Practical Oral Care for People with Autism

This information is adapted from the National Institute of Dental Craniofacial Research on Practical Oral Care for People with Autism.

This information is provided as a clinical support tool and does not warrant continuing education credit.

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Oral Health Problems in Autism and Strategies for Care

People with autism experience few unusual oral health conditions. Although commonly used medications and damaging oral habits can cause problems, the rates of caries and periodontal disease in people with autism are comparable to those in the general population. Communication and behavioral problems pose the most significant challenges in providing oral care.

Damaging Oral Habits include bruxism; tongue thrusting; self-injurious behavior such as picking at the gingiva or biting the lips; and pica–eating objects and substances such as gravel, cigarette butts, or pens. If a mouth guard can be tolerated, prescribe one for patients who have problems with self-injurious behavior or bruxism.

Dental Caries risk increases in patients who have a preference for soft, sticky, or sweet foods; damaging oral habits; and difficulty brushing and flossing.

• Recommend preventive measures such as fluorides and sealants.
• Caution patients or their caregivers about medicines that reduce saliva or contain sugar. Suggest that patients drink water often, take sugar-free medicines when available, and rinse with water after taking any medicine.
• Advise caregivers to offer alternatives to cariogenic foods and beverages as incentives or rewards.
• Encourage independence in daily oral hygiene. Ask patients to show you how they brush, and follow up with specific recommendations. Perform hands-on demonstrations to show patients the best way to clean their teeth. If appropriate, show patients and caregivers how a modified toothbrush or floss holder might make oral hygiene easier.
• Some patients cannot brush and floss independently. Talk to caregivers about daily oral hygiene and do not assume that they know the basics. Use your experiences with each patient to demonstrate oral hygiene techniques and sitting or standing positions for the caregiver. Emphasize that a consistent approach to oral hygiene is important–caregivers should try to use the same location, timing, and positioning.

Periodontal Disease occurs in people with autism in much the same way it does in persons without developmental disabilities.

• Some patients benefit from the daily use of an antimicrobial agent such as chlorhexidine.
• Stress the importance of conscientious oral hygiene and frequent prophylaxis.

Tooth Eruption may be delayed due to phenytoin-induced gingival hyperplasia. Phenytoin is commonly prescribed for people with autism.

Trauma and Injury to the mouth from falls or accidents occur in people with seizure disorders.

Suggest a tooth saving kit for group homes.

• Emphasize to caregivers that traumas require immediate professional attention and explain the procedures to follow if a permanent tooth is knocked out.
• Instruct caregivers to locate any missing pieces of a fractured tooth, and explain that radiographs of the patient’s chest may be necessary to determine whether any fragments have been aspirated.