful visit: schedules, "social stories", books, pictures.
J. Some dentists keep a copy of a social story to send to families prior to visit.
K. Use the same staff, appointment time, day of the week etc...
L. ASK THE PARENTS... about everything.

Assessment of Article: The title of the article doesn't seem to accurately depict the content.

5/18/11 Dental Injuries in Autistic Children

Department of Pediatric Dentistry
Resident’s Name: Murphy Program: Lutheran Medical Center - Providence
Article title: Dental Injuries in Autistic Children
Author(s): Ceyhan Altun, DDS, PhD, Gunseli GUven DDS, PhD, et al
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2010. V32. No 4. 343-346
Major topic: Trauma in autistic kids

Overview of method of research: Turkish cross sectional survey. The dental injuries of 186 children and adolescents (138 males and 48 females) 93 w/ autism (autistic group, AG), and 93 without (control group, CG) were classified according to drawings and text based on the world health organization (WHO) system (Andreasen). The system took into account age, sex, # and type of teeth involved, and type of injury. The data was entered into a computer, and analyzed using the SPSS software.

Findings:
Types of injuries ranged from crown discoloration and enamel fracture to subluxation. The most common injury was enamel fracture, and the rate of fracture was higher in the CG group as compared to the AG group. The most injured tooth was the max. CI. There were no significant differences in the rates of traumatic dental injuries between children and adolescents, between males and females, or between the AG or CG groups. However, the distribution of types of traumatic dental injuries differed significantly between the two groups.

Assessment of Article: Straight forward review. Relevant to our daily practice.