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Medical history
The patient was diagnosed with autism at age 3 years. He
has no other medical conditions and takes melatonin to help
him sleep. His mother thinks that he may be allergic to
wheat and dairy produce and consequently tries to exclude
these from his diet.
Examination
Extraoral examination
The patient is shown in Figure 42.1.
What do you see?
SUMMARY
The mother of a 6-year-old child brings him to your
practice to ask for an appointment. She cannot find
another dentist to see him.
What is autism?
Autism is a developmental disorder, more accurately
described as autistic spectrum disorder (ASD) because it
includes a range of conditions. All are characterized by three
key diagnostic features:
1. Impairment of social interaction
2. Impairment of communication
3. Repetitive, stereotypical patterns of behaviour.
Autism has a wide range of expression. Some individuals
have normal or near-normal intelligence, though threequarters have some degree of learning disability. Males are
four times more frequently affected than females. The mildest
form, Aspergers syndrome, is compatible with a near-normal
life.
History
Complaint
The mother reports that she has asked several dentists to
see her autistic son, but they all find reasons not to.
History of complaint
No one has ever been able to perform a proper check-up on
her son. A recent attempt by another dentist ended in
CASE
42
196
W ill y o u s e e m y s o n ?
Lack of nonverbal communication may prevent you from
using alternative strategies. There is a lack of eye contact,
making it difficult to gain and maintain attention, and an
inability to interpret nonverbal signals or emotions from facial
expression or tone of voice.
Aversion to physical contact makes examination, treatment
and the usual means of physical reassurance ineffective.
Hypersensitivity to sights, sounds, smells and touch
may be a feature and present problems with tooth brushing
and dental treatment.
Idiosyncratic behaviours, such as highly specific insistence
on the colour or consistency of food, are frequent. This may
make dietary control difficult.
Resistance to change. Autism is associated with a strong
need for routine. Individuals will like events to be predictable
and new experiences may unbalance the whole day.
Unusual diets are frequent because many parents exclude
wheat, dairy products or yeast in an attempt to improve the
condition. In combination with the patients own dietary
demands, this may make dietary prevention very difficult.
W ill y o u s e e m y s o n ?
How can you communicate with the patient?
There are some basic rules that will stand you in good stead.
Keep the language very simple and limit yourself to a few
concepts.
Toothbrush
Fig. 42.2 A pictorial exchange picture.
Fig. 42.3 Example of social storyline preparing for a visit to the dentist.
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CASE
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CASE
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198
W ill y o u s e e m y s o n ?