Megan Baitey

10/22/20
Special Care Client
“Autism spectrum disorder (ASD) is a developmental disability that can cause significant social,

communication and behavioral challenges” (Basics About Autism Spectrum Disorder (ASD).

Autism is a common disorder that is diagnosed through a medical professional based on

behaviors and developments. Those with autism typically don’t look “different”, but rather

communicate, behave, learn, and interact with others in a way that stands out from other

people. The autism spectrum ranges greatly. Individuals can be severely challenged or

considered “gifted” (Basics About Autism Spectrum Disorder (ASD). There is no cure for autism

however, interventions can be done which could include therapy to help the child talk, walk,

and interact with others. The prognosis for autism is a normal life expectancy. “Social and

communication deficits continue in some form throughout life; some of the negative behaviors

may change or diminish over time with appropriate treatment” (Wilkins, E. (2016).

“Epilepsy is a chronic noncommunicable disease of the brain” and is characterized “by recurrent

seizures, which are brief episodes of involuntary movement that may involve a part of the body

(partial) or the entire body (generalized) and are sometimes accompanied by loss of

consciousness and control of bowel or bladder function” (World Health Organization). Seizure

episodes are due to extra electrical discharges in the brain. “Seizures can vary from the briefest

lapses of attention or muscle jerks to severe and prolonged convulsions” (World Health

Organization). Frequency can also vary when it comes to seizures, from less than 1 per year to

several per day. “Temporary symptoms occur, such as loss of awareness or consciousness, and
disturbances of movement, sensation (including vision, hearing and taste), mood, or other

cognitive functions” (World Health Organizations). People with epilepsy also have higher rates

of psychological conditions like depression and anxiety. The prognosis for seizure control is

good, and “approximately 75% of patients become seizure free” and the “disorder tends to be

stable, and does not worsen over time” (Wilkins, E. (2016).

My special care client that I am bringing in has both autism and epilepsy. He was diagnosed

with epilepsy a few years ago and autism about ten years ago. Though his autism is considered

highly functioning and he has a milder form of epilepsy he still has his own everyday challenges

he faces. He is taking the following medications that have been very helpful in preventing

seizures: lamotrigine ER 300 mg and 50 mg twice daily (350mg total), oxcarbazepine 300mg two

tablets in the morning and two tablets at bedtime, and allopurinol twice daily.

I know my patient very well and I know what things can make him uncomfortable or even

possibly trigger a seizure, given you can’t always predict those. Typically, large group settings

can make him feel uncomfortable. He feels like he doesn’t fit in and doesn’t know what to say

to other people. When he is uncomfortable or overwhelmed his stress levels usually increase,

and his communication with others decreases or stops completely. When his stress levels

increase, we have also noticed he tends to have more seizures. His seizures usually are not

tonic-clonic type seizures. In fact, he luckily has only had a couple like that since starting his

medications, but rather the loss of awareness type. He will suddenly just forget where he is or

what he should be doing. This can be nerve racking when it comes to dental treatment because

I wouldn’t want him to be scared or not understand what is happening to him.

My goal for his treatment is to be very obvious and vocal about every step along the way to

make sure during his appointment, he is fully aware of everything. The Clinical Practice of the

Dental Hygienist book recommends a “tell-show-do” instruction to help desensitize the

situation. I am also planning on playing some quite music (of his choice) to make the

environment a little more comforting and to help him relax. I will be sure to check in with him

regularly on how he is feeling and see if there is anything else that I can do to accommodate

him and his comfort. The night before the appointment when I do the usual COVID

questionnaire and appointment confirmation, I will be sure to check in on how he is feeling

about the upcoming appointment and see if there is anything I can do before he arrives to

make him feel comfortable as well. I believe having the new doors and walls around the dental

units will be beneficial because I feel like having the privacy will keep his stress down since he

won’t be around a lot of people. My patient is especially good about communicating with me,

and he is usually pretty good with strangers as well depending on the comfort he feels. He

might not make eye contact and keep his answers or questions short, but he doesn’t have

issues with actually communicating with others.

My patient does not require a medical consult for the disorders listed above. However, he did

come in for an NPI with me during first year and was told to bring back a medical consult form

due to the high blood pressure at the time. This may have been related to stress because he

told me he never normally has issues with high blood pressure. He hasn’t been to the dentist in

years and his oral health condition at the time was too advanced for me at the time, so I was

told to schedule him during my second year of school. He has never needed anesthesia during

dental treatment before, but this is the longest he has gone without getting his teeth cleaned. I
am hoping as long as he is comfortable without it, to avoid using anesthesia because I feel it

might raise his stress levels due to it being something new to him. If he does need it, I will do

my best to keep him calm during the process so he can hopefully sit through his non-surgical

periodontal therapy without pain. My patient has also had troubles in the past with his hand-

eye coordination so my goal is to really work with him on some home care regimens that are

effective, but also easy for him to be consistent with proper brushing, tepe brush for

interproximal use, and floss sticks rather than stringed floss.

I feel like bringing this patient in is not only good for his oral hygiene, but also very beneficial to

me so that I can see what its like to work on someone with autism and/or epilepsy and how I

should handle the situation and meet every need they may have. With autism being pretty

common; its very important for me to be educated about it, and make sure to have different

solutions for any problems that may arise. One interesting fact that I did learn while doing

research for this paper is “Up to a third of people with autism spectrum disorder also develop

seizure disorders—the rate of seizures in people with ASD is 10 times higher than in the general

population” (Massachusetts General Hospital). This was the case for my patient, and I think this

is very important for healthcare professionals to be aware of this fact in case they are working

on someone that has autism and may have an unknown or known seizure disorder. My patient

is almost thirty and as I mentioned above, he didn’t find out about his epilepsy until a few years

ago. We all need to try and be prepared for any kind of situation that may arise.

References
Basics About Autism Spectrum Disorder (ASD) | NCBDDD | CDC. (2020, March 25). Centers for
Disease Control and Prevention. https://www.cdc.gov/ncbddd/autism/facts.html
Massachusetts General Hospital. (2007). 30 Facts to Know about Autism Spectrum Disorder.
https://www.massgeneral.org/children/autism/lurie-center/30-facts-to-know-about-
autism-spectrum-disorder
Wilkins, E. (2016). Clinical Practice of the Dental Hygienist (12th ed.). Jones & Bartlett Learning.
World Health Organization: WHO. (2019, June 20). Epilepsy. World Health Organization.
https://www.who.int/news-room/fact-sheets/detail/epilepsy