Education and dentistry: advanced synergy in the dental treatment of children with autism; a pilot clinical trial

Abstract

Background. From the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), autism is considered a pervasive
developmental disorder. It manifests as a behavioral syndrome characterised by impairment in social interaction and communication,
restricted interests and activities, as well as repetitive and stereotyped patterns. Such profile renders prevention measures and dental
care seriously compromised so that usually autistic children are treated and cared following general anesthesia.
Aims. We aimed at developing a target-specific educational approach allowing to avoid general anesthesia in autistic patients
subjected to dental care treatments (e.g. sealing, plaque ablation, minimal carious lesions etc.); such protocol should also facilitate the
implementation of prevention measures.
Design. It is proposed a target-specific educational research protocol adopting individual strategies and methodologies, including
Augmentative and Alternative Communication (AAC) for patients with speech and language impairments. The dentists are trained
by the educator, who acts as a filter between the patient and the medical team. The team is required until a relationship of trust with
the patient is built and the dentist is able to continue independently
Results. We present a pilot clinical trial in which out of 34 patients between 6 and 12 years old showed a positive response to the
application of the protocol, allowing the execution of dental therapies together with a long-term prevention programme and in 32 of
them the general anesthesia was avoided. Negative results regarded two patients who had not undergone any behavioral, psychomotor
or speech rehabilitation therapy
Conclusions. Though the results should be considered as preliminary, the application of the method with the synergistic action of the
people in the team allowed the execution of dental therapies. Given the positive outcomes, the Pediatric Dentistry Unit of the
Umberto I Hospital (Rome) decided to continue the trials following such methodological approach, in order to improve patient
compliance in autistic children and to avoid the operating room.