Introduction
Tooth decay and crossbite are common dental problems that affect many children, especially those with special needs such as autism. In this blog post, we will review a case report that describes how prefabricated zirconia crowns and preformed metal crowns were used to treat a 5-year-old boy with autism who had severe tooth decay and crossbite.
What are Prefabricated Zirconia Crowns and Preformed Metal Crowns?
Prefabricated zirconia crowns and preformed metal crowns are types of dental restorations that cover the entire tooth surface. They are designed to restore the shape, size, function, and appearance of decayed or damaged teeth. Prefabricated zirconia crowns are made of a ceramic material that mimics the natural color and translucency of teeth. Preformed metal crowns are made of stainless steel or nickel-chromium alloy that have a silver or gold color.
Why are They Used for Children with Autism?
Children with autism often have difficulty cooperating with dental procedures due to their impaired behaviors and communication disorders. They may also have sensory issues that make them uncomfortable with the noises, vibrations, and tastes associated with dental treatments. Therefore, dental restorations that require minimal preparation, adjustment, and cementation are preferred for children with autism. Prefabricated zirconia crowns and preformed metal crowns are ideal for this purpose, as they can be placed in a single visit with minimal tooth reduction and local anesthesia. They also have high durability, biocompatibility, and esthetics, which are important factors for long-term success and patient satisfaction.
How did They Work for the Case Report Patient?
The case report patient was a 5-year-old boy with autism who had severe tooth decay and crossbite. He had multiple cavities in his primary teeth, especially in the maxillary anterior teeth, which resulted in an anterior crossbite. An anterior crossbite is a condition where the upper front teeth are behind the lower front teeth when the mouth is closed. This can cause problems with chewing, speech, and facial development.
The patient was treated under general anesthesia, as he was unable to cooperate with dental procedures. The decayed teeth were cleaned and filled with glass ionomer cement, a material that releases fluoride and prevents further decay. The maxillary anterior teeth were restored with prefabricated zirconia crowns, which improved the esthetics and corrected the crossbite. The mandibular posterior teeth were restored with preformed metal crowns, which restored the occlusal function and protected the teeth from further damage. The patient was followed up for 12 months, and no complications or failures were observed. The patient and his parents were satisfied with the treatment outcome and the improved oral health and quality of life.
What are the Benefits and Limitations of This Approach?
The case report demonstrates that prefabricated zirconia crowns and preformed metal crowns are effective and efficient dental restorations for children with autism who have severe tooth decay and crossbite. They offer the following benefits:
- They can be placed in a single visit with minimal tooth preparation and local anesthesia, which reduces the stress and discomfort for the patient and the dentist.
- They have high strength, durability, and biocompatibility, which reduces the risk of fracture, wear, and infection.
- They have good esthetics, especially for the anterior teeth, which enhances the appearance and self-esteem of the patient.
- They can correct the crossbite and restore the occlusal function, which improves the chewing, speech, and facial development of the patient.
However, this approach also has some limitations, such as:
- It requires general anesthesia, which has potential risks and complications, such as allergic reactions, respiratory problems, and nausea.
- It is more expensive than other dental restorations, such as composite resin or amalgam fillings, which may not be affordable or accessible for some patients or families.
- It may not be suitable for all cases of tooth decay and crossbite, depending on the extent and location of the lesions and the occlusal relationship of the teeth.
- It may not be accepted by some patients or parents, who may prefer more conservative or natural-looking dental restorations.
What are the Implications and Recommendations for Future Practice?
The case report suggests that prefabricated zirconia crowns and preformed metal crowns are viable options for treating severe tooth decay and crossbite in children with autism. However, more research and evidence are needed to support their use and effectiveness in this population. Therefore, the authors recommend the following:
- Dentists should consider the individual needs and preferences of each patient and their family when choosing the type and extent of dental restorations.
- Dentists should educate and counsel the patients and their parents about the benefits and risks of different dental restorations and the importance of oral hygiene and preventive care.
- Dentists should collaborate with other health professionals, such as pediatricians, psychologists, and therapists, to provide comprehensive and holistic care for children with autism and their families.
- Researchers should conduct more clinical trials and systematic reviews to compare the outcomes and costs of different dental restorations for children with autism and other special needs.
Faq
What is childhood caries?
Childhood caries, also known as early childhood caries (ECC) or baby bottle tooth decay, is a condition where one or more primary teeth have decayed or cavitated lesions. Childhood caries can be caused by various factors, such as frequent consumption of sugary foods and drinks, poor oral hygiene, lack of fluoride exposure, and bacterial infection. Childhood caries can lead to pain, infection, tooth loss, malnutrition, and impaired oral health-related quality of life.
What is anterior crossbite?
Anterior crossbite, also known as negative overjet or reverse overjet, is a condition where the upper front teeth are behind the lower front teeth when the mouth is closed. Anterior crossbite can be caused by various factors, such as genetics, thumb sucking, mouth breathing, trauma, or tooth decay. Anterior crossbite can cause problems with chewing, speech, and facial development.
What are the criteria for selecting children with autism for dental treatment under general anesthesia?
Children with autism are a heterogeneous group of individuals who have different levels of cognitive, behavioral, and communication abilities. Therefore, the selection of children with autism for dental treatment under general anesthesia should be based on a comprehensive assessment of the following criteria:
- The oral health status and needs of the child, such as the type, extent, and urgency of the dental problems, the presence of pain, infection, or bleeding, and the impact of the oral health on the general health and quality of life of the child.
- The behavioral and emotional characteristics of the child, such as the level of cooperation, compliance, and consent, the ability to cope with stress, anxiety, and fear, and the preference and expectation of the child and the family.
- The medical and physical condition of the child, such as the presence of any medical problems, allergies, or medications, the risk of anesthesia-related complications, and the suitability of the child for the anesthesia procedure.
What are the types of general anesthesia used for dental procedures?
General anesthesia is a state of unconsciousness induced by drugs that affect the brain and nervous system. General anesthesia can be administered in different ways, such as:
- Inhalation: The patient breathes in a mixture of gases, such as nitrous oxide and oxygen, through a mask or a tube.
- Intravenous: The patient receives an injection of drugs, such as propofol and fentanyl, through a vein.
- Intramuscular: The patient receives an injection of drugs, such as ketamine and midazolam, into a muscle.
- Oral: The patient swallows a liquid or a pill that contains drugs, such as chloral hydrate and hydroxyzine.
What are the benefits of using general anesthesia for dental treatment in children with autism?
General anesthesia is a state of unconsciousness that is induced by drugs and monitored by an anesthesiologist. General anesthesia has several benefits for dental treatment in children with autism, such as:
- It eliminates the fear, anxiety, and pain that the child may experience during the dental procedure, which can improve the quality and outcome of the treatment.
- It allows the dentist to perform multiple or complex dental procedures in a single session, which can reduce the number of visits and the duration of the treatment.
- It prevents the child from moving, resisting, or injuring themselves or others during the dental procedure, which can enhance the safety and comfort of the child and the dental team.
What are the risks and complications of general anesthesia?
General anesthesia is generally safe and effective, but it may have some risks and complications, such as:
- Allergic reactions: The patient may have an allergic reaction to the drugs or the materials used for anesthesia, which can cause itching, rash, swelling, or breathing problems.
- Respiratory problems: The patient may have difficulty breathing, low oxygen levels, or aspiration of stomach contents into the lungs, which can cause pneumonia or lung damage.
- Nausea and vomiting: The patient may feel sick or vomit after the anesthesia, which can cause dehydration, electrolyte imbalance, or aspiration.
- Dental injuries: The patient may have injuries to the teeth, gums, or tongue, such as chipping, cracking, or bleeding, due to the insertion or removal of the mask or the tube.
- Cognitive problems: The patient may have temporary or permanent problems with memory, concentration, or learning, due to the effects of the drugs on the brain.
How can the risks and complications of general anesthesia be minimized?
The risks and complications of general anesthesia can be minimized by following some precautions, such as:
- Preoperative evaluation: The patient should have a thorough medical and dental history, physical examination, and laboratory tests, to identify any potential problems or contraindications for anesthesia.
- Informed consent: The patient and the parents should be informed about the benefits and risks of anesthesia, the alternatives, and the possible outcomes, and they should sign a consent form before the procedure.
- Fasting: The patient should not eat or drink anything for several hours before the procedure, to reduce the risk of aspiration or vomiting.
- Monitoring: The patient should be monitored continuously during and after the procedure, by using devices that measure the heart rate, blood pressure, oxygen saturation, and other vital signs, and by observing the patient’s appearance and behavior.
- Postoperative care: The patient should be given adequate pain relief, hydration, and nutrition, and should be observed for any signs of complications, such as bleeding, infection, or fever.
What are the alternatives to general anesthesia for dental procedures?
General anesthesia is not the only option for dental procedures, especially for children with ASD. There are other alternatives, such as:
- Local anesthesia: The patient receives an injection of a drug, such as lidocaine or articaine, that numbs the area of the mouth where the procedure will be done. The patient remains awake and aware, but does not feel pain.
- Sedation: The patient receives a drug, such as nitrous oxide, midazolam, or dexmedetomidine, that reduces the anxiety, fear, and pain associated with the procedure. The patient remains conscious, but may not remember the procedure.
- Behavioral management: The patient receives no drugs, but is guided by the dentist and the staff, who use techniques such as tell-show-do, positive reinforcement, distraction, or modeling, to help the patient cooperate and cope with the procedure.
Source:
https://scholar.google.com/scholar?hl=en&as_sdt=0,5&q=autism&scisbd=1