Oral health care for
a child with the diagnosis of autism is not much different from the oral
health care of other children. However, children with autism often have
difficulty in communication skills, so cooperation from your child might be a
difficult challenge when visiting the dentist. For parents of children with
autism, a visit to the dentist is more than a child opening his or her mouth
and getting a reward after. If your child is too difficult to work with and
the need for a dental procedure is urgent enough, a dentist may have no choice
but to use dental sedation in order to perform his job.
What is dental
sedation? Is it necessary? Is it safe? Sedation is the utilization of
medications called "sedatives" to create a state of relaxation. It
is usually done to facilitate a medical, or in this case, dental procedure.
There are three levels of sedation that may be used with pediatric patients
that require extensive dental care:
- Conscious sedation is inducing a
minimally depressed level of consciousness that retains the patient's ability
to maintain an open airway independently and continuously and respond
appropriately to physical stimulation or verbal commands.
- Deep sedation is a
type of sedation in which the patient is not easily aroused and which may be
accompanied by a partial loss of protective reflexes, including the ability to
maintain an airway or to respond properly to physical stimulation or verbal
commands.
- General anesthesia is an induced state of unconsciousness. The
patient cannot respond to physical or verbal stimulation of any kind and it
will be up to the dentist to insure that an airway is maintained. Most people
immediately associate sedation with general anesthesia, in which the patient
is put to sleep during the whole procedure and awakens afterward in a recovery
room. However this is normally the last possible choice for a pediatric
dentist. He will recommend a lower level of sedation instead if he can, trying
to use whichever form of anesthesia has the lowest risk while being effective.
To make his decision he will take the child's age, cognitive level, coping and
communication skills, physical health, the attitude of the parents toward
anesthesia and the urgency of the procedure into consideration. Although the
decision regarding which level of sedation to be used on your child must
ultimately be made by the dentist, you as the parent should always have a say
in the matter. If you are not comfortable with the suggestion of your dentist,
make sure that your concerns about it are heard.
To help you further
understand the decision the dentist will be making, here are some guidelines
from the American Academy of Pediatrics (AAPD) that the dentist will be using
in making his recommendation: (American Academy of Pediatric Dentistry, 2010)
The AAPD recommends conscious sedation for:
- Preschool children who cannot
understand or cooperate for definitive treatment
- Patients requiring dental
care who cannot cooperate due to lack of psychological or emotional maturity
- Patients
requiring dental treatment who cannot cooperate due to a cognitive, physical
or medical disability
- Patients who require dental care but are fearful and
anxious and cannot cooperate for Treatment The AAPD recommends deep sedation
or general anesthesia for:
* Patients with certain physical, mental or
medically compromising conditions
* Patients with dental restorative or
surgical needs for whom local anesthesia is ineffective
*The extremely
uncooperative, fearful, anxious or physically resistant child or adolescent
with substantial dental needs and no expectation that the behavior will
improve soon
* Patients who have sustained extensive orofacial or dental trauma
Patients with dental needs who otherwise would not receive comprehensive
dental care Sedation Procedure Dental Sedations are usually done in an
outpatient dental clinic that is well-equipped. The whole procedure usually
won't take more than 90 minutes for most procedures.
Although some details
vary depending on the dentist's practice among other things, in general the
process will go like this:
- Initial assessment of the pediatric dentist and
scheduling of the actual procedure.
- Consent signing by the parents
- Guidelines are given prior to the procedure - your child will be asked to go
on a NPO (nothing per orem or mouth) diet 6-8 hours before the procedure. This
is a standard operating procedure for any sedation process. It will aid in the
proper ventilation of your child and will avoid any episodes of vomiting after
the procedure is done.
- Sedation medication is introduced via injection, an IV
line, rectal line (just like when you give suppositories for fever), orally or
through inhalation.
- Dental procedures are done. Your child may or may not be
strapped onto a papoose board. Papoose boards restrain the child's limbs and
help in stabilizing your child during the procedure. Oxygen and pulse
oximeters should be available and used if the need arises. -Monitoring of the
patient until sedative wears off. Safety of Sedation Sedation is an accepted standard
of care.
The 3 levels of sedation are all accepted and supported by the
American Academy of Pediatric Dentistry, the American Dental Association, the
American Medical Association, and the U.S. Department of Health and Human
Services. Pediatrics dentists are also trained and certified to perform
sedation as part of their profession. Usually, dentists who specialize in
treating pediatric patients are also well equipped to handle children with
Autism Spectrum Disorder.
