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PICA Disorder with Autism: Intervention in Dental Settings

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PICA Disorder with Autism: Intervention in Dental Settings Review__________________ Article _________________________________ ____________________ J Res Adv Dent 2015; 4:3:281-291. PICA Disorder with Autism: Intervention In Dental Settings Harender Singh1* Surbhi Agarwal2 Vikas Singh3 Rahila Rehman4 Nitin Patwardhan5 1Post Graduate Student, Department of Public Health Dentistry, Teerthanker Mahaveer Dental College, Moradabad, U.P, India. 2Reader, Department of Pedodontics, Teerthanker Mahaveer Dental College, Moradabad, U.P, India. 3Senior Lecturer, Department of Public Health Dentistry, Teerthanker Mahaveer Dental College, Moradabad, U.P, India. 4M.Phil, Educational & Career Guidance Counselor, Ghaziabad, U.P, India. 5Professor, Department of Public Health Dentistry, Teerthanker Mahaveer Dental College, Moradabad, U.P, India. ABSTRACT Background: This review provides information on the dental intervention of pica disorder in autistic people. Before stepping on to the intervention part, it throws light on the meaning, sign and symptoms, etiology of the disorder etc. Pica is an eating disorder typically defined as the persistent eating or mouthing of non-nutritive substances. A dental complication depends on the duration and the type of material eaten leading to abrasion, erosion, staining of teeth, periodontal problems, poor hygiene and halitosis. Generally it has been found in several studies that pica is developed in autistic people with a rapid speed. 30% of children with autism have moderate to severe pica. For an effective dental intervention a dentist must know how to deal pica in a person with autism. Diagnostic criteria and important guidelines for the treatment should be followed by the care giver and dentists. Keywords: Autism, Dental intervention, Pica. INTRODUCTION surroundings. They do not respond appropriately to common verbal and social cues given to them. This Pica can be defined as an eating disorder disorder includes obsessive routines, unpredictable typically including the continual eating or mouthing body movements, repetitive behaviors, and self- of inedible or non-nutritive substances. The word detrimental behavior along with some dental ‘pica’ is derived from the Latin word used for complications due to the development of some ‘magpie’, a kind of bird that is famous for eating eating disorders, such as ‘pica’. 4 almost anything. Pica is often observed in all the stages of life i.e. infancy, childhood, adolescence and The exact calculation of the patients with later stages of life. It has generally been combined pica is not known, but the research estimation with developmental disabilities (autism or mentally reported that pica generally seen in 75% infants, retarded) and seen in pregnant women also. In this 15% in two-three year old kids and 10-33% among disorder patient is indulged in eating inedible or the autistic patients and institutionalized mentally non-nutritive substances.1-3 This disorder is retarded children.5,6 generally found with autism, it is essential to know the Autism, it is a difficult developmental disability PICA WITH AUTISM that interrupts normal communication, social, Pica is often observed in patients with behavioral, and intellectual activities. People with autism and mentally disabled people, as they make autism often observed distant, unfriendly, or them detached from their surroundings and separate from other people or from their develop their own alone world. They do not _______________________________________________________________________________________ Copyright ©2015 participate in social groups and other activities, and It might be said that some of these items are often spend their time in doing some specific harmless but some items such as lead-based paint behaviours, one of them is kept busy in eating non- chips and pebbles or hard substances, are nutritive or inedible material, which give them dangerous and can cause lead poisoning or tooth satisfaction. Various researches reported that 60- erosion. Thus children with pica may be at risk for 66% people with autism often develop pica, which other serious health problems including: show the intense relationship in such disorders. bowel problems (from consuming Pica, united with autism spectrum disorder indigestible substances like hair) was demonstrated to show the slightest amount of intestinal obstruction or perforation (from social activities and pro-social behavior. One more eating objects that could get lodged in the fact regarding this disorder is that a large amount of intestines) negative behavior was found in patients with a dental injury (from eating hard items like combination of pica and autism, when the buttons) comparison made between groupings with single parasitic infections (from eating dirt or disorders. This concluding statement was given by feces)7,8 researchers studying on adults and their degree to which autism and intellectual disabilities combined SIGN & SYMPTOMS with pica in them, and the result showed that they The section provides information regarding have a lack of social skills. This study was published clinical presentation of pica with autism. It is in the month of October 2012 issued in The Journal essential for every parents/healthcare provider to of Developmental and Physical Disorders, and the keenly observe the unusual symptoms of eating results claimed that adults having intellectual habits and social behavior of a child/person to early disabilities and/or with ASD are frequently detection of such disorders to provide suitable observed at risk for rising additional forms of treatment with the help of clinical practitioners to psychopathology and/or challenging behaviors, prevent it as early as possible. Here are some sign including pica.6 and symptoms given below regarding ‘pica’ and ITEMS INTAKEN BY PATIENT WITH PICA ‘autism spectrum disorder’: DISORDER Pica Disorder: It is highly changeable and The people suffering with developmental is correlated with the particular nature of the disabilities, including autism and mental consequential medical conditions and the retardation, frequently exhibit pica behavior, in the substances ingested by the person. In the case of in age between 2 to 3. According to Meredith Garrity taking of poisonous or infectious agents, the (clinical director of May Institute’s school for observed symptoms are tremendously variable and children with autism in Arlington) children younger are associated with the kind of toxin or infectious than 2, frequently put inedible items in their agent ingested. mouths, but all those behaviours may not Physical findings of pica may include the following: considered as eating disorder or pica. But if this type of behavior is consistent in the children, then Manifestations of toxic intake (i.e. lead its psychological and dental intervention is strongly poisoning) recommended. Some of the non-food items that Manifestations of infection or parasitic people with pica crave and consume includes: dirt, infestation (i.e. toxocariasis and ascariasis) clay, paint chips, plaster, chalk, cornstarch, laundry GI manifestations (i.e. constipation, starch, baking soda, coffee grounds, cigarette ashes, mechanical bowel problems, ulcerations, burnt match heads, cigarette buds, feces, ice, glue, intestinal obstructions and perforations) hair, buttons, paper, sand, toothpaste & etc. Dental manifestations (i.e. abfraction, severe tooth abrasion, and tooth erosion) EFFECT OF PICA DISORDER 282 Repetitive ingestion of nonfood items, in 2) Coprophagy: A rare eating disorder that spite of various efforts to restrict it, for a includes eating of feces is called period of at least 1 month or longer coprophagy. It is often seen among animals The behavior is measured as improper but very rarely in human beings. according to child's age or developmental stage (older than 18 to 24 months) 3) Geophagy: A compulsive eating of soil-like The behavior must not be considered as a or earthy substances i.e. clay, chalk, soil etc. part of a cultural, ethnic, or religious It is common among children and pregnant practice.8,9 women. Autism Spectrum Disorder: Before starting any 4) Lithophagia: It is another form of dental intervention of the patient with, it is essential geophagia, it includes a craving to intake for the practitioner to observe the patients behavior pebbles, pieces of bricks, stones etc. It is to find out any other combined disease with pica, generally seen in children. such as Autism. In the dental intervention of pica, if 5) Hyalophagia: This disorder is consists the a person is suffering from autism, he/she does not ingestion of glass objects. This is usually cooperate in treatment. Thus a pre-treatment observed as a performance technique by observation of the following symptoms of Autism performers. will be helpful for the practitioner to plan the intervention strategy accordingly. Autism can 6) Mucophagia: A includes the consumption severely impair the patient’s ability to of mucus of the invertebrates and fishes is communicate, interact with others and maintain called mucophagia. normal contact with the outside world. Symptoms can range from very mild to very severe. 7) Pagophagia: This form of includes excessive consumption of ice cubes or iced Lack of consistent use of eye contact. drinks. It is known as pagophagia. This Lack of interest in others. condition is associated with the iron Lack of social smile, response to name, deficiency or minerals deficiency. imitation. Lack of emotional expression. 8) Self-cannibalism: This form of pica Lack of directed vocalizations. includes
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