Migration and impact on dentistry for people with Autism Spectrum Disorder in primary health care

Abstract

Background: Autism Spectrum Disorder (ASD), a neurological disorder characterized by alterations in socialization, communication, and behavior, presents barriers to access to dental care and usually requires specialized clinical management. Difficulties in accessing preventive services in primary health care (PHC) restrict their treatment to secondary care and social determinants in health (DSS), including immigration status and socioeconomic status, play a fundamental role. 

Clinical presentation: Male patient, migrant, 9-year-old, ASD diagnosis, potentially cooperative, goes to San Miguel de Azapa’s rural health center for dental care after failed care in other services. On clinical examination, cavity lesions, gingivitis and root remnants are observed. Dental treatment is planned with previous adaptation appointments, personalized education with visual pedagogy and consultation with psychology, nutrition, and medicine fields. 

Clinical relevance: ASD by itself does not increase the predisposition to oral pathologies, but there are factors that increase its risk. There is worse oral hygiene; higher prevalence of periodontal disease and cavities; aversive responses to dental care; possible bidirectionality between ASD severity and oral dysbiosis. Short scheduled care, individualized behavioral techniques and multidisciplinary treatment are recommended, understanding the DSS and barriers (high costs, ethnic groups, socioeconomic status, etc.), internalizing the concept of the migrant's right to health and interculturality, generating a therapeutic alliance, and in where PHC is essential in care under a biopsychosocial model. 

Conclusion: The dentist must be trained in the care of ASD patients by analyzing DSS with a biopsychosocial approach with emphasis on PHC and applying health promotion and prevention protocols.