1.     Problems with social interactions.

2.    Problems with verbal and nonverbal communication.

3.    Ritualistic or compulsive behaviors.

4.    Atypical responses to the environment.

NO

Occurs in all racial ethnic and socioeconomic groups.

An Average 1 in 50 children in the US have autism

1 to 1.5 million Americans

Fastest growing disability

 Likely that genetics and environment play a role.  Researchers have defined a number of genes associated with the disorder. 

Studies have shown irregularities in several regions of the brain. 

·         Not responding to name by 12 months.

·         Not pointing at objects or show interest by 14 months.

·         Don’t play “pretend” games by 18 months.

·         Avoid eye contact and want to be alone.

·         Delayed speech and language skills.

·         Repeats words/phrases over and over.

·         Get upset by minor changes.

·         Obsessive traits, flap hands, rock back and forth, spin in circles, unusual reactions to sound, smell, taste, look or feel.

• -PDD-NOS – Pervasive Developmental Disorder – Not Otherwise Specified.
• Aspergen Syndrome – Milder than Autism, but still a form of.
• Childhood disintegrative disorder – rare condition, starts around age 3-4.
• Rett syndrome – Mainly in girls, inherited disease – related to autism.

-Except when autistic spectrum disorder is combined with a developmental disability of a different nature, no specific oral manifestation exists.  Several factors can contribute to poor oral hygiene/health.

·         Damaging oral habits:  bruxism, tongue thrusting, self injurious behavior: picking at gingival, biting lips.

·         Tooth eruption might be delayed due to medications.

-Use a toothbrush first to gain access to the patients mouth because it is something they are familiar with.

-Make appointments short and positive.

-try to gain cooperation with least restrictive manner.

-Try to reduce unnecessary sights, sounds, and odors.  This could be disruptive stimuli.

-Allow time for the patient to adjust.

-Document findings and experiences.

***Talk with the parent or caregiver, they know the patient best and will be able to tell you how to overcome obstacles you may face during your appointment

• Blindness- no perception of visual stimuli; lack or loss of ability to see.
• Legal blindness- less than 20/200 vision with corrective eyeglasses.

Children- Half of the blindness in children is a result of maternal infections (rubella, syphilis and toxoplasmosis). Other causes include retinopathy of prematurity, neoplasm and injuries. Retinopathy of prematurity has increased due to increased survival rate of premature babies.

Age-related- Leading causes of blindness are diabetic retinopathy, age-related macular degeneration, senile cataracts, vascular disease, glaucoma, corneal opacities, trauma and infections.

Other causes include vitamin A deficiency, contact lenses, optic nerve problems, and stroke.    

21.2 million Americans

approx 1,100,000 legally blind

3% of population

List some clinical manifestations of blindness

-Suspect blindness if patient is squinting unusually, blinking rapidly, has lack of continued attention and if you are talking to them and they do not know where you are.

• If there are oral complications they are related to etiology of the blindness.
• If a patient has gone blind due to diabetes for example, then we would expect a higher risk for candadiasis, periodontitis, delayed wound healing etc.

Dental considerations and management-clinical, psychological and home care; instructions to caregiver for totally blind

• maintain neutral tone
• clear pathway
• guide patient with arm without pushing or pulling
• most times they prefer to wear their own glasses
• tell them when leaving and entering the room to avoid embarrassment of speaking to no one
• describe all procedures
• instruments
• flavors
• material
• have patient feel but avoid handing the patient sharp instruments. Speak before touching them.
• Warn patients before using air, water, and power driven instruments

Dental considerations and management-clinical, psychological and home care; instructions to caregiver for partially blind?

• -Partially blind: Watch position of patient because glaucoma patients may experience increased pain and pressure in the eyes if chair is tilted. Glaucoma patients have no peripheral vision, so speak to these patients straight on.
• -Avoid light in eyes because of sensitivity as with all patients
• -Work patiently, slowly and allow extra time because the clinician will need to read all materials and explain everything in detail. Don’t talk louder, maintain neutral tone in voice.

• -Home care- have patient feel plaque/calculus with tongue and explain that tooth surfaces should feel smooth. Demo brushing and flossing in patient’s mouth and have patient show you. Provide caregiver with instructions as well

Dental considerations and management-clinical, psychological and home care; instructions to caregiver for partially blind?

• Anyone can get MS
• 2 to 3 times more common women than men
• Most people with MS are of northern European descent and are diagnosed between the ages of 20 and 50. Worldwide, about 2.5 million people have MS
• US approximately 400,000 people have MS.

The exact cause of MS is unknown.

•  environmental elements (e.g., temperature)
• infectious agents (i.e., bacteria or virus)
• genetic predisposition.

In MS, the immune system attacks the myelin sheath, damaging it. There can be so much damage that the neuron itself is hurt or even broken. When this happens, the neuron cannot help electrical impulses travel where they are supposed to go.

List the 10 Clinical Manifestations of MS

1. Common multiple sclerosis symptoms include:
2. Bladder and bowel problems
3. Cognitive difficulties
4. Depression
5. Fatigue
6. Muscle rigidity or stiffness
7. Weakness or poor coordination
8. Numbness and tingling
9. Pain in arms and legs
10. Visual disturbances

Name the 11 Differential Diagnosis

1. Encephalomyelitis
2. CNS Vasculitis
3. Lyme Disease
4. Lupus Erythematosus
5. Spastic Paraparesis
6. Behçet Syndrome
7. Sarcoidosis and Sjogren's Syndrome
8. Vitamin B-12 Deficiency and Syphilis
9. Leukodystrophies
10. Hereditary Degenerative Disorders
11. Multifocal Leukoencephalopathy

1. Natalizumab (TYSABRI^®)
2. Interferon beta 1-a (AVONEX^®, Rebif^®), interferon beta-1b (Betaseron^®)*
3. Glatiramer acetate (Copaxone^®)*
4. Mitoxantrone (Novantrone^®)

Disabilities seen with MS

Patients with advanced stages of MS may be wheelchair bound or are able to walk but may need assistance with a cane or help from a caregiver or you.

• Use toothbrushes with built-up handles (or cut a small slit in the sides of a tennis ball and slide it onto the handle of the toothbrush)
• use flossing tools consider electric toothbrushes and flossing devices
• Sit to brush and floss, if standing at the basin is tiring.
• Floss in the morning if you are too tired at night.
• Since flossing at bedtime is preferable because it removes bacteria that will multiply while you sleep, try flossing in bed.
• Allow a family member or personal assistant to help with tooth brushing/
• flossing.
• Manage tremors by wearing a weighted glove while brushing.
• Some medications used to treat MS symptoms can cause dry mouth.
• In addition, spicy or salty foods may cause pain in a dry mouth.
• Suggest the following to help minimize effects of dry mouth:
• Sipping water or sugarless drinks often
• Avoiding caffeine, tobacco, and alcohol
• Using a small squirt of lemon in the mouth or sugarless lemon candies to
• stimulate the parotid glands (which control saliva)
• Using a humidifier at night
• Using special products that are available in pharmacies to moisten dry mouth (Biotene)