Assessment of olfactory detection thresholds in children with autism spectrum disorders using a pulse ejection system.

BACKGROUND: Atypical responsiveness to olfactory stimuli has been reported as the strongest predictor of social impairment in children with autism spectrum disorders (ASD). However, previous laboratory-based sensory psychophysical studies that have aimed to investigate olfactory sensitivity in children with ASD have produced inconsistent results. The methodology of these studies is limited by several factors, and more sophisticated approaches are required to produce consistent results. METHODS: We measured olfactory detection thresholds in children with ASD and typical development (TD) using a pulse ejection system-a newly developed methodology designed to resolve problems encountered in previous studies. The two odorants used as stimuli were isoamyl acetate and allyl caproate. RESULTS: Forty-three participants took part in this study: 23 (6 females, 17 males) children with ASD and 20 with TD (6 females, 14 males). Olfactory detection thresholds of children with ASD were significantly higher than those of TD children with both isoamyl acetate (2.85 ± 0.28 vs 1.57 ± 0.15; p < 0.001) and allyl caproate ( 3.30 ± 0.23 vs 1.17 ± 0.08; p < 0.001). CONCLUSIONS: We found impaired olfactory detection thresholds in children with ASD. Our results contribute to a better understanding of the olfactory abnormalities that children with ASD experience. Considering the role and effect that odors play in our daily lives, insensitivity to some odorants might have a tremendous impact on children with ASD. Future studies of olfactory processing in ASD may reveal important links between brain function, clinically relevant behavior, and treatment.

Predicting dental avoidance among dentally fearful Australian adults.

Dental fear is related to poorer oral health outcomes, and this might be explained by the less frequent dental visiting of many fearful people. The objectives of this study were to investigate differences between dentally fearful people who regularly attend the dentist and fearful people who infrequently visit the dentist. A random sample of 1,082 Australians ≥ 15 yr of age completed a mailed questionnaire (response rate = 71.6%), and 191 dentate, high-fear adults (≥ 18 yr of age) were selected for further analysis. Dental avoidance was recorded if a person was currently avoiding or delaying dental care and if he/she had not been to a dentist in the previous 2 yr. Among the selected dentally fearful adults, dental avoidance was predicted by smoking status, toothbrushing frequency, coping strategy use, perceptions of dental visits as uncontrollable and unpredictable, and by anxiety relating to numbness, not knowing what the dentist is going to do, and cost. In a multivariate logistic regression model, smoking, toothbrushing, coping, and anxiety about numbness and cost remained as statistically significant predictors, with the model accounting for 30% of the variance. While several variables were associated with dental avoidance among fearful adults, the nature and causal directions of these associations remain to be established.

Quantification of patient fears regarding dental injections and patient perceptions of a local noninjectable anesthetic gel.

Data have shown that 30% of all Americans do not seek dental care and/or treatment unless a problem arises that causes them severe pain. Similar study results have been found in Europe as well. While some studies indicate that cost concerns prevent people from seeking dental care, the fear of pain has been identified as a factor in keeping people from seeing a dentist. A random sample of US and European patients who had recently undergone a scaling and root planing procedure was surveyed via telephone interview to quantify data on patient concerns and fears regarding anesthesia administered by injection, as well as to determine patient interest and price perception of an anesthetic gel product. The survey also provided data on the patient's experience and perception about the scaling and root planing procedure. Responses from the study population showed that patients find the injection painful and do not like the prolonged numbness. Additionally, based on the patients surveyed, they experience injection anxiety before appointments, and a significant number of them cancel appointments or simply do not seek treatment because they are afraid of the injection. Finally, the study also demonstrated that, while not eliminating dental anxiety completely, the availability of a new noninjectable anesthetic would assist in relieving patient fear, with almost half of the patients surveyed being more likely to seek treatment if only the new noninjectable anesthetic was used. Additionally, most patients surveyed would be willing to pay for the noninjectable anesthetic out of their own pockets if it was not covered by their health insurance.

Pain and self-injury in borderline patients: sensory decision theory, coping strategies, and locus of control.

Fifteen women with borderline personality disorder who do not experience pain during self-injury were found to discriminate more poorly between imaginary painful and mildly painful situations, to reinterpret painful sensations (a pain-coping strategy related to dissociation), and to have higher scores on the Dissociative Experiences Scale than 24 similar female patients who experience pain during self-injury and 22 age-matched normal women. "Analgesia' during self-injury in borderline patients may be related to a cognitive impairment in the ability to distinguish between painful and mildly painful situations, as well as to dissociative mechanisms.