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Zerman N, Zotti F, Chirumbolo S, Zangani A, Mauro G, Zoccante L. Insights on dental care management and prevention in children with autism spectrum disorder (ASD). What is new? FRONTIERS IN ORAL HEALTH 2022; 3:998831. [PMID: 36238091 PMCID: PMC9551997 DOI: 10.3389/froh.2022.998831] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
Autistic subjects represent a severe concern to dentistry due to the considerable difficulty in managing their oral health, maintaining routine toothbrushing, and preventing dental and periodontal problems. The social and economic burden of managing dental care in autism spectrum disorder (ASD) children is particularly cumbersome for families and public and private health expenditure, especially when children reach the dentist following a late diagnosis with evident oral health problems. An early diagnosis of ASD helps dentists better address these children's oral health. Unfortunately, insufficient attention is paid to the training and education of general pediatricians, dentists, and dental hygienists, allowing them to get to approach the different clinical aspects of ASD. Usually, children diagnosed with ASD are scheduled for dental appointments like their neurotypical peers, whereas their needs are typically complex and personalized. Scant attention is also devoted to these patients by commercial manufacturers of dental products and devices for oral hygiene and prevention of caries and periodontal diseases, leaving parents without the support and often failing when they address the oral health of autistic children. The difficulties of oral care do not derive simply from the behavior of ASD patients, as is commonly assumed, and therefore cannot be overcome solely by the patience and attention of parents and dentists. Genetics, dietary habits, sensory impairments, and cognition disorders are other causes contributing in various degrees to the impact on the mood and psychological reactions of autistic children towards dentists. How can we prevent teeth caries, periodontal disorders, and other oral health impairments by properly managing ASD children? This manuscript gives an up-to-date overview of these problems and helps to provide good remarks.
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Affiliation(s)
- Nicoletta Zerman
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Francesca Zotti
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Zangani
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | | | - Leonardo Zoccante
- Autism Veneto Region Center, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Hong SJ, Chae YK, Lee C, Choi SC, Nam OH. A Digital Fabrication of Dental Prosthesis for Preventing Self-Injurious Behavior Related to Autism Spectrum Disorder: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179249. [PMID: 34501850 PMCID: PMC8430482 DOI: 10.3390/ijerph18179249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 12/02/2022]
Abstract
This case report aimed to demonstrate the prosthetic solution of an autism patient with self-injurious behavior using digital dentistry. A 24-year-old male visited our clinic with chief complaints of severe gingival recession associated with self-injurious behavior. Bilateral fixed prosthesis with denture flange were delivered using a digital workflow for the protection of the gingiva. The patient showed healed gingival tissue, behavioral modification, and acceptable oral hygiene during the follow-up period. Also, his caregivers reported no recurrence of the self-injurious behavior. Autism patients usually show self-injurious behavior, which can damage their oral tissue. With adoption of this prosthesis, behavior modification as well as healing of oral tissue was achieved.
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Affiliation(s)
- Seoung-Jin Hong
- Department of Prosthodontics, School of Dentistry, Kyung Hee University, Seoul 02447, Korea;
| | - Yong Kwon Chae
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul 02447, Korea; (Y.K.C.); (S.C.C.)
| | - Chunui Lee
- Department of Oral and Maxillofacial Surgery, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea;
| | - Sung Chul Choi
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul 02447, Korea; (Y.K.C.); (S.C.C.)
| | - Ok Hyung Nam
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul 02447, Korea; (Y.K.C.); (S.C.C.)
- Correspondence: ; Tel.: +82-2-958-9372; Fax: +82-2-965-7247
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Verhaltensbedingte dentale und orale Befunde bei Menschen mit Autismus-Spektrum-Störung – eine ausgewählte Übersicht. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-01078-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Zusammenfassung
Hintergrund
Charakteristisch für Menschen mit einer Störung aus dem Autismusspektrum (ASS) sind qualitative und quantitative Störungen der Kommunikation und sozialen Interaktion, stereotypes Verhalten und ggf. auch Sonderinteressen.
Ziel der Arbeit
Der vorliegende Artikel blickt auf unterschiedliche ASS-assoziierte Verhaltensmuster und deren Auswirkungen, die sich im Mundraum oder an den Zähnen darstellen.
Ergebnis
Im klinischen Alltag wird vermehrt ein Zusammenhang zum Mundraum festgestellt. Konkret sind Aspekte der einseitigen Ernährungsgewohnheiten, der Selbststimulation oder Selbstverletzung zu nennen, die einen Einfluss auf die Entstehung oraler und dentaler Erkrankungen wie Karies, Gingivitis haben können.
Diskussion
Mittel- und langfristig können sich abnorme, repetitive Verhaltensweisen in dentalen oder oralen Erkrankungen manifestieren. Der dadurch verursachte Krankheitswert kann letztlich die Lebensqualität der Person und des sozialen Umfelds negativ beeinflussen.
Schlussfolgerung
Folglich ist es wichtig zu wissen, dass eine orale Beteiligung einer individuellen Verhaltensauffälligkeit bei einem Menschen mit einer ASS häufig gegeben ist. Im klinischen Alltag der Kinder- und Jugendmedizin ist dieses Wissen für Diagnose und Therapie, aber auch für die interdisziplinäre Zusammenarbeit mit dem (Kinder‑)Zahnarzt hilfreich.
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Diekamp M, Jenter L, Schulte AG, Fricke O, Schmidt P. Restoration of an Upper Anterior Tooth in an Adolescent with Autism Spectrum Disorder-A Student Case Report. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E237. [PMID: 33227942 PMCID: PMC7699251 DOI: 10.3390/children7110237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with autism spectrum disorder (ASD) or other mental or physical limitations experience an imbalance in the frequency of dental treatment as compared with the general patient population, in part, due to inadequate pre-graduate training of future dentists. CASE PRESENTATION This case report describes a successful anterior tooth restoration, in awake state, in a 15-year-old boy with early childhood autism. The procedure was carried out independently by students of dentistry within the scope of their integrated clinical training semesters. Desensitization sessions were used as a preparatory measure and elements of behavioral facilitation (tell-show-feel-feel-do) were applied during the treatment. CONCLUSIONS To avoid discrimination of this group of patients in the provision and quality of dental care, a structured approach to the transfer of theoretical and practical knowledge in the field of special care dentistry is indispensable. To this end, treatment strategies for special care patients should be taught to pre-graduate dental students as a fundamental part of their university curriculum.
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Affiliation(s)
- Max Diekamp
- Integrated Clinical Course, Dental School, Witten/Herdecke University, 58455 Witten, Germany; (M.D.); (L.J.)
| | - Leonie Jenter
- Integrated Clinical Course, Dental School, Witten/Herdecke University, 58455 Witten, Germany; (M.D.); (L.J.)
- Department of Special Care Dentistry, Dental School, Witten/Herdecke University, 58455 Witten, Germany;
| | - Andreas G. Schulte
- Department of Special Care Dentistry, Dental School, Witten/Herdecke University, 58455 Witten, Germany;
| | - Oliver Fricke
- Department of Child and Adolescent Psychiatry, Psychotherapy and Child Neurology, Gemeinschaftskrankenhaus Herdecke, 58313 Herdecke, Germany;
- Department of Child and Adolescent Psychiatry, Witten/Herdecke University, 58455 Witten, Germany
| | - Peter Schmidt
- Department of Special Care Dentistry, Dental School, Witten/Herdecke University, 58455 Witten, Germany;
- Department of Child and Adolescent Psychiatry, Psychotherapy and Child Neurology, Gemeinschaftskrankenhaus Herdecke, 58313 Herdecke, Germany;
- Department of Child and Adolescent Psychiatry, Witten/Herdecke University, 58455 Witten, Germany
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Ghanim D, Llewellyn SR, Khodaee M. Embedded fingernail in the gingival sulcus of a boy. BMJ Case Rep 2020; 13:13/6/e235746. [DOI: 10.1136/bcr-2020-235746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Two Cases of Nonsuicidal Self-Injury Comprising Partial Autoamputation of the Apex of the Tongue. Case Rep Dent 2020; 2020:8691270. [PMID: 32148976 PMCID: PMC7057006 DOI: 10.1155/2020/8691270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/04/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
The prevalence of nonsuicidal self-injury (NSSI) in adults is lower than that in adolescents and it is more prevalent in patients with psychiatric disorders. Sleep disturbances such as nightmares are associated with NSSI after accounting for depression; thus, persons with major NSSI sometimes present at medical institutions during the night seeking emergency treatment. Gingival tissues comprise the most frequent target of self-injury of the oral cavity using oral hygiene tools. Most NSSI in the oral cavity is minor because such tools are blunt. Major NSSI such as autoamputation of the tongue is rare. We describe two patients who partially autoamputated the apex of their own tongues using edged tools. Case 1 was a 55-year-old female with depression who had defaulted from psychiatric intervention. She had cut off her tongue using a Japanese kitchen knife and presented with the dry, necrotic amputated portion and blood oozing from the remainder of her tongue. We debrided and sutured the remainder of the tongue without reattaching the amputated portion. Her postoperative course was uneventful, and she was free of adverse events such as functional disability and wound infection. Case 2 was a 69-year-old female with schizophrenia who had defaulted from psychiatric intervention and had cut off her tongue using scissors. The amputated portion of the tongue was lost and the remainder, which was oozing blood, was debrided and sutured. She defaulted on a follow-up appointment. Neither of these patients had suicidal intent. The prevalence of NSSI across all age groups has recently increased, and the risk that self-injury will become normalized has become a concern. Thus, dentists as well as oral and maxillofacial surgeons should be aware of the possibility that patients will present with major NSSI requiring emergency treatment.
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Gandhi RP, Klein U. Autism spectrum disorders: an update on oral health management. J Evid Based Dent Pract 2014; 14 Suppl:115-26. [PMID: 24929596 DOI: 10.1016/j.jebdp.2014.03.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
UNLABELLED Dental professionals caring for patients with a diagnosis of autism spectrum disorder (ASD) will need to provide oral health care based on a family-centered approach that involves a comprehensive understanding of parental concerns and preferences, as well as the unique medical management, behaviors, and needs of the individual patient. BACKGROUND With the rising prevalence of autism spectrum disorders (ASD), oral health providers will find themselves increasingly likely to care for these patients in their daily practice. The purpose of this article is to provide a comprehensive update on the medical and oral health management of patients with autism spectrum disorders. METHODS The authors conducted a literature review by searching for relevant articles written in English in the PubMed database pertaining to the medical and oral health management of autism, including caries status, preventive, behavioral, trauma, and restorative considerations. CONCLUSIONS A detailed family centered approach based on parental preferences and concerns, the patient's challenging behaviors, and related comorbidities can serve to improve the treatment planning and oral health management of dental patients with ASD.
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Affiliation(s)
- Roopa P Gandhi
- Department of Pediatric Dentistry, Children's Hospital Colorado and University of Colorado School of Dental Medicine, Aurora, CO, USA.
| | - Ulrich Klein
- Department of Pediatric Dentistry, Children's Hospital Colorado and University of Colorado School of Dental Medicine, Aurora, CO, USA
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Jaber MA. Dental caries experience, oral health status and treatment needs of dental patients with autism. J Appl Oral Sci 2011; 19:212-7. [PMID: 21625735 PMCID: PMC4234331 DOI: 10.1590/s1678-77572011000300006] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 02/16/2010] [Indexed: 12/24/2022] Open
Abstract
Objectives Autism is a lifelong neurodevelopmental disorder. The aims of this study were to
investigate whether children with autism have higher caries prevalence, higher
periodontal problems, or more treatment needs than children of a control group of
non-autistic patients, and to provide baseline data to enable comparison and
future planning of dental services to autistic children. Material and Methods 61 patients with autism aged 6-16 years (45 males and 16 females) attending Dubai
and Sharjah Autism Centers were selected for the study. The control group
consisted of 61 non-autistic patients chosen from relatives or friends of autistic
patients in an attempt to have matched age, sex and socioeconomic status. Each
patient received a complete oral and periodontal examination, assessment of caries
prevalence, and caries severity. Other conditions assessed were dental plaque,
gingivitis, restorations and treatment needs. Chi-square and Fisher's exact test
of significance were used to compare groups. Results The autism group had a male-tofemale ratio of 2.8:1. Compared to controls,
children with autism had significantly higher decayed, missing or filled teeth
than unaffected patients and significantly needed more restorative dental
treatment. The restorative index (RI) and Met Need Index (MNI) for the autistic
children were 0.02 and 0.3, respectively. The majority of the autistic children
either having poor 59.0% (36/61) or fair 37.8% (23/61) oral hygiene compared with
healthy control subjects. Likewise, 97.0% (59/61) of the autistic children had
gingivitis. Conclusions Children with autism exhibited a higher caries prevalence, poor oral hygiene and
extensive unmet needs for dental treatment than non-autistic healthy control
group. Thus oral health program that emphasizes prevention should be considered of
particular importance for children and young people with autism.
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Affiliation(s)
- Mohamed Abdullah Jaber
- Dental School, Ajman University of Science & Technology, Al Jurf campus, Ajman, United Arab Emirates.
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Jaber MA, Sayyab M, Abu Fanas SH. Oral health status and dental needs of autistic children and young adults. ACTA ACUST UNITED AC 2010; 2:57-62. [DOI: 10.1111/j.2041-1626.2010.00030.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Romer M, Dougherty NJ. Oral self-injurious behaviors in patients with developmental disabilities. Dent Clin North Am 2009; 53:339-xi. [PMID: 19269402 DOI: 10.1016/j.cden.2008.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Self-injurious behaviors (SIB) in patients who have developmental disabilities is a complex disorder, and its underlying etiologies are poorly understood. SIB is a significant factor in hospitalizations, decisions to use psychotropic medications, and institutional placement for people who have developmental disabilities. Because this group often manifests oral SIB, the dentist may be the first professional called upon to evaluate a patient. Dental therapy focuses on symptomatic treatment to minimize tissue damage caused by SIB, but addressing the underlying impetus for the behavior is essential for successful treatment. Determining definitive therapeutic interventions is difficult because of the mixed bio behavioral etiologies for SIB. This complication necessitates a team approach that includes medical and behavioral specialists.
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Affiliation(s)
- Maureen Romer
- Arizona School of Dentistry and Oral Health, A.T. Still University, 5855 E. Still Circle, Mesa, AZ 85206, USA.
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Affiliation(s)
- Esmonde F Corbet
- Periodontology, Faculty of Dentistry, University of Hong Kong, Hong Kong, China
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Abstract
Self Injurious Behaviour (SIB) is a deliberate harm to the body that may lead to factitial injuries. Its origin may be functional or biological and it has a higher prevalence in females and in psychologically impaired individuals. Seventy per cent of autistic patients have SIB. Seventy-five per cent of factitial injuries are located in the head and neck region. A paediatric case report concerning a 4-year-old autistic female is presented. Detailed medical history, physical examination, clinical intraoral and radiographic examination, incisional biopsy, neuropaediatrical, psychological and speech evaluation were undertaken. Diagnosis included hypochromic macrocytic anaemia, caries, coronal fracture, factitial ulcer, factitial periodontitis, self-extraction of primary teeth and permanent teeth buds, non-specific oral ulcer with inflammatory reaction, mild mental retardation, speech impairment, autistic syndrome and self injurious behaviour consisting of putting fingers and foreign objects in the gingiva, fingernail biting and hair pulling. Differential diagnosis included hystiocitosis X, prepuberal periodontitis and leukocyte adhesion deficiency. Dental preventive and restorative treatment was performed. Non-contingent reinforcement therapy was successfully used to diminish SIB. Treatment of factitial oral injuries must be interdisciplinary and requires cooperation of the patient, the parents, health care providers, and medical team.
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Affiliation(s)
- A C Medina
- Universidad Central de Venezuela Dental School, Caracas, Venezuela.
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Cutando A, Gil JA, López J. Oral health management implications in patients with tuberous sclerosis. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 90:430-5. [PMID: 11027378 DOI: 10.1067/moe.2000.105766] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report 6 cases of patients with tuberous sclerosis and concomitant dental pathosis. The multiple manifestations in tuberous sclerosis determine its impact on dental therapy. A lack of awareness of this condition may compound the possible side effects of dental treatment. Possible preventive measures by dentists are highlighted in this presentation. Medical evaluation and the control of risk factors in relation to general anesthesia and sedation are key considerations for the management of patients with tuberous sclerosis.
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Affiliation(s)
- A Cutando
- Dental School, Granada University, Spain
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Romer M, Dougherty N, Fruchter M. Alternative therapies in the treatment or oral self-injurious behavior: a case report. SPECIAL CARE IN DENTISTRY 1998; 18:66-9. [PMID: 9680913 DOI: 10.1111/j.1754-4505.1998.tb00906.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This paper presents the case of a child with severe mental retardation and a history of oral self-injurious behavior (SIB). While the behavior was refractory to a number of dental interventions, some success was achieved through a combination of behavioral therapy techniques and therapeutic touch (a relaxation technique). Etiologies of SIB are discussed, along with descriptions of alternatives to traditional dental therapy for this difficult problem.
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Affiliation(s)
- M Romer
- Special Care Dental Program, Rose F. Kennedy Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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