Oral health care for a child with the diagnosis of autism is not much different from the oral health care of other children. However, children with autism often have difficulty in communication skills, so cooperation from your child might be a difficult challenge when visiting the dentist. For parents of children with autism, a visit to the dentist is more than a child opening his or her mouth and getting a reward after. If your child is too difficult to work with and the need for a dental procedure is urgent enough, a dentist may have no choice but to use dental sedation in order to perform his job.
What is dental sedation? Is it necessary? Is it safe?
Sedation is the utilization of medications called 'sedatives' to create a state of relaxation. It is usually done to facilitate a medical, or in this case, dental procedure. There are three levels of sedation that may be used with pediatric patients that require extensive dental care:
-Conscious sedation is inducing a minimally depressed level of consciousness that retains the patient's ability to maintain an open airway independently and continuously and respond appropriately to physical stimulation or verbal commands.
-Deep sedation is a type of sedation in which the patient is not easily aroused and which may be accompanied by a partial loss of protective reflexes, including the ability to maintain an airway or to respond properly to physical stimulation or verbal commands.
-General anesthesia is an induced state of unconsciousness. The patient cannot respond to physical or verbal stimulation of any kind and it will be up to the dentist to insure that an airway is maintained.
Most people immediately associate sedation with general anesthesia, in which the patient is put to sleep during the whole procedure and awakens afterward in a recovery room. However this is normally the last possible choice for a pediatric dentist. He will recommend a lower level of sedation instead if he can, trying to use whichever form of anesthesia has the lowest risk while being effective. To make his decision he will take the child's age, cognitive level, coping and communication skills, physical health, the attitude of the parents toward anesthesia and the urgency of the procedure into consideration.
Although the decision regarding which level of sedation to be used on your child must ultimately be made by the dentist, you as the parent should always have a say in the matter. If you are not comfortable with the suggestion of your dentist, make sure that your concerns about it are heard. To help you further understand the decision the dentist will be making, here are some guidelines from the American Academy of Pediatrics (AAPD) that the dentist will be using in making his recommendation: (American Academy of Pediatric Dentistry, 2010)