What should you pay attention to in the oral care of an autism patient?

Autism is a lifelong mental developmental disorder characterized by an insidious inability to use language and abstract concepts, in communication and social relations. Deformities occur in the brain (cerebellum and limbic system). As a result, it shows a wide range of systemic and behavioral symptoms. Oral health care of such patients can be complex as they cannot express any dental problems they may experience and can show various behaviors and reactions to minor changes.

Why are dental and gum diseases common in children with autism? 

Studies have shown that the rate of dental caries may be higher in children with autism. Since these children have poor language coordination, they prefer sugary foods. On the other hand, they tend to keep sugary foods in the mouth instead of swallowing them. He also has issues with using toothpaste and flossing.

In most children with autism, there may be gingival hypertrophy and delayed tooth eruption. Dental injuries were also common in autistic patients due to the need for skills. Some anomalies such as ogival palate, crowding and closing problems are more common. Harmful habits such as nocturnal bruxism, tongue thrusting, lip biting, and gingival needle sticking are common.

How can teeth and gum diseases be understood in children with autism? 

Communication problems, attention deficit-related hyperactivity, and repetitive body movements in children with autism make early diagnosis of dental and gum diseases difficult. Restlessness, irritability, and strange sounds may suggest tooth and gum disease.



In the presence of symptoms such as bad breath, visible dark areas on the teeth, swelling of the cheek or jaw, recession or swelling of the gums, consult your dentist.

How to care for the mouth in children with autism? 

Gaining the habit of protecting oral and dental health in children with autism is a very difficult and troublesome process. A person who is constantly taking care of the child can be an example for the child if he or she does his own oral care regularly. It is necessary to familiarize children with patience, with frequent and constant repetitions. Oral care is no different from other children, there is no special practice other than proper communication.

Regular dental check-ups of children with autism are important for oral and dental health. Frequent visits to the dentist are beneficial in terms of early diagnosis of diseases, as well as in establishing a communication between the dentist and the child.

How are dental and gum diseases treated in children with autism? 

Treatment in children with autism may require multistakeholder work. The main stakeholders here are the family and the dentist. If necessary, trainers, psychologists, etc. can be added to them. The main purpose of treatment management is to increase individual performance and support families and caregivers.

The dental clinic that will provide treatment for children with autism should be easily accessible, patient and family-centered, and have complete and appropriate treatment facilities. Before the treatment of children with autism, it will be beneficial for the family and the dental team to come together and plan the treatment. The dentist should be given detailed information about the child’s health status and the drugs he uses.

Fluoride administration in children with autism may cause gastrointestinal irritation and dental fluorosis. In the use of amalgam, problems may occur in terms of endocrine disorders due to the bisphenol A content.

When caries, abscesses and gingival disorders occur in children with autism, it is usually not possible to treat them under normal clinical conditions. In such cases, it may be necessary to perform the treatment under general anesthesia and to complete all treatments in a single session.

While the child with autism can be communicated, simple treatments can be done in the clinic. However, it is a laborious process that requires maximum attention and good planning.

It is necessary to pay attention to the fact that there are no sudden movements, colorful toys, etc. that will distract the child with autism during dental and gingival treatments. Since peripheral vision is developed in these children, they notice the slightest change in the room and become distracted. The treatment team should be knowledgeable and sensitive about this issue.

 What is behavioral guidance for children with autism? 

Behavioral guidance in children with autism is a set of practices that aim to establish a lifelong reliable and positive relationship between health professionals and the child, to develop harmony, to reduce anxiety and to provide quality dental treatments. It requires flexibility as the child’s movements and psychology are constantly changing. Inappropriate behavior of the child is ignored.



The stages of behavioral guidance are:

• Communication: It ensures mutual trust and cooperation. Good and constant communication is required with the participation of all staff throughout the visit to the dental clinic. Verbal commands should be short, clear and simple sentences. Picture communication techniques can be used in cases where verbal communication is very weak or absent.
• Tell-Show-Do: To show the child the dental equipment and procedures that he or she will be exposed to. Dental equipment is shown, how it is used. Sometimes pictures are used. If it is determined that communication with the child has been established, the procedure is applied.
• Limitations / Touch of Pressure: It is still a controversial method. Some dentists oppose this. It is the practice of restricting the movements of the child, such as being wrapped in a blanket. There are those who argue that this pressure has a calming effect on the child.
• Desensitization: It is a time consuming method. At home, the child with autism is gradually accustomed to basic dental procedures in small steps.
• Voice control: Before dental treatments, voice control exercises are performed by families at home to prepare the child with autism in the clinic. Simple commands such as “open your mouth”, “look at me” are tried. It can give successful results in children without hearing problems.
• Reward: Rewarding positive, desired behaviors. Rewards are made, such as being appreciated and making sure that he can achieve something he wants.
• Distraction: It may be helpful to distract the child with autism during dental examinations or simple procedures. Techniques such as watching cartoons, listening to music, giving special toys can be tried.
• Reducing sensory exposures: Children with autism should not be exposed to unpleasant-tasting toothpastes. Rechargeable toothbrushes can be tried. Toothpaste with acceptable taste can be preferred.
• Preliminary interview: A pre-visit meeting with the family dentist may be helpful in determining the possible behaviors of the autistic child during the visit.