Use of alternative communication with pictures for outpatient periodontal treatment in fragile X syndrome patients.

The purpose of this article is to discuss the clinical management and behavior during periodontal treatment in two patients with fragile X syndrome (FXS) using alternative communication with pictures (ACP). Both patients had a history of previous dental care only possible under general anesthesia. The ACP was used to anticipate the activities to be carried out, promoting ambiance, improving the professional-patient communication, and decreasing the stress of the patient. It was possible to carry out outpatient care without oral sedation and containment/physical restraint in both patients, being surpassed the communicative and behavioral difficulties. These case reports allow us to re-think dental care under general anesthesia or other invasive methods for patients with FXS. Therefore, the ACP is an important mediator tool that can facilitate the insertion and the management of patients with FXS, allowing the dental care outpatient clinic to promote oral health and quality of life for these patients, improving adherence to periodontal treatment and the periodontal maintenance for oral hygiene.

Importance of syngap1 syndrome diagnosis in autism spectrum disorder for dental treatment / Importância do diagnóstico de síndrome syngap1 no transtorno do espectro autista para o tratamento odontológico

ABSTRACT This paper reports on a patient with initial clinical diagnosis of Autism Spectrum Disorder level 3 and genetically confirmed as Syngap1 Syndrome (Synaptic RasGTPase activating protein). This study aimed to show the importance of genetic testing and accurate diagnoses associated with syndromes for the planning and accomplishment of dental treatments. The new diagnosis allowed reorganization of the plan and was useful in decision-making for the clinical practice of dental treatment for patients diagnosed with Syngap1.

RESUMO Apresentamos um paciente com diagnóstico clínico inicial de Transtorno do Espectro Autista nível 3 e geneticamente confirmado como Síndrome Syngap1 (proteína ativadora Synaptic RasGTPase). O objetivo deste estudo foi mostrar a importância de exames genéticos e diagnósticos precisos associados a síndromes na elaboração do planejamento e condução de tratamentos odontológicos. O novo diagnóstico possibilitou a reorganização do plano e pôde ser útil na tomada de decisão para prática clínica do tratamento odontológico de pacientes com diagnóstico de Syngap1.

Communication Application for Use During the First Dental Visit for Children and Adolescents with Autism Spectrum Disorders.

PURPOSE: The purpose of this study was to develop and evaluate an application (app) facilitating patient-professional communication among individuals with autism spectrum disorder (ASD) and compare it with the Picture Exchange Communication System (PECS). METHODS: Forty nine- to 15-year-olds were randomly divided into two groups: G1 (app; N equals 20) and G2 (PECS; N equals 20). Initially, the visual contact timing of the groups was measured. Pictures of a room, ground, chair, dentist, mouth, low-speed handpiece, and air-water syringe were presented to both groups. Each picture was shown up to three times per appointment to evaluate whether or not the child accepted the procedure. After dental prophylaxis, caries experience was recorded. RESULTS: The prevalence of dental caries was 37.5 percent. Differences in the number of attempts required for each picture to acquire the skill proposed were found between the groups (Mann-Whitney, P<0.05). A significant difference in the median number of attempts (G1 equals 9.5 and G2 equals 15) and appointments (G1 equals three and G2 equals five) was observed (Mann-Whitney, P<0.05). CONCLUSIONS: The app was more effective than the Picture Exchange Communication System for dentist-patient communication, decreasing the number of appointments required for preventive dental care and clinical examinations.

Transtorno do Espectro Autista (TEA): abordagem e condicionamento para o atendimento odontológico - revisão de literatura / Autism Spectrum Disorder: approach and conditioning for dental care – literature review

O atendimento odontológico de pacientes especiais não colaboradores tem sido realizado geralmente sobanestesia geral. Pacientes com Transtorno do Espectro Autista (TEA) são de difícil abordagem pela dificuldadeno atendimento de vínculo e contato, sobretudo o uso de anestesia geral ocasiona alterações docomportamento no pós-cirúrgico e traumas psicológicos. Diante das dificuldades encontradas no paciente comTEA no consultório odontológico, o objetivo deste trabalho é abordar a importância do condicionamentopsicológico a fim de minimizar tanto o uso de anestesia geral como também de contenção física. O tratamentoodontológico de pacientes com TEA a nível ambulatorial é possível, desde que seja realizada uma adequadaabordagem por um profissional capacitado, condicionamento prévio, individualizado e diferenciado a cadapaciente, limitando-se a indicação da anestesia geral a poucas situações e em último caso. No atendimentoodontológico ao paciente com TEA o cirurgião-dentista deve estar preparado para as intercorrências clínicas etempo maior de atendimento para a inserção desses indivíduos a condutas odontológicas que visem àpromoção de saúde e acesso a serviços especializados

The dental care for special patients no employees have been generally performed under general anesthesia.Patients with Autism Spectrum Disorder (ASD) are difficult to approach due to the difficulty in meeting bondand touch, especially the use of general anesthesia causes behavioral changes after surgery and psychologicaltrauma. Given the difficulties encountered in patients with ASD in the dental office, the aim of this study is todiscuss the importance of psychological conditioning to minimize both the use of general anesthesia as well asphysical restraint. Dental treatment of patients with ASD on an outpatient basis is possible, provided that anappropriate approach by a trained professional, previous, differentiated and individualized conditioning toeach patient, limiting the indication of general anesthesia in a few situations and in last case. In dental care forpatients with ASD the dentist should be prepared for clinical complications and a longer time for inserting theseindividuals to dental behaviors aimed at health promotion and access to specialized services

Use of a Picture Exchange Communication System for preventive procedures in individuals with autism spectrum disorder: pilot study.

The aim of the present study was to evaluate the use of the Picture Exchange Communication System (PECS) in individuals with autism spectrum disorder (ASD) in order to facilitate patient-professional communication during preventive procedures. In this study, 26 patients with ASD, between 5 and 19 years of age (10±3.3 y), were divided into two groups: G1 (n = 13) with no previous experience of dental treatment, and G2 (n = 13), with such previous experience. The initial approach followed the principles of the Son-Rise Program®. The seven PECSs presented the routine of the dental office: "room," "ground," "chair," "dentist," "mouth," "low," and "triple." Each PEC was used up to three times in order to acquire the skill proposed. It was verified that G2 required a greater number of times to achieve the acceptance of PECS "ground," "dentist," "mouth," and "triple" (p < .05). We concluded that PECS facilitated patient-professional communication during preventive procedures, including for ASD patients with previous dental experience.