Improving Compliance in Patients With Autism Spectrum Disorders
Treating patients with autism spectrum disorder requires compassion, patience, and ingenuity. This slideshow focuses on how you can provide safe and effective care to this patient population.
Autism spectrum disorder (ASD) is a complex, lifelong developmental disability that impairs communication, as well as social, behavioral, and intellectual functioning. Behaviors can range from aggression and being inattentive or hyperactive, to having a short attention span and/or having difficulty listening. It can also manifest as anxiety, extreme mood swings, being oppositional defiant, and/or obsessive-compulsive. Communication deficits, sensory perception/overstimulation, obsessive routines, repetitive behaviors, unpredictable body movements, and self-injurious behavior can cause some patients with ASD to exhibit poor oral hygiene. In order to provide effective care, oral health professionals should be knowledgeable about management strategies for patients with ASD.
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Managing Sensory-Related Aspects of Oral Care
Sensory-related features of oral care are of prime importance when treating patients with ASD. Often, these patients do not like having the tongue touched or the teeth brushed; they may also dislike the taste and texture of all brands of dentifrice, and prove uncooperative during treatment. In addition, this population may dislike bright lights, loud sounds, smells, touching the inside of the mouth, or leaning back in the dental chair. Providers should implement strategies to mitigate sensory difficulties, such as reducing unnecessary sights, sounds, odors, or other stimuli. Additional anxiety-reducing methods include booking early day appointments when patients are most rested and blocking the schedule to minimize surrounding stimuli. Another technique is to desensitize the oral cavity through intense pressure therapy in areas away from the mouth. Finally, providing written instructions for care and appointment reminders will reduce issues with overbrushing and missed appointments.
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When treating patients with ASD, the planning phase should involve interprofessional collaboration as part of a team approach to care. Collaboration advances oral care; an example would be partnering with a registered dietitian and/or physician to manage nutritional selections that support oral health. This may help limit sugary and acidic diets that exacerbate oral disease. Occupational therapists are helpful partners in mitigating sensory sensitivities in relation to oral health; similar collaborations can also prove beneficial when finding ways to work through patients’ damaging oral habits.
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Seeking Family Support
In addition, collaboration with family members and caregivers is necessary to authorize protective stabilization techniques. For patients who have issues with cooperation, tongue thrusting, or nonnutritive chewing, stabilization of the patient’s head, lips, and tongue is needed to maintain procedural safety. This can be achieved with rolled towels, pillows, and bite blocks. Another strategy to comfort this patient population is to leave the lead X-ray apron draped over the patient for the duration of the appointment. In order to provide safe care, communicating each step of the procedure to the patient and/or parent/caregiver minimizes anxiety and aids in patient compliance.
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Strategies for Success
Oral care providers can more effectively communicate treatment and provide a dental environment tailored for patients with ASD by drawing from special techniques, such as desensitizing, developing a sensory adapted environment, utilizing a picture exchange communication system, and knowing when to refer for advanced behavior guidance techniques. This patient group can undergo desensitizing via a minimal threshold examination in which the exam is done with an intraoral mirror while the patient is seated in the dental chair. Results might take a few sessions, but the goal is to create a favorable dental experience starting with the first appointment.
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Clinicians should be prepared for patients whose ability to communicate varies significantly. Individuals exhibiting a measureable level of communication ability can benefit from the tell-show-do approach, voice control, and positive reinforcement behavior management techniques. Nonverbal patients with more severe levels of autism will likely not respond to conventional behavior management (especially if they are combative), and may require restraints, sedation, and/or general anesthesia.