SPECIAL CARE

CLIENT REPORT

Reyna Gutierrez

DH222
 My patient presents with Asperger Syndrome, which is currently under the umbrella of

Autism Spectrum Disorders ,and Dyspraxia, which is coordination disorder. My patient was

diagnosed with these disorders at a young age.

“Autism spectrum disorders (ASDs) cover a wide spectrum of neurodevelopmental

disorders that affect how a person interacts, communicates, relates, plays, imagines, and learns.”

(Darby et al., 2020). A range of behaviors from hyperactivity, short attention spans, impulsivity,

and aggressiveness may be evident with those who have ASD. The exact cause of ASD is

unknown, however, according to the Autism and Developmental Disabilities Monitoring

Network, the prevalence of ASDs has increased to 1 in every 68 children, with an approximate

five times higher incidence in men. (Darby et al., 2020).

My patient was specifically diagnosed with Asperger syndrome, once considered a

distinct diagnosis, and characterized by impaired social communication and interaction, average

or superior intelligence, and no significant language delay, now falls under the umbrella of

autism spectrum disorders (Hosseini & Molla, 2023). However, due to Asperger syndrome’s

extensive history and characteristic clinical presentations, specialists continue to use Asperger’s

as a subtype of ASDs. (Hosseini & Molla, 2023) Individuals with Asperger syndrome have a

mild form of autism, often lacking empathy, unable to understand and use hand gestures, avoid

eye contact, and can seem unengaged. (Darby et al., 2020).

In addition to Asperger Syndrome, my patient was also diagnosed with dyspraxia as a

child. Dyspraxia, also known as “developmental coordination disorder,” is a neurodevelopmental

condition that causes issues with coordination and makes it difficult for an individual to perform

motor skills. Like autism spectrum disorders, the exact cause of dyspraxia is unknown. Although
these two disorders are distinct, oftentimes dyspraxia and autism spectrum disorder can co-occur

or share symptoms (Cleveland Clinic, 2022).

As previously mentioned, my patient was diagnosed with Asperger Syndrome and

Dyspraxia as a child. Because of his dyspraxia, my patient explained he is unable to operate a

motor vehicle and relies on receiving a ride from his brother to each appointment at our dental

clinic. Although my patient is unable to operate a vehicle, he does ride his bike to and from his

part-time job where he works in a kitchen. My patient expressed that he experiences

nervousness, generalized anxiety, and depression. According to an article by Hollocks et al.,

(2018), adults who have autism spectrum disorder experience high rates of comorbid mood

disorders, with anxiety and depression being the most prominent. This patient is currently taking

venlafaxine for depression and anxiety, hydroxyzine for anxiety, and atorvastatin for high

cholesterol.

As an adult, my patient required no assistance into my operatory upon his first visit. He

was very interested in the assessment procedures and asked many questions to improve his

understanding. My patient did well when he was listening to his headphones during treatment,

however when they were removed, he noted that the saliva ejector was too loud and asked for it

to be turned off. Turning the saliva ejector off and giving my patient a minute to himself

alleviated the problem and we were able to proceed. Thus, minimizing the amount of overall

stimuli, including sounds during their appointments will help with this sensory sensitivity.

According to Darby et al., (2020), a patient who has autism spectrum disorder should not wait

for extended periods of time in the wait room due to heightened fear and stress. Procedures

should be kept as short as possible and organized. If my patient is required to return for

additional appointments, these appointments should remain on the same day of the week, at the
same time, and with the same dental professional. Currently my patient is scheduled on Monday

at 1pm for the following two weeks. During his initial appointment, he did well with the longer

appointment times. For the following appointments, when providing oral hygiene instruction,

extra instructional time may be necessary for conveying new information, and instructions

should be presented concisely utilizing the “tell-show-do” approach. Tools such as an electric

toothbrush with a two-minute timer should be suggested to assist in at home care and caries

prevention since my patient finds it difficult to maintain an oral homecare routine. An

interproximal aid with a long handle can be beneficial to my patient due to dyspraxia.

Hypersensitivity is common among individuals with autism. According to an article by

Heather Davis (2021), not only can an individual be affected by an office full of noise, but

hypersensitity in the oral cavity is common. For example, the sensation of a cold instrument may

cause discomfort and the sound of a drill may cause distress. My patient was incredibly sensitive

while I probed and oraqix was utilized and successful. Dependent upon how my patient is

feeling, and most likely past experiences, either oraqix or a local anesthetic without

vasoconstrictor, to reduce post-operative tissue trauma, will be implemented during each

appointment. The use of local anesthetic was discussed with my patient during treatment

planning but will be discussed again during their next appointment.

The preceding modifications are intended to provide my patient, who has autism

spectrum disorder and dyspraxia, the best quality of care. Further adjustments and modifications

may be necessary as I complete therapy with this patient. By paying close attention to detail,

especially to the body language of my patient, I should be able to navigate most challenges that

may present. In doing so, I will be able to provide the comprehensive dental care my patient

deserves.
Sources:

Cleveland Clinic. (2022, August 9). Dyspraxia: What it is, causes, symptoms, diagnosis &
treatment. Cleveland Clinic. Retrieved April 15, 2023, from
https://my.clevelandclinic.org/health/diseases/23963-dyspraxia-developmental-coordination-
disorder-dcd

Darby, M. L., Walsh, M. M., Bowen, D. M., & Pieren, J. A. (2020). Chapter 60 Intellectually
and Developmentally Challenged. In Dental hygiene: Theory and practice (pp. 952–957).
essay, Elsevier/Saunders.

Davis, H. (2021, July 15). Autism dental care- a guide for adults with autism: AAC. Adult
Autism Center of Lifetime Learning. Retrieved April 10, 2023, from
https://adultautismcenter.org/blog/autism-dental-care-a-guide-for-adults-with-autism/

Hollocks, M., Lerh, J., Magia3, I., Meiser-Stedman, R., & Brugha, T. (2019). Anxiety and
depression in adults with au3sm spectrum disorder: A systema3c review and meta-
analysis. Psychological Medicine,49(4), 559-572. doi:10.1017/S0033291718002283

Hosseini, S. A., & Molla, M. (Updated 2023, February 12). Asperger Syndrome . National
Library of Medicine. Retrieved April 15, 2023, from
https://www.ncbi.nlm.nih.gov/books/NBK557548/