Pacific Coast Society of Orthodontists Bulletin Winter 2014 - (Page 41)
and SPECIAL NEEDS CHILDREN
Presented by Dr. Heather Sesma at the 2014 PCSO Annual Session, October 3, 2014.
Summarized by Jenifer Vetter.
n her presentation, Dr. Heather Sesma broke down
stereotypes and barriers that might cause autistic
and special needs children to feel uncomfortable
when they receive much-needed orthodontic treatment.
Dr. Sesma reports that this population of patients is the
least likely group to receive oral health care; 13% to 75%
of these individuals report problems with access to care,
but 40% cannot find a provider willing to treat them.
By helping orthodontists and orthodontic staff peek
behind the curtain and into the minds of those with
special needs, we may be encouraged to overcome this
lapse in care.
Children with the autism spectrum disorder (ASD) often
have a co-morbidity with another disorder or syndrome.
For instance, 10% of children with ASD have a propensity
toward an additional genetic, neurological, or metabolic disorder. ASD patients often will have intellectual
disabilities, cerebral palsy, spina bifida, speech and/
or language issues, or learning disabilities. The rate
of ASD continues to increase each year in the United
States, where it currently affects one in 68 children.
ASD is more common in males than in females, with
males outnumbering females five to one. Chromosomal
abnormalities that accompany ASD can include Fragile
X syndrome, Down syndrome, tuberous sclerosis, and
For a child to be diagnosed with ASD, Dr. Sesma notes
that he/she must exhibit certain sets of criteria.
(must meet all criteria in this section):
Primarily deficient in social reciprocity:
You may find these patients to be "active, but odd," and
have difficulty with social cues. Their approach to social
situations may seem "off."
Deficient in non-verbal communication:
These patients may lack facial expression, be unaware of
personal space, and/or avoid eye contact with others.
Lacking personal relationships with others:
They may be unable to identify friendships or close perWINTER
2014 * PCSO BULLETIN
sonal relationships with others, beyond identifying other
RESTRICTED or REPEATED BEHAVIORS
(TWO of FOUR NEEDED):
Repetitive use of objects (hand flapping, finger
Excessive routines (inflexible adherence to
routines) and resistance to change
Restricted or quirky interests that may be abnormally intense. (Dr. Sesma gave the example of her
patient who only talks about Thomas the Train.)
Hyper- or hypo-activity to sensory input, with
adverse response to sounds and/or textures
Indifference to pain, heat, or cold
Dr. Sesma also noted that these symptoms or behaviors
might not be present at the same time and can individually fade or develop as the patient ages. Symptoms are
present in early childhood, with four years being the
ideal age to diagnose a child with ASD. Symptoms must
impair the child's daily functioning.
Often, ASD patients will present with diets heavy in
carbs and high in refined sugars. This can be due to
sugar cravings from ASD or the medications they take
for the co-morbidity disorders. Providers should be aware
that patients with ASD might present with self-injury
due to secondary disorders such as epilepsy. Patients
with ASD can also suffer from poor oral hygiene due
to deficient fine motor skills, or sensory or behavior
problems. Tongue thrust is also common in patients
with ASD. These patients can benefit from a referral to a
For the practitioner, common concerns with dentition
include enamel defects stemming from high fevers,
missing teeth and open bites, and craniofacial deficiencies and abnormalities (because the ASD patient is prone
to co-morbidity with other syndromes and defects). The
ASD patient may also have trauma to the teeth from
seizures, and gingival overgrowth.
Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2014
A Clear Message and a Clear Plan
So Much to Share and Celebrate!
Facebook and Orthodontic Practice Marketing
PCSO At a Glance
Poor Posture = Back and Neck Pain
Resident Spotlight: Roseman University College of Dental Medicine, Postgraduate Orthodontic Program
Younger Member Spotlight: Dr. Mahbod Rashidi
The University of the Pacific’s Arthur A. Dugoni School of Dentistry
Dr. Terry McDonald Interviews Dr. Glenn Sameshima
New Technology for a New Office: Cost-Effective and Space-Saving
Case Report Pre-Treatment
Dr. Frank Beglin, PCSO President 2014-2015
Helping Autistic and Special Needs Children
Organization and Innovation are Intertwined
Patient Service: Thinking Outside the Box
Clinical Applications of TADs and Outcome Evaluations with 3-D CBCT Superimposition
Tips and Tricks from the Trenches
Case Report Post-Treatment
Dr. David Thomas Lawless
Pacific Coast Society of Orthodontists Bulletin Winter 2014