Oral, Dental Health in Autism

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By Anil Minocha MD, author: Guide to Alternative Medicine and the Digestive System

In addition to the well known neurodevelopmental behavioral manifestations, autism spectrum disorders is characterized by atypical eating patterns including picky eating along with unhealthy oral practices such as bruxism, tongue thursting, lip biting and gingival picking.

Implications of good oral-dental health in autism:

Bad teeth and gum equal to inflammation. The pro-inflammation cytokines, chemical signals are thus circulating throughout and effecting the whole body including the heart and the brain.

Inflammation is an important component of chronic disease states including disorders affecting brain. Neuro-inflammation creates disruption in brain cells as well as signalling pathways and as such may have important role in neuro-behavioral manifestations of autism spectrum disorders. Maintaining good oral-dental health is part of the 12-point autism treatment program.

Studies comparing the orodental issues among autism and non-autism subjects have yielded mixed results. In fact, some studies have reported lower prevalence of dental caries among kids with autism. Perhaps the prevalence of caries is higher only among institutionalized subjects in contrast to otherwise fully functional kids with autism.

Autism oral-dental Study: Dr. Jaber from the Dental School, Ajman University of Science & Technology,  investigated the orodental health status and needs of kids with autism.The study titled, “Dental caries experience, oral health status and treatment needs of dental patients with autism” was published in the Journal of  Applied Oral Sciences in May-June 2011.

Objectives of autism oral-dental study:

• Prevalence of caries in children with autism
• Prevalence of periodontal disease in autism
• Orodental treatment needs in autism

Study design and methods:

• Study group n=61 kids with autism (6-16 years; males vs females 45:16)
• Controls: 61 kids without autism and selected from relatives or friends
• Full oral and periodontal examination
• Parameters examined: Caries prevalence, and caries severity, dental plaque, gingivitis, restorations and treatment needs.

Results of autism oral-dental study:

1. Only 3.3% of kids with autism have good oral hygiene as compared to 59% among controls

2. Kids with autism have higher prevalence of:

• Tooth decay
• Missing or filled teeth
• Need for more restorative dental treatment

3. Dental caries occurs in 77% of kids with autism as compared to 46% among controls.

4. 97.0% of the autistic children have gingivitis including 78% with generalized gingivitis.

5. The ratio of Met Need Index to Restorative Index is lower in kids with autism. Only 9.5% of kids with autism received restorative care as compared to 29.6% among controls.

 Guide to Alternative Medicine and the Digestive System

Conclusions of autism oral-dental study

• Children with autism have higher oral-dental problems and a greater unmet needs for oral-dental treatment as compared to controls.
• The differences in results from different studies may be due to cultural differences as well as the subjects recruited.

Potential causes for high prevalence of oral-dental problems in autism

• Preference for soft, sweetened foods.
• Poor tongue coordination increasing the amount of time food staying in mouth prior to swallowing.
• Suboptimal manual dexterity causing problems related to brushing and flossing.
• Adverse effects due to psychoactive drugs use.
• Lower Met Need Index may be due to limited access to health services and/or problems controlling these kids.

Potential solutions to improve oral-dental health

• Improved dental awareness and education.
• Detailed personalized oral dental hygiene (brushing, cleaning, flossing) instructions from dentist and dental hygienist.
• Use of structured method and technique based on visual pedagogy  for brushing teeth using pictures and placing them in bathroom. Pilebro and Blackman produced a series of pictures that demonstrated a structured method of tooth brushing. The pictures were placed in the bathroom or wherever tooth brushing was performed. At 18 months, plaque was reduced in all kids and most parents found it easy to maintain good oral hygiene.  All but one of the 14  children adopted the program long-term.
• Use of sedation and even general anesthesia for difficult  to manage select patients.
• Use of combined dental and pedopsychiatric teams.

 Guide to Alternative Medicine and the Digestive System

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