Tooth Decay
Oral Hygiene
Anaesthesia Options
Drug Interactions
Filling Materials
AUTISM AND DENTISTRY
Presented by David Isen B.Sc.,
D.D.S., F.A.D.I.
COURSE 009
Outline:
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Tooth Decay |
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Oral Hygiene |
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Anaesthesia Options |
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Drug Interactions |
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Filling Materials |
TOOTH DECAY
What causes tooth decay?
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Bacteria |
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Plaque |
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Sugar |
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pH (5.5) |
Other factors are:
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Time |
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Fluoride |
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Saliva |
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Salivary enzymes |
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Immunity |
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Age (11-18) |
DIET
INCREASES DECAY:
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Sweets |
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Carbs |
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Citrus Fruits |
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Apples! |
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Juice, Pop |
DECREASES DECAY:
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Cheese |
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Nuts |
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Chewing action (raw veggies) |
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Sugarless Gum |
MECHANICAL STIMULATION
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Tooth brush |
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Hand towel |
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Water-pik |
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Braun Oral B |
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Fancy Device |
DENTAL OFFICE REQUIREMENTS
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Facility permit |
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Properly trained dentist |
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Following RCDSO guidelines |
DRUG INTERACTIONS
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Sedatives |
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Herbal drugs |
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Ritalin and paradoxical reactions |
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Drugs and General Anesthesia (GA) |
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Tricyclics |
(no studies show that GA drugs cause or worsen autism)
AMALGAM FILLINGS vs.
COMPOSITE RESINS
AMALGAM
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Mixture of alloys |
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Formed by mixing with ~ 50% Mercury |
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Mostly Silver |
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Other metals |
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Tin |
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Copper |
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Zinc |
OTHER ISSUES
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h Body levels of mercury |
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Mercury chemically bound to silver |
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Scientific studies |
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Dentists and amalgam |
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RCDSO recommendations |
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Psychological issues |
COMPOSITE RESINS
Plastic, glass or silica fillers
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i longevity * |
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Wear |
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Thermal conduction |
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h cost |
*must consider this for GA patients
GENERAL ANAESTHESIA (GA)
"A controlled state of unconsciousness accompanied by partial or complete loss of reflexes including inability to maintain an airway independently and respond purposefully to physical stimulation or verbal command." RCDSO GUIDELINES, NOV. 1995
INDICATIONS FOR GA
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Dental phobic |
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Cerebral palsy |
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Very young |
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Cognitive impairment |
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Downs Syndrome |
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Senile dementia |
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Head trauma |
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Autism |
FACILITIES
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Downtown: Drs. Small, Dann, Copp |
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Scarborough: Dr. H. Kestenberg |
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Kitchener: Dr. J. Suljak |
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Hamilton: Drs. Harper & Nenninger |
GENERAL ANAESTHESIA
Advantages:
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Control |
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Complete treatment |
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Good dentistry |
Disadvantages:
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Risk |
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Side effects |
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Cost |
Hospital vs. Dental Office
HOSPITAL BASED GA
Advantages:
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MD anaesthetist |
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Paedo dentist |
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Hospital support |
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OHIP coverage |
Disadvantages:
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Long wait |
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Environment |
DENTAL OFFICE BASED GA
Advantages:
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Dental anaesthetist |
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Environment |
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Shorter wait |
Disadvantages:
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Cost |
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No hospital support |
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Parental separation |
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Induction |
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I.V., I.M., oral |
TOOTH PASTE
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Yay or nay? = spit or swallow? |
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Fluoride vs. not |
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Flavours |
FLOSSING
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Why? |
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How? |
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Flavours |
SPECTRUM OF ANAESTHESIA
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Conscious Sedation |
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Deep Sedation |
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General Anaesthesia |
CONSCIOUS SEDATION
"A minimally depressed level of consciousness that retains the patient's ability to independently and continuously maintain and airway and respond appropriately to physical stimulation and verbal command. It is produced by a pharmacologic or non-pharmacologic method or a combination thereof. In dentistry, it is used to reinforce positive suggestion and reassurance in a way which allows dental treatment to be performed with minimal physiological and psychological stress and enhanced physical comfort. The technique must carry a margin of safety wide enough to render loss of conscious highly unlikely." RCDSO GUIDELINES, NOV., 1995
CONSCIOUS SEDATION MODATLITIES
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Hypnotherapy |
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N2O + oxygen sedation |
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Oral sedation |
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N2O + oxygen with oral sedation |
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IM sedation |
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IV conscious sedation |
ALL CAN CAUSE GA!
DEEP SEDATION
"A controlled state of depressed consciousness, accompanied by partial loss of protective reflexes, including inability to respond purposefully to verbal command." RCDSO GUIDELINES, NOV., 1995
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2: August 11, 2002