Practical Oral care for People with Autism Stress the importance of conscientious Making a difference in the oral health oral hygiene and frequent prophylaxis. of a person with autism may go slowly at first, but determination can TOOTH ERUPTION may be delayed due bring positive results—and invaluable to phenytoin-induced gingival hyperplasia. rewards. By adopting the strategies Phenytoin is commonly prescribed for discussed in this booklet, you can contents roviding oral care to people with autism requires adaptation of the people with autism. have a significant impact not only on your patients’ oral health, but on their Health Challenges skills you use every day. In fact, most people with mild or moderate TRAUMA and INJURY to the mouth quality of life as well. IN autism and from falls or accidents occur in people Strategies for Care forms of autism can be treated successfully in the general practice with seizure disorders. Suggest a tooth- 2 ...... saving kit for group homes. Emphasize to Additional Readings Communication problems Psetting. This booklet will help you make a difference in the lives of people and mental capabilities caregivers that traumas require immediate Hyman SL, Towbin K. Autism Spectrum This booklet is one in a series on providing oral care for people professional attention and explain the Disorders. In Batshaw ML, Pellegrino L, Behavior problems who need professional oral care. with mild or moderate developmental disabilities. The issues and 3 ...... procedures to follow if a permanent tooth Roizen NJ (eds.). Children With Disabilities care strategies listed are intended to provide general guidance on is knocked out. Also, instruct caregivers (6th ed.). Baltimore, MD: Paul H. Brookes Unusual responses how to manage various oral health challenges common in people to stimuli Autism is a complex developmental disability that impairs communication to locate any missing pieces of a fractured Publishing Co., 2007. with autism. Unusual and unpredictable tooth, and explain that radiographs of National Institute of Dental and social, behavioral, and intellectual functioning. Some people with the National Institute of Child Health and and Craniofacial Research Other booklets in this series: body movements the patient’s chest may be necessary to Human Development, National Institutes of Seizures determine whether any fragments have Health (NIH). Autism Questions and Answers Continuing Education: Practical Oral Care for People disorder appear distant, aloof, or detached from other people or from their been aspirated. for Health Professionals. Retrieved July 9, With Developmental Disabilities Oral Health Problems 2009, from http://www.nichd.nih.gov/publi- IN autism and surroundings. Others do not react appropriately to common verbal and social Physical abuse often presents as oral cations/pubs/autism/QA/index.cfm. Practical Oral Care for People With Cerebral Palsy Strategies for Care trauma. Abuse is reported more frequently 4 ...... cues, such as a parent’s tone of voice or smile. Obsessive routines, repetitive Practical Oral Care for People With Down Syndrome in people with developmental disabilities National Institute of Child Health and Damaging oral habits behaviors, unpredictable body movements, and self-injurious behavior may than in the general population. If you Human Development, National Institutes of Practical Oral Care for People With Intellectual Disability Dental caries Autism Spectrum Disorders suspect that a child is being abused or Health (NIH). . Periodontal disease Retrieved July 9, 2009, from http://www. Wheelchair Transfer: A Health Care Provider’s Guide all be symptoms that complicate dental care. neglected, State laws require that you call nichd.nih.gov/health/topics/asd.cfm. 5 ...... your Child Protective Services agency. Centers for Disease Dental Care Every Day: A Caregiver’s Guide Tooth eruption Assistance is also available from the NLM Family Foundation. D-Termined Control and Prevention Trauma and injury Autism varies widely in symptoms

Childhelp® National Child Abuse Hotline program of repetitive tasking and SAFER • HEALTHIER • PEOPLETM Additional readings Making a difference at (800) 422–4453 or the Child familiarization in dentistry: a behavior and severity, and some people management approach. View at in the oral health of Welfare Information Gateway have coexisting conditions such as (www.childwelfare.gov). http://www.nlmfoundation.org/media.htm. Special Care Dentistry a person with autism Association AckNOwlEdgMENTs intellectual disability or epilepsy. They may go slowly at first, The National Institute of Dental and Craniofacial Research can be among the most challenging of thanks the oral health professionals and caregivers who but determination can For more information about autism, contact contributed their time and expertise to reviewing and patients, but following the suggestions pretesting the Practical Oral Care series. bring positive results and National Institute of Child Health and Human For additional copies of this booklet, contact in this booklet can help make their Development Information Resource Center Expert Review Panel National Institute of Dental and Craniofacial Research invaluable rewards. • Mae Chin, RDH, University of Washington, Seattle, WA P.O. Box 3006 National Oral Health Information Clearinghouse dental treatment successful. Rockville, MD 20847 1 NOHIC Way • Sanford J. Fenton, DDS, University of Texas, Houston, TX (800) 370–2943 Bethesda, MD 20892–3500 1–866–232–4528 • Ray Lyons, DDS, New Mexico Department of Health, www.nichd.nih.gov www.nidcr.nih.gov Albuquerque, NM [email protected] • Christine Miller, RDH, University of the Pacific, This publication is not copyrighted. San Francisco, CA Make as many photocopies as you need. • Steven P. Perlman, DDS, Special Olympics Special Smiles, Lynn, MA NIH Publication No. 09–5190 5 Reprinted July 2009 • David Tesini, DMD, Natick, MA U.s. dEPARTMENT OF HEAlTH ANd HUMAN sERVIcEs l NATIONAL INSTITUTeS OF HeALTH l National Institute of Dental and Craniofacial Research autism

Health Challenges in Autism • Once your patient is seated, allow you to provide care safely. Allow time for your patient to adjust Be prepared to manage a seizure. If them quickly. Do not attempt to insert begin a cursory examination Immobilization should not cause and become desensitized to the noise one occurs during oral care, remove any objects between the teeth during and Strategies for Care using your ­fingers. physical injury or undue discomfort. of a dental setting. Some patients any instruments from the mouth a seizure. may be hypersensitive to the sound and clear the area around the dental • Next, use a toothbrush to brush the If all other strategies fail, pharmaco- Stay with your patient, turn him or her Before the appointment, obtain and review of dental instruments. chair. Attaching dental floss to rubber teeth and gain additional access to logical options are useful in managing to one side, and monitor the airway to the patient’s medical history. Consultation dam clamps and mouth props when the patient’s mouth. The familiarity some patients. Others need to be Talk to the caregiver to get a sense of reduce the risk of aspiration. with physicians, family, and caregivers is treatment begins can help you remove of a toothbrush will help your patient treated under general anesthesia. the patient’s level of tolerance. People essential to assembling an accurate medical feel comfortable and provide you with However, caution is necessary because with autism differ in how they accept history. Also, determine who can legally an opportunity to further examine some patients with developmental physical contact. Some are defensive provide informed consent for treatment. the mouth. disabilities can have unpredictable and refuse any contact in or around the medicines when available, and rinse reactions to medications. mouth, or cradling of the head or face. oral Health problems in Autism Communication problems and When the patient is prepared for with water after taking any medicine. Others find such cradling comforting. mental capabilities are central treatment, make the appointment People with autism often engage in and Strategies for Care Advise caregivers to offer alternatives concerns when treating people with autism. short and positive. per severation, a continuous, meaningless Note your findings and experiences in to cariogenic foods and beverages as repetition of words, phrases, or the patient’s chart. People with autism experience few Talk with the parent or caregiver to Pay special attention to the treatment incentives or rewards. movements. Your patient may mimic unusual oral health conditions. Although determine your patient’s intellectual setting. Keep dental instruments out of Encourage independence in daily oral the sound of the suction, for example, unusual and unprediCtable commonly used medications and damaging and functional abilities, and then sight and light out of your patient’s eyes. hygiene. Ask patients to show you how or repeat an instruction over and again. body movements are sometimes oral habits can cause problems, the rates communicate with the patient at a they brush, and follow up with specific Praise and reinforce good behavior after Avoid demonstrating dental equipment observed in people with autism. These of caries and periodontal disease in people level he or she can understand. recommendations. Perform hands-on each step of a procedure. Ignore inap- if it triggers perseveration, and note movements can jeopardize safety as well with autism are comparable to those in demonstrations to show patients the best Use a “tell-show-do” approach to propriate behavior as much as you can. this in the patient’s record. as your ability to deliver oral health care. the general population. Communication pro viding care. Start by explaining and behavioral problems pose the most way to clean their teeth. If appropriate, Try to gain cooperation in the least Make sure the path from the reception each procedure before it occurs. unusual responses to stimuli significant challenges in providing oral care. show patients and caregivers how a People with restrictive manner. Some patients’ area to the dental chair is clear. Take the time to show what you have can create distractions and interrupt modified toothbrush or floss holder behavior may improve if they bring damaging oral habits autism need explained, such as the instruments treatment. People with autism need Observe the patient’s movements and are might make oral hygiene easier. comfort items such as a stuffed animal common and include bruxism; tongue consistency and you will use and how they work. consistency and can be especially sensitive look for patterns. Try to anticipate Some patients cannot brush and floss or a blanket. Asking the caregiver to sit thrusting; self-injurious behavior such as Demonstrations can encourage some to changes in their environment. They the movements, either blending your independently. Talk to caregivers can be especially nearby or hold the patient’s hand may Record in the picking at the gingiva or biting the lips; patients to be more cooperative. may exhibit unusual sensitivity to sensory movements with those of your patient about daily oral hygiene and do not be helpful as well. patient’s chart and pica—eating objects and substances sensitive to stimuli such as sound, bright colors, and or working around them. assume that they know the basics. Behavior problems—which such as gravel, cigarette butts, or pens. If Use immobilization techniques only strategies that touch. Reactions vary: Some people with Use your experiences with each patient changes in their may include hyperactivity and quick seizures a mouth guard can be tolerated, prescribe when absolutely necessary to protect autism may overreact to noise and touch, may accompany autism but can to demonstrate oral hygiene techniques frustration—can complicate oral health were successful one for patients who have problems with environment. the patient and staff during dental while exposure to pain and heat may not usually be controlled with anti convulsant and sitting or standing positions for the care for patients with autism. The invasive in providing care. self-injurious behavior or bruxism. treatment—not as a convenience. provoke much reaction at all. medications. The mouth is always at risk caregiver. Emphasize that a consistent nature of oral care may trigger violent There are no universal guidelines Note your patient’s during a seizure: Patients may chip teeth Use the same staff, dental operatory, and dental Caries risk increases in patients approach to oral hygiene is important— and self-injurious behavior such as temper on immobilization that apply to all or bite the tongue or cheeks. People with preferences and appointment time to sustain familiarity. who have a preference for soft, sticky, or caregivers should try to use the same tantrums or head banging. treatment settings. Before employing controlled seizure disorders can easily be other unique details These details can help make dental sweet foods; damaging oral habits; and location, timing, and positioning. Plan a desensitization appointment to any kind of immobilization, it may treated in the general dental office. treatment seem less threatening. difficulty brushing and flossing. help the patient become familiar with help to consult available guidelines that will facilitate Consult your patient’s physician. periodontal disease occurs in the office, staff, and equipment through on federally funded care, your State treatment, such Minimize the number of distractions. Record information in the chart Recommend preventive measures such people with autism in much the same Try to reduce unnecessary sights, as fluorides and sealants. a step-by-step process. These steps may department of mental health/disabilities, as music, comfort about the frequency of seizures and way it does in persons without sounds, odors, or other stimuli that take several visits to accomplish. and your State Dental Practice Act. the medications used to control them. Caution patients or their caregivers developmental disabilities. Guidelines on behavior management items, and might be disruptive. Use an operatory • Have the patient sit alone in the Determine before the appointment about medicines that reduce saliva or Some patients benefit from the daily published by the American Academy of flavor choices. that is somewhat secluded instead of one ­dental chair to become familiar whether medications have been taken as contain sugar. Suggest that patients use of an antimicrobial agent such Pediatric Dentistry (www.aapd.org) may in the middle of a busy office. Also, with the treatment setting. Some directed. Know and avoid any factors drink water often, take sugar-free as chlorhexidine. also be useful. Obtain consent from consider lowering ambient light and patients may refuse to sit in the that trigger your patient’s seizures. your patient’s legal guardian and choose asking the patient’s caregiver whether chair and choose instead to sit on the least restrictive technique that will soft music would help. TipS for CAregiverS Are AvAilAble in THe bookleT the operator’s stool. Dental Care every Day: a Caregiver’s guiDe, AlSo pArT of THiS SerieS.

2 3 4 autism

Health Challenges in Autism • Once your patient is seated, allow you to provide care safely. Allow time for your patient to adjust Be prepared to manage a seizure. If them quickly. Do not attempt to insert begin a cursory examination Immobilization should not cause ­ and become desensitized to the noise one occurs during oral care, remove any objects between the teeth during and Strategies for Care using your fingers. physical injury or undue discomfort. of a dental setting. Some patients any instruments from the mouth a seizure. may be hypersensitive to the sound and clear the area around the dental • Next, use a toothbrush to brush the If all other strategies fail, pharmaco- Stay with your patient, turn him or her Before the appointment, obtain and review of dental instruments. chair. Attaching dental floss to rubber teeth and gain additional access to logical options are useful in managing to one side, and monitor the airway to the patient’s medical history. Consultation dam clamps and mouth props when the patient’s mouth. The familiarity some patients. Others need to be Talk to the caregiver to get a sense of reduce the risk of aspiration. with physicians, family, and caregivers is treatment begins can help you remove of a toothbrush will help your patient treated under general anesthesia. the patient’s level of tolerance. People essential to assembling an accurate medical feel comfortable and provide you with However, caution is necessary because with autism differ in how they accept history. Also, determine who can legally an opportunity to further examine some patients with developmental physical contact. Some are defensive provide informed consent for treatment. the mouth. disabilities can have unpredictable and refuse any contact in or around the medicines when available, and rinse reactions to medications. mouth, or cradling of the head or face. oral Health problems in Autism CommuniCation problems and When the patient is prepared for with water after taking any medicine. Others find such cradling comforting. mental Capabilities are central treatment, make the appointment People with autism often engage in and Strategies for Care Advise caregivers to offer alternatives concerns when treating people with autism. short and positive. per severation, a continuous, meaningless Note your findings and experiences in to cariogenic foods and beverages as repetition of words, phrases, or the patient’s chart. People with autism experience few Talk with the parent or caregiver to Pay special attention to the treatment incentives or rewards. movements. Your patient may mimic unusual oral health conditions. Although determine your patient’s intellectual setting. Keep dental instruments out of Encourage independence in daily oral the sound of the suction, for example, Unusual and unpredictable commonly used medications and damaging and functional abilities, and then sight and light out of your patient’s eyes. hygiene. Ask patients to show you how or repeat an instruction over and again. body movements are sometimes oral habits can cause problems, the rates communicate with the patient at a they brush, and follow up with specific Praise and reinforce good behavior after Avoid demonstrating dental equipment observed in people with autism. These of caries and periodontal disease in people level he or she can understand. recommendations. Perform hands-on each step of a procedure. Ignore inap- if it triggers perseveration, and note movements can jeopardize safety as well with autism are comparable to those in demonstrations to show patients the best Use a “tell-show-do” approach to propriate behavior as much as you can. this in the patient’s record. as your ability to deliver oral health care. the general population. Communication pro viding care. Start by explaining and behavioral problems pose the most way to clean their teeth. If appropriate, Try to gain cooperation in the least Make sure the path from the reception each procedure before it occurs. unusual responses to stimuli significant challenges in providing oral care. show patients and caregivers how a People with restrictive manner. Some patients’ area to the dental chair is clear. Take the time to show what you have can create distractions and interrupt modified toothbrush or floss holder behavior may improve if they bring damaging oral habits autism need explained, such as the instruments treatment. People with autism need Observe the patient’s movements and are might make oral hygiene easier. comfort items such as a stuffed animal common and include bruxism; tongue consistency and you will use and how they work. consistency and can be especially sensitive look for patterns. Try to anticipate Some patients cannot brush and floss or a blanket. Asking the caregiver to sit thrusting; self-injurious behavior such as Demonstrations can encourage some to changes in their environment. They the movements, either blending your independently. Talk to caregivers can be especially nearby or hold the patient’s hand may Record in the picking at the gingiva or biting the lips; patients to be more cooperative. may exhibit unusual sensitivity to sensory movements with those of your patient about daily oral hygiene and do not be helpful as well. patient’s chart and pica—eating objects and substances sensitive to stimuli such as sound, bright colors, and or working around them. assume that they know the basics. behavior problems—which such as gravel, cigarette butts, or pens. If Use immobilization techniques only strategies that touch. Reactions vary: Some people with Use your experiences with each patient changes in their may include hyperactivity and quick Seizures a mouth guard can be tolerated, prescribe when absolutely necessary to protect autism may overreact to noise and touch, may accompany autism but can to demonstrate oral hygiene techniques frustration—can complicate oral health were successful one for patients who have problems with environment. the patient and staff during dental while exposure to pain and heat may not usually be controlled with anti­convulsant and sitting or standing positions for the care for patients with autism. The invasive in providing care. self-injurious behavior or bruxism. treatment—not as a convenience. provoke much reaction at all. medications. The mouth is always at risk caregiver. Emphasize that a consistent nature of oral care may trigger violent There are no universal guidelines Note your patient’s during a seizure: Patients may chip teeth Use the same staff, dental operatory, and dental Caries risk increases in patients approach to oral hygiene is important— and self-injurious behavior such as temper on immobilization that apply to all or bite the tongue or cheeks. People with preferences and appointment time to sustain familiarity. who have a preference for soft, sticky, or caregivers should try to use the same tantrums or head banging. treatment settings. Before employing controlled seizure ­disorders can easily be other unique details These details can help make dental sweet foods; damaging oral habits; and location, timing, and positioning. Plan a desensitization appointment to any kind of immobilization, it may treated in the general dental office. treatment seem less threatening. difficulty brushing and flossing. help the patient become familiar with help to consult available guidelines that will facilitate Consult your patient’s physician. periodontal disease occurs in the office, staff, and equipment through on federally funded care, your State treatment, such Minimize the number of distractions. Record information in the chart Recommend preventive measures such people with autism in much the same Try to reduce unnecessary sights, as fluorides and sealants. a step-by-step process. These steps may department of mental health/disabilities, as music, comfort about the frequency of seizures and way it does in persons without sounds, odors, or other stimuli that take several visits to accomplish. and your State Dental Practice Act. the ­medications used to control them. Caution patients or their caregivers developmental disabilities. Guidelines on behavior management items, and might be disruptive. Use an operatory • Have the patient sit alone in the Determine before the appointment about medicines that reduce saliva or Some patients benefit from the daily published by the American Academy of flavor choices. that is somewhat secluded instead of one dental chair to become familiar whether medications have been taken as contain sugar. Suggest that patients use of an antimicrobial agent such Pediatric Dentistry (www.aapd.org) may in the middle of a busy office. Also, with the treatment setting. Some directed. Know and avoid any factors drink water often, take sugar-free as chlorhexidine. also be useful. Obtain consent from consider lowering ambient light and patients may refuse to sit in the that trigger your patient’s seizures. your patient’s legal guardian and choose asking the patient’s caregiver whether chair and choose instead to sit on the least restrictive technique that will soft music would help. TipS for CAregiverS Are AvAilAble in THe bookleT the operator’s stool. Dental Care every Day: a Caregiver’s guiDe, AlSo pArT of THiS SerieS.

2 3 4 autism

Health Challenges in Autism • Once your patient is seated, allow you to provide care safely. Allow time for your patient to adjust Be prepared to manage a seizure. If them quickly. Do not attempt to insert begin a cursory examination Immobilization should not cause and become desensitized to the noise one occurs during oral care, remove any objects between the teeth during and Strategies for Care using your fingers. physical injury or undue discomfort. of a dental setting. Some patients any instruments from the mouth a seizure. may be hypersensitive to the sound and clear the area around the dental • Next, use a toothbrush to brush the If all other strategies fail, pharmaco- Stay with your patient, turn him or her Before the appointment, obtain and review of dental instruments. chair. Attaching dental floss to rubber teeth and gain additional access to logical options are useful in managing to one side, and monitor the airway to the patient’s medical history. Consultation dam clamps and mouth props when the patient’s mouth. The familiarity some patients. Others need to be Talk to the caregiver to get a sense of reduce the risk of aspiration. with physicians, family, and caregivers is treatment begins can help you remove of a toothbrush will help your patient treated under general anesthesia. the patient’s level of tolerance. People essential to assembling an accurate medical feel comfortable and provide you with However, caution is necessary because with autism differ in how they accept history. Also, determine who can legally an opportunity to further examine some patients with developmental physical contact. Some are defensive provide informed consent for treatment. the mouth. disabilities can have unpredictable and refuse any contact in or around the ­medicines when available, and rinse reactions to medications. mouth, or cradling of the head or face. oral Health problems in Autism CommuniCation problems and When the patient is prepared for with water after taking any medicine. Others find such cradling comforting. mental Capabilities are central treatment, make the appointment People with autism often engage in and Strategies for Care Advise caregivers to offer alternatives concerns when treating people with autism. short and positive. per severation, a continuous, meaningless Note your findings and experiences in to cariogenic foods and beverages as repetition of words, phrases, or the patient’s chart. People with autism experience few Talk with the parent or caregiver to Pay special attention to the treatment incentives or rewards. movements. Your patient may mimic unusual oral health conditions. Although determine your patient’s intellectual setting. Keep dental instruments out of Encourage independence in daily oral the sound of the suction, for example, unusual and unprediCtable commonly used medications and damaging and functional abilities, and then sight and light out of your patient’s eyes. hygiene. Ask patients to show you how or repeat an instruction over and again. body movements are sometimes oral habits can cause problems, the rates communicate with the patient at a they brush, and follow up with specific Praise and reinforce good behavior after Avoid demonstrating dental equipment observed in people with autism. These of caries and periodontal disease in people level he or she can understand. recommendations. Perform hands-on each step of a procedure. Ignore inap- if it triggers perseveration, and note movements can jeopardize safety as well with autism are comparable to those in demonstrations to show patients the best Use a “tell-show-do” approach to propriate behavior as much as you can. this in the patient’s record. as your ability to deliver oral health care. the general population. Communication pro viding care. Start by explaining and behavioral problems pose the most way to clean their teeth. If appropriate, Try to gain cooperation in the least Make sure the path from the reception each procedure before it occurs. unusual responses to stimuli significant challenges in providing oral care. show patients and caregivers how a People with restrictive manner. Some patients’ area to the dental chair is clear. Take the time to show what you have can create distractions and interrupt modified toothbrush or floss holder behavior may improve if they bring Damaging oral habits autism need explained, such as the instruments treatment. People with autism need Observe the patient’s movements and are might make oral hygiene easier. comfort items such as a stuffed animal common and include bruxism; tongue consistency and you will use and how they work. consistency and can be especially sensitive look for patterns. Try to anticipate Some patients cannot brush and floss or a blanket. Asking the caregiver to sit thrusting; self-injurious behavior such as Demonstrations can encourage some to changes in their environment. They the movements, either blending your independently. Talk to caregivers can be especially nearby or hold the patient’s hand may Record in the picking at the gingiva or biting the lips; patients to be more cooperative. may exhibit unusual sensitivity to sensory movements with those of your patient about daily oral hygiene and do not be helpful as well. patient’s chart and pica—eating objects and substances sensitive to stimuli such as sound, bright colors, and or working around them. assume that they know the basics. behavior problems—which such as gravel, cigarette butts, or pens. If Use immobilization techniques only strategies that touch. Reactions vary: Some people with Use your experiences with each patient changes in their may include hyperactivity and quick seizures a mouth guard can be tolerated, prescribe when absolutely necessary to protect autism may overreact to noise and touch, may accompany autism but can to demonstrate oral hygiene techniques frustration—can complicate oral health were successful one for patients who have problems with environment. the patient and staff during dental while exposure to pain and heat may not usually be controlled with anti convulsant and sitting or standing positions for the care for patients with autism. The invasive in providing care. self-injurious ­behavior or bruxism. treatment—not as a convenience. provoke much reaction at all. medications. The mouth is always at risk caregiver. Emphasize that a consistent nature of oral care may trigger violent There are no universal guidelines Note your patient’s during a seizure: Patients may chip teeth Use the same staff, dental operatory, and Dental caries risk increases in patients approach to oral hygiene is important— and self-injurious behavior such as temper on immobilization that apply to all or bite the tongue or cheeks. People with preferences and appointment time to sustain familiarity. who have a preference for soft, sticky, or caregivers should try to use the same tantrums or head banging. treatment settings. Before employing controlled seizure disorders can easily be other unique details These details can help make dental sweet foods; damaging oral habits; and location, ­timing, and positioning. Plan a desensitization appointment to any kind of immobilization, it may treated in the general dental office. treatment seem less threatening. ­difficulty brushing and flossing. help the patient become familiar with help to consult available guidelines that will facilitate Consult your patient’s physician. Periodontal disease occurs in the office, staff, and equipment through on federally funded care, your State treatment, such Minimize the number of distractions. Record information in the chart Recommend preventive measures such ­people with autism in much the same Try to reduce unnecessary sights, as fluorides and sealants. a step-by-step process. These steps may department of mental health/disabilities, as music, comfort about the frequency of seizures and way it does in persons without sounds, odors, or other stimuli that take several visits to accomplish. and your State Dental Practice Act. the medications used to control them. Caution patients or their caregivers developmental disabilities. Guidelines on behavior management items, and might be disruptive. Use an operatory • Have the patient sit alone in the Determine before the appointment about medicines that reduce saliva or Some patients benefit from the daily published by the American Academy of flavor choices. that is somewhat secluded instead of one dental chair to become familiar whether medications have been taken as contain sugar. Suggest that patients use of an antimicrobial agent such Pediatric Dentistry (www.aapd.org) may in the middle of a busy office. Also, with the treatment setting. Some directed. Know and avoid any factors drink water often, take sugar-free as chlorhexidine. also be useful. Obtain consent from consider lowering ambient light and patients may refuse to sit in the that trigger your patient’s seizures. your patient’s legal guardian and choose asking the patient’s caregiver whether chair and choose instead to sit on the least restrictive technique that will soft music would help. Tips for caregivers are available in the booklet the operator’s stool. Dental Care Every Day: A Caregiver’s Guide, also part of this series.

2 3 4 Practical Oral care for People with Autism Stress the importance of conscientious Making a difference in the oral health oral hygiene and frequent prophylaxis. of a person with autism may go slowly at first, but determination can TOOTH ERUPTION may be delayed due bring positive results—and invaluable to phenytoin-induced gingival hyperplasia. rewards. By adopting the strategies Phenytoin is commonly prescribed for discussed in this booklet, you can contents roviding oral care to people with autism requires adaptation of the ­people with autism. have a significant impact not only on your patients’ oral health, but on their HeAltH CHAllenges skills you use every day. In fact, most people with mild or moderate TRAUMA and INJURY to the mouth quality of life as well. In AutIsm And from falls or accidents occur in people stRAtegIes foR CARe forms of autism can be treated successfully in the general practice with seizure disorders. Suggest a tooth- 2 ...... saving kit for group homes. Emphasize to Additional Readings Communication problems Psetting. This booklet will help you make a difference in the lives of people and mental capabilities caregivers that traumas require immediate Hyman SL, Towbin K. Autism Spectrum This booklet is one in a series on providing oral care for people ­professional attention and explain the Disorders. In Batshaw ML, Pellegrino L, Behavior problems who need professional oral care. with mild or moderate developmental disabilities. The issues and 3 ...... ­procedures to follow if a permanent tooth Roizen NJ (eds.). Children With Disabilities care strategies listed are intended to provide general guidance on is knocked out. Also, instruct caregivers (6th ed.). Baltimore, MD: Paul H. Brookes Unusual responses how to manage various oral health challenges common in people to stimuli Autism is a complex developmental disability that impairs communication to locate any missing pieces of a fractured Publishing Co., 2007. National Institute of Dental with autism. Unusual and unpredictable tooth, and explain that radiographs of body movements and social, behavioral, and intellectual functioning. Some people with the NLM Family Foundation. D-Termined and Craniofacial Research Other booklets in this series: the patient’s chest may be necessary to Seizures determine whether any fragments have program of repetitive tasking and disorder appear distant, aloof, or detached from other people or from their familiarization in dentistry: a behavior Continuing Education: Practical Oral Care for People been aspirated. With Developmental Disabilities oRAl HeAltH PRoblems management approach. View at In AutIsm And surroundings. Others do not react appropriately to common verbal and social Physical abuse often presents as oral http://www.nlmfoundation.org/media.htm. Practical Oral Care for People With Cerebral Palsy stRAtegIes foR CARe trauma. Abuse is reported more frequently 4 ...... cues, such as a parent’s tone of voice or smile. Obsessive routines, repetitive Practical Oral Care for People With Down Syndrome in people with developmental disabilities Damaging oral habits behaviors, unpredictable body movements, and self-injurious behavior may than in the general population. If you Practical Oral Care for People With Intellectual Disability Dental caries ­suspect that a child is being abused or Periodontal disease Wheelchair Transfer: A Health Care Provider’s Guide all be symptoms that complicate dental care. ­neglected, State laws require that you call 5 ...... your Child Protective Services agency. Centers for Disease Dental Care Every Day: A Caregiver’s Guide Tooth eruption Assistance is also available from the Control and Prevention Trauma and injury Autism varies widely in symptoms

Childhelp® National Child Abuse Hotline SAFER • HEALTHIER • PEOPLETM AddItIonAl ReAdIngs Making a difference at (800) 422–4453 or the Child and severity, and some people in the oral health of Welfare Information Gateway have coexisting conditions such as (http://www.childwelfare.gov). Special Care Dentistry a person with autism Association AckNOwlEdgMENTs intellectual disability or epilepsy. They may go slowly at first, The National Institute of Dental and Craniofacial Research can be among the most challenging of thanks the oral health professionals and caregivers who but determination can For more information about autism, contact contributed their time and expertise to reviewing and patients, but following the suggestions pretesting the Practical Oral Care series. bring positive results and National Institute of Child Health and Human For additional copies of this booklet, contact in this booklet can help make their Development Information Resource Center Expert Review Panel National Institute of Dental and Craniofacial Research invaluable rewards. • Mae Chin, RDH, University of Washington, Seattle, WA P.O. Box 3006 National Oral Health Information Clearinghouse dental treatment successful. Rockville, MD 20847 1 NOHIC Way • Sanford J. Fenton, DDS, University of Texas, Houston, TX (800) 370–2943 Bethesda, MD 20892–3500 1–866–232–4528 • Ray Lyons, DDS, New Mexico Department of Health, http://www.nichd.nih.gov www.nidcr.nih.gov Albuquerque, NM [email protected] • Christine Miller, RDH, University of the Pacific, This publication is not copyrighted. San Francisco, CA Make as many photocopies as you need. • Steven P. Perlman, DDS, Special Olympics Special Smiles, Lynn, MA NIH Publication No. 09–5190 5 Reprinted July 2009 • David Tesini, DMD, Natick, MA U.s. dEPARTMENT OF HEAlTH ANd HUMAN sERVIcEs l NATIONAL INSTITUTeS OF HeALTH l National Institute of Dental and Craniofacial Research Practical Oral care for People with Autism Stress the importance of conscientious Making a difference in the oral health oral hygiene and frequent prophylaxis. of a person with autism may go slowly at first, but determination can TOOTH ERUPTION may be delayed due bring positive results—and invaluable to phenytoin-induced gingival hyperplasia. rewards. By adopting the strategies Phenytoin is commonly prescribed for discussed in this booklet, you can contents roviding oral care to people with autism requires adaptation of the people with autism. have a significant impact not only on your patients’ oral health, but on their HeAltH CHAllenges skills you use every day. In fact, most people with mild or moderate TRAUMA and INJURY to the mouth quality of life as well. In AutIsm And from falls or accidents occur in people stRAtegIes foR CARe forms of autism can be treated successfully in the general practice with seizure disorders. Suggest a tooth- 2 ...... saving kit for group homes. Emphasize to Additional Readings Communication problems Psetting. This booklet will help you make a difference in the lives of people and mental capabilities caregivers that traumas require immediate Hyman SL, Towbin K. Autism Spectrum This booklet is one in a series on providing oral care for people professional attention and explain the Disorders. In Batshaw ML, Pellegrino L, Behavior problems who need professional oral care. with mild or moderate developmental disabilities. The issues and 3 ...... procedures to follow if a permanent tooth Roizen NJ (eds.). Children With Disabilities care strategies listed are intended to provide general guidance on is knocked out. Also, instruct caregivers (6th ed.). Baltimore, MD: Paul H. Brookes Unusual responses how to manage various oral health challenges common in people to stimuli Autism is a complex developmental disability that impairs communication to locate any missing pieces of a fractured Publishing Co., 2007. with autism. Unusual and unpredictable tooth, and explain that radiographs of National Institute of Dental and social, behavioral, and intellectual functioning. Some people with the National Institute of Child Health and and Craniofacial Research Other booklets in this series: body movements the patient’s chest may be necessary to Human Development, National Institutes of Seizures determine whether any fragments have Health (NIH). Autism Questions and Answers Continuing Education: Practical Oral Care for People disorder appear distant, aloof, or detached from other people or from their been aspirated. for Health Professionals. Retrieved July 9, With Developmental Disabilities oRAl HeAltH PRoblems 2009, from http://www.nichd.nih.gov/publi- In AutIsm And surroundings. Others do not react appropriately to common verbal and social Physical abuse often presents as oral cations/pubs/autism/QA/index.cfm. Practical Oral Care for People With Cerebral Palsy stRAtegIes foR CARe trauma. Abuse is reported more frequently 4 ...... cues, such as a parent’s tone of voice or smile. Obsessive routines, repetitive Practical Oral Care for People With Down Syndrome in people with developmental disabilities National Institute of Child Health and Damaging oral habits behaviors, unpredictable body movements, and self-injurious behavior may than in the general population. If you Human Development, National Institutes of Practical Oral Care for People With Intellectual Disability Dental caries Autism Spectrum Disorders suspect that a child is being abused or Health (NIH). . Periodontal disease Retrieved July 9, 2009, from http://www. Wheelchair Transfer: A Health Care Provider’s Guide all be symptoms that complicate dental care. neglected, State laws require that you call nichd.nih.gov/health/topics/asd.cfm. 5 ...... your Child Protective Services agency. Centers for Disease Dental Care Every Day: A Caregiver’s Guide Tooth eruption Assistance is also available from the NLM Family Foundation. D-Termined Control and Prevention Trauma and injury Autism varies widely in symptoms

Childhelp® National Child Abuse Hotline program of repetitive tasking and SAFER • HEALTHIER • PEOPLETM AddItIonAl ReAdIngs Making a difference at (800) 422–4453 or the Child familiarization in dentistry: a behavior and severity, and some people management approach. View at in the oral health of Welfare Information Gateway have coexisting conditions such as (www.childwelfare.gov). http://www.nlmfoundation.org/media.htm. Special Care Dentistry a person with autism Association AckNOwlEdgMENTs intellectual disability or epilepsy. They may go slowly at first, The National Institute of Dental and Craniofacial Research can be among the most challenging of thanks the oral health professionals and caregivers who but determination can For more information about autism, contact ­contributed their time and expertise to reviewing and patients, but following the suggestions For additional copies of this booklet, contact pretesting the Practical Oral Care series. bring positive results and National Institute of Child Health and Human in this booklet can help make their Development Information Resource Center National Institute of Dental and Craniofacial Research Expert Review Panel invaluable rewards. 1 NOHIC Way • Mae Chin, RDH, University of Washington, Seattle, WA P.O. Box 3006 National Oral Health Information Clearinghouse dental treatment successful. Rockville, MD 20847 Bethesda, MD 20892–3500 • Sanford J. Fenton, DDS, University of Texas, Houston, TX (800) 370–2943 1–866–232–4528 http://www.nidcr.nih.gov • Ray Lyons, DDS, New Mexico Department of Health, www.nichd.nih.gov Albuquerque, NM [email protected] This publication is not copyrighted. • Christine Miller, RDH, University of the Pacific, Make as many photocopies as you need. San Francisco, CA NIH Publication No. 09–5190 • Steven P. Perlman, DDS, Special Olympics Special Smiles, Reprinted July 2009 Lynn, MA 5 NIH...Turning Discovery Into Heath • David Tesini, DMD, Natick, MA U.s. dEPARTMENT OF HEAlTH ANd HUMAN sERVIcEs l NATIONAL INSTITUTeS OF HeALTH l National Institute of Dental and Craniofacial Research