The neuropathology, medical management and dental implications of autism

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ABSTRACT

Background

A paucity of information exists in the dental literature about autism and its dental implications.

Types of Studies Reviewed

The authors conducted a MEDLINE search for the period 2000 through 2006, using the term “autism,” with the aim of defining the condition's clinical manifestations, dental and medical treatment and dental implications.

Results

Autism is a severe developmental brain disorder that appears in infancy, persists throughout life, and is characterized by impaired social interaction, abnormalities in communication (both verbal and nonverbal) and restricted interests. Often accompanying the disorder are behavioral disturbances—such as self-mutilation, aggression, psychiatric symptoms and seizures—that necessitate the administration of multiple medications to help the affected person participate effectively in the educational and rehabilitative process.

Clinical Implications

Dentists caring for people with autism must be familiar with the manifestations of the disease and its associated features so that they can garner the maximum level of patient cooperation. They also must be familiar with the medications used to treat the associated features of the disorder because many of them cause untoward orofacial and systemic reactions and may precipitate adverse interactions with dental therapeutic agents.

Section snippets

AUTISM

Autism (also known as “autistic disorder” and “classic autism”) is a neurodevelopmental disorder in which social interaction, language, behavior and cognitive functions are impaired severely.1, 2 Interpersonal skill weaknesses are evident during infancy, when the baby does not seek the attention of the care-giver and fails to cuddle, make direct eye contact, raise arms in anticipation of being picked up, engage in imitation games (for example, peekaboo), point to or show an object such as a toy

ADVERSE EFFECTS OF DRUG THERAPY AND THEIR DENTAL IMPLICATIONS

Many of the drugs used to treat the associated features of autism have systemic side effects (Table 2), orofacial side effects and adverse orofacial interactions with drugs used in dentistry (Table 3, pages 1524 and 1525).65, 66, 67, 68, 69, 70, 71

Risperidone and olanzapine are classified as “atypical” antipsychotic medications and often are prescribed to people with autism to manage the symptoms of irritability, agitation, self-injurious behavior, aggressivity, repetitive behaviors, delusions

DENTAL TREATMENT OF PATIENTS WITH AUTISM

Patients with autism will exhibit wide variation in their level of understanding and ability to cooperate during dental treatment. A preliminary office visit to assess their capabilities, obtain a medical history and gauge the extent of dental disease should be arranged. It is best to conduct the first two components of this analysis in the dentist's private office rather than in the operatory, because the dental examination light and the noise of a dental engine (even if in another operatory)

CONCLUSIONS

With the high prevalence of children with autism, dentists are likely to have one or more children with this disorder in their practice. As dentists, we must exhibit compassion as we provide care to patients with autism, as well as to their family members and caregivers when they request assistance in the preventive aspects of care. Our expectations as dentists, however, must be tempered by the realization that the patient's preventive dental needs constitute only a small component of their

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  • Cited by (0)

    1

    Dr. Friedlander is associate chief of staff and director of graduate medical education, VA Greater Los Angeles Healthcare System, director of quality assurance, Hospital Dental Service, University of California Los Angeles Medical Center, and professor-in-residence, Oral and Maxillofacial Surgery, University of California Los Angeles School of Dentistry.

    2

    Dr. Yagiela is a professor and chair, Diagnostic and Surgical Sciences, University of California Los Angeles School of Dentistry, and a professor of anesthesiology, David Geffen School of Medicine, University of California Los Angeles.

    3

    Dr. Paterno is an assistant clinical professor, Pediatrics, David Geffen School of Medicine, University of California Los Angeles.

    4

    Dr. Mahler is director of organizational improvement, VA Greater Los Angeles Healthcare System, an attending neurologist, Neurobehavior Clinic, VA Greater Los Angeles Healthcare System, and a professor of neurology, David Geffen School of Medicine, University of California Los Angeles.

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