The teeth of children with FAS are typically normal in appearance and function and seem to not be affected by the prenatal alcohol exposure. True False

 

 

The dental treatment of children with FAS DOES require modifications and it can be a bit challenging to dental hygienists, assistants and dentists alike.

According to "Treating the Patient with Fetal Alcohol Syndrome," by Peggy Seo Oba, RDH, MPA, MBA, the following tips will help the dental professional provide these patients with optimal care:

Provide a steady, structured and unstimulating environment to make your patient feel comfortable and to reassure them.

To make the "newness" of the dental office easier to handle, take photos of the building, parking lot, doors, staff, instruments, equipment and any other things your patient may encounter on their visit. Allow the parent to show these to the child every day, starting 2 weeks prior to their visit. Also have them talk to their child about the entire experience - what will be done that day, what equipment will be used and what the purpose of the visit is. Role playing, with the child playing the part of the dental professional, is recommended.

Try to schedule the child to walk through the office on a day when it's empty and prior to their visit. Role play what their entire visit will be like and use the actual chair, equipment and instruments that you will use for their appointment. Patients with FAS cannot generalize well and one instrument is not the same as another.

Try to schedule your patient at the end of the day, after other patients have already left or when the patient load is light.

Remove posters, plants and any extraneous materials that may distract the child. Close the blinds, but if the curtains have a "busy" design on them, do not draw them closed - this may also distract the child and set off "pseudo-absence seizures". Be certain the room is quite, plain, uncluttered and non-stimulating. This will help make the child calm while in your chair.

Repeat these procedures EVERY time the child comes to your office, particularly if there has been any length of time between visits

Once the child is in your operatory, reacquaint them with the equipment, etc. Since their hearing may be very acute, warn them ahead of time before turning on the aspirator. Music headphones are a viable option.

Dark glasses can be worn by your patient so the overhead light doesn't bother their sensitive eyes.

To be certain you have their attention, touch them gently on the arm.

Look into their eyes when you speak to them. This will assure that they hear you. You could use sign language or be very demonstrative with your hands as you talk to them.

It's a good idea to allow the parent or caregiver to stay with the child while dental treatment is being rendered to keep them calm and provide reassurance so they don't lose control.

If your patient with FAS is a teenager or older, they will need to have any instructions regarding the maintenance of their oral health or prescribed medications written down. These patients are very visual and not very auditory.

Since these children have experienced brain damage, they have unique problems that your "average" patient may not have, such as hypersensitivity and hyposensitivity on different parts of their body. The oral structures may be hypersensitive, hyposensitive or a combination of both. Their tongue may not be completely under their control and their cheek muscles may be weak. It may be difficult for them to swallow. Take these things into consideration when planning your treatment.

You can use the lead apron to lay over the child, as its weight reassures the child. An option would be to tuck a blanket around them.

Some recommendations to make to the parent/caregiver about their personal oral hygiene:

-Use a toothpaste that the child doesn't object to, or baking soda may be used. If all else fails, water can be the sole agent on the toothbrush - it's better than not brushing.

-The parent can desensitize the child's oral tissues by running their fingers over oral tissues daily.

- Flossing and rinsing after meals should be encouraged, also.

 

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