Oral Health Fact Sheet for Medical Professionals Treating Children with Autism Spectrum Disorder
Autistic disorder is the abnormal or impaired development in social interaction and communication coupled with a restricted repertoire of activity and interest. Manifestations of the disorder vary depending on the developmental level and chronological age of the individual. (ICD 9 Code 299.0)
Oral Manifestations and Considerations
Oral
- Bruxism (20-25%)
- Non-nutritive chewing
- Tongue thrusting
- Self-injury (picking at gingiva, biting lips) creating ulcerations
- Caries-similar to general population, however some children receive sweet foods as behavioral rewards (suggest sugar-free substitutes)
- Poor oral hygiene since home care measures are exceedingly difficult for many children/parents
- Many patients have very limited dietary preferences (exclusively pureed foods, no fruits/vegetables, etc.)
Other Potential Disorders/Concerns
- 70% with cognitive impairment; 40% of whom are “severe”
- Epilepsy over 30% have experienced seizures by adolescence
- Depression/Anxiety
- Attention Deficit Hyperactivity Disorder (ADHD)
- Obsessive Compulsive Disorder (OCD)
- Schizophrenia
Oral Side Effects of Commonly Prescribed Medications
| SYMPTOM | MEDICATION | SIDE EFFECTS |
|---|---|---|
| Hyperactivity | A. CNS Stimulants (Methylphenidate) | A. Xerostomia |
| B. Antihypertensive (Clonidine) | B. Xerostomia, dysphagia, sialadenitis. May cause orthostatic hypotension and potentiate CNS depression of other CNS depressants used in dentistry | |
| Repetitive Behaviors | Antidepressants (Fluoxetine and Sertraline) | Xerostomia, dysphagia, sialadenitis, dysgeusia, stomatitis, gingivitis, glossitis, discolored tongue, bruxism |
| Agressive Behaviors | A. Anticonvulsants (Carbamazepine and Valproate) | A. Xerostomia, stomatitis, glossitis, dysgeusia. Excessive bleeding may result when either medication is combined with aspirin or nonsteroidal anti-inflammatory drugs |
| B. Antipsychotics (Olanzapine and Risperidone) | B. Xerostomia, sialorrhea, dysphagia, dysgeusia, stomatitis, gingivitis, tongue edema, glossitis, discolored tongue |
Xerostomia is highly conducive to dental caries.
Parent/Caregiver Support and Guidance
- Discourage consumption of cariogenic (cavity causing) foods and beverages.
- Prescribe sugar-free medications, if available.
- Recommend preventive measures such as topical fluoride and sealants.
- Advise brushing teeth with fluoridated toothpaste twice daily. Have parents be cautious with power toothbrushes which can be too stimulating for some children.
- Instruct caregiver on appropriate protocol following dental trauma (locate/preserve missing tooth and put in cold milk; seek immediate professional care).
- Review safety issues appropriate to the age of the child, such as mouth guards to prevent oral-facial trauma.
- Recommend rinsing with water thoroughly after taking each dose of sugar containing medication and suggest frequent water intake for children taking xerostomic medications.
- Discuss habits that may harm the child’s teeth, such as propping baby bottles, putting child to bed with bottle.
- Refer to dentist any oral developmental abnormalities.
References
- Friedlander, A.H., Yagiela, J.A., Paterno, V.I., Mahler, M.E. (2006) The neuropathology, medical management and dental implications of autism. J Am Dent Assoc, 137(11): 1517-1527.
- Loo, C., Graham, R., Hughes, C. (2008) The caries experience and behavior of dental patients with autism spectrum disorder. J Am Dent Assoc, 139: 1518-1524.
- Ming, X., Brimacombe, M., Chaaban, J., Zimmerman-Bier, B., Wagner, G. C. (2008). Autism Spectrum Disorders: Concurrent Clinical Disorders. Journal of Child Neurology. 23, 6-13
Additional Resources
- NIH institute for Autism Spectrum Disorders
- Special Care: an Oral Health Professionals Guide to Serving Young Children with Special Health Care Needs
- Bright Futures Oral Health Pocket Guide
- American Academy of Pediatric Dentistry: 2011–2012 Definitions, Oral Health Policies and Clinical Guidelines
- MCH Resource Center
- ASTDD – Special Needs
- Block Oral Disease, MA
- Free of charge CDE courses: MCH Oral Health CDE (4 CDE hours) NIDCR CDE (2 CDE hours)
Permission is given to reproduce this fact sheet. Oral Health Fact Sheets for Patients with Special Needs © 2011 by University of Washington and Washington State Oral Health Program.
Fact sheets developed by the University of Washington DECOD (Dental Education in the Care of Persons with Disabilities) Program through funding provided to the Washington State Department of Health Oral Health Program by HRSA grant #H47MC08598).
For persons with disabilities, this document is available on request in other formats. To submit a request, please call 1-800-525-0127 (TTY/TDD 1-800-833-6388).