Multidisciplinary dental management of autism spectrum disorder in Primary Health Care: clinical-sociocultural approach.

Abstract

Background: Autism spectrum disorder (ASD) is a neurological disorder characterized by problems in socialization, communication, and repetitive and stereotyped behaviors, with an increasing incidence.  In regard to oral health, these patients present multiple access barriers, greater susceptibility to oral pathologies, and usually require specialized clinical management. Difficulties in accessing preventive services in primary care (PHC) usually bind their treatment to secondary care, where social determinants of health (DSS), including immigration status and socioeconomic status, play a fundamental role. 

Clinical Presentation: 9-year-old male migrant patient, diagnosed ASD, potentially cooperative, goes to Posta Rural de San Miguel de Azapa consulting for dental care after failed care in other services. On clinical examination, multiple caries lesions, gingivitis, and residual roots are present. Comprehensive dental treatment was planned with previous desensitization appointments and adaptation to cross-sectional care, along with personalized education with visual pedagogy techniques, and coordinated interconsultations with psychology-nutritionist-medicine. 

Clinical relevance: Recent literature describes that ASD alone does not increase predisposition to oral pathologies, but there are associated factors that increase its risk¹. Poor oral hygiene, a higher prevalence of periodontal disease, ² prevalences of caries with dissimilar results, self-injuries, and aversive responses to dental care have been described. In addition, bidirectionality between ASD severity and oral dysbiosis is also postulated⁴. Regarding clinical management, short appointments are recommended, strategically scheduled, applying individualized behavioral techniques supported by visual pedagogy and multidisciplinary treatment^5-6. On the other hand, it is important to recognize migration as a DSS, therefore, the associated access barriers must be reduced and the concept of the migrant's right to health and interculturality must be understood⁷. Other demographic-systemic barriers are the high costs associated with care and the lack of health insurance, also suggesting that ethnicity, socioeconomic status, and immigration status affect oral health^8-9. It is imperative to create a therapeutic alliance between family members and the health team, applying preventive measures to avoid future dental decay, so PHC is essential to provide patient-centered care under the principles of the biopsychosocial model¹⁰. 

Conclusion: Dentists must be trained for the multidisciplinary dental treatment that ASD patients require, thus, being able to eliminate associated access barriers, analyzing the DSS involved under a biopsychosocial approach, and emphasizing the importance of PHC, applying preventive protocols and hence improving the quality of life from the patients.