Wednesday, January 17, 2018

The Neuropathology, Medical Management, and Dental Implications of Autism

Resident’s Name: Michael Hatton                                                                                    Date: 1/17/2018

Article Title: The Neuropathology, medical management, and dental implications of autism
Author(s): Arthur Friedlander, John Yagiela, Victoria Paterno, Michael Mahler
Journal: JADA
Date: Nov 2006
Major Topic: Special care for special patients
Type of Article: Systematic literature review
Main Purpose: Evidence based presentation of autism, its clinical manifestations, dental and medical treatment, and dental implications
Key Points: There is insufficient dental literature on autism and its management in the dental setting.

Autism is a neurodevelopmental disorder in which social interaction, language, behavior, and cognitive functions are impaired severely.

Autistic individuals:
-Fail to respond to normal interactive activities; such as seeking attention of the caregiver, fails to cuddle, no direct eye contact, not raising arms to be picked up, not pointing to objects, no responding to smiles or mother’s voice
-As they get older, young child may not participate in group play or share in other children’s activities and appear to in their own world.
-Verbal and nonverbal communication is delayed or absent (50% do speak)
-Become obsessed with lining things up, and sensory features like buttons on electrical appliances; and immutable rules like timetables, numbers, tables.
-Stress or excitement or stimuli like noise may trigger repetitive actions
-Cognitive impairment is evident in ~70% of people with autism (Severe in ~40%)
-Behavior symptoms associated with autism include temper tantrums, impulsivity, agitation, anger, aggression, self-injury
-Psychological illnesses such as anxiety disorders, mood disorders, ADHD, OCD, schizophrenia

MRI studies have shown abnormal structure, function, or both of the limbic system; this system responsible for emotional and social behaviors, and deciphering facial expressions of other people and understanding their thoughts, feelings, and intentions. Structural imaging also shows overgrowth of brain during first 2 years of life, possibly during prenatal period as well

Treatments
Medications cannot effect ability to socialize or communicate, but can help control associated symptoms such as hyperactivity, repetitive behaviors, aggression.

Dental management
-Visual and auditory hypersensitivity
-Generally dislike being touched
-Parental presence may calm patients
-Tell-show-do and short, clear commands, positive/negative reinforcement useful
- Look for erosion of teeth due to regurgitation
-Look for signs of bruxism
-Surgical procedures need to consider hematopoietic system (for patients taking carbamazepine, methylphenidate, risperidone, valproate)
-May need CBC including platelets

-Psychiatrist usually monitors 2x/year (ask for records)

No comments:

Post a Comment