35e nieuwsbrief
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In het blad de TandartsPraktijk nr. 6, 2019 is het eerste deel van Mondzorg en autisme verschenen. Het tweede deel volgt in september.

Citaat
" Voor kinderen met autisme is de wereld vaak chaotisch. Dat geldt des te meer voor de onbekende en daardoor bedreigende situatie van de behandelkamer. Hoe kan een behandelaar het vertrouwen van de patiënt winnen en behouden? Hoe ontstaat er meer duidelijkheid en voorspelbaarheid in de praktijk voor de kinderen/adolescenten met autisme? In deze eerste bijdrage gaan we vooral in op theoretische verklaringen van autisme en wat de consequenties daarvan voor de praktijk zijn. Hierin worden handvatten aangereikt om ervoor te zorgen dat kinderen/adolescenten zich veilig voelen in je behandelstoel ".

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Op 30 augustus 2019 is er een minsymposium van het register preventie assistente. Henk Algra verzorgt de lezing: "Ik wil weten waar ik aan toe ben"

Citaat
" Voor mensen met autisme is de wereld vaak erg complex. Er komt veel informatie op hen af die ze moeilijk kunnen plaatsen. Deze lezing heeft als uitgangspunt dat autisme vooral een prikkelverwerkingsstoornis is. Het kost mensen met autisme meer energie om de informatie die ze zien en horen een betekenis te geven. Voor veel jonge kinderen is mondzorg vaak eerst spannend, maar voor autistische kinderen des te meer: er gebeurt van alles waar je geen grip op denkt te hebben. Wat zijn handvatten waar we aan kunnen denken om de mondzorg meer autismevriendelijk te maken?"

Ga voor meer informatie en inschrijving naar onderstaande link:
www.registerpreventieassistenten.nl/cursussen-en-congressen/mini-symposium

ortho 2
AUTISME EN ORTHODONTIE
De werkgroep wil in de toekomst aandacht besteden aan het onderwerp 'autisme en orthodontie'.
Enkele vragen zijn:
- wie wil ervaringen hiermee delen?
- wie wil hierin participeren?
- zijn er studenten die geinterseerd zijn in het onderwerp?

Men kan het een en ander via het contactformulier aangeven.

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Knipsel
RECENTE ENGELSTALIGE PUBLICATIES:
McDowell, C., Barry, J., & Smyth, S. (2017). Reducing Rumination of a Child with Autism Spectrum Disorder Using Post-Meal Tooth Brushing. Psychology and Psychological Research International Journal, 2(3), 1-6

Abstract
Background: Rumination is defined as the regurgitation, chewing and re-swallowing of partially digested food. It is estimated that it occurs in about 10% of individuals with developmental disabilities.
Method: An AB design was employed to assess the effectiveness of an intervention designed to reduce the number of occurrences where rumination followed eating in two settings, one of which acted as a control setting
Materials: Materials included a digital wristwatch, pen and paper based food diary and a child sized manual toothbrush and mint flavoured children’s toothpaste.
Results: Baseline measures showed that the percentage of sessions where rumination occurred was similar in both the snack and lunch settings. The intervention which was implemented in the snack setting only resulted in a decrease in the number of times rumination occurred after school snack time. There was no significant decrease in rumination following lunch which remained under baseline conditions.
Conclusions: The data add to the PBS literature on non-aversive interventions for rumination and suggest a healthy, age appropriate and functional means of decreasing the behaviour in a young child with Autism Spectrum Disorder
.
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Doichinova, L., Gateva, N., & Hristov, K. (2019). Oral hygiene education of special needs children. Part 1: children with autism spectrum disorder. Biotechnology & Biotechnological Equipment, 33(1), 748-75.

ABSTRACT
The purpose of this study was to implement an educational programme for oral hygiene of children with autism. It involved 30 children with autism aged 6–11 years. For their training, Picture Exchange Communication System (PECS) images for oral hygiene and tooth-brushing techniques were made. The oral hygiene level was assessed using the Silness & L€oe Oral Hygiene Index. The children had poor oral hygiene due to hindered communication and motivation. The practical training of the children with autism included in the study lasted one year and was performed with the help of their parents. At the end of the one-year educational programme in oral hygiene, there was improvement in the oral hygiene habits of the children. The PECS images helped to improve the communication and the oral hygiene habits in the children with autism.

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Stein Duker, L. I., Floríndez, L. I., Como, D. H., Tran, C. F., Henwood, B. F., Polido, J. C., & Cermak, S. A. (2019). Strategies for success: A qualitative study of caregiver and dentist approaches to improving oral care for children with autism. Pediatric dentistry, 41(1), 4E-12E

Purpose: Oral health is important to physical and psychological health. Individuals with autism spectrum disorder (ASD) experience significant oral care challenges, but little research exists examining efficacious interventions to improve care. This study qualitatively explored parent-and dentist-reports of successful strategies implemented during dental care with children with ASD.
Methods: Focus groups were conducted with parents of children with ASD (n=2 groups) and dentists treating children with ASD (n=2 groups). Focus group transcripts were transcribed verbatim and analyzed using a thematic analysis approach.
Results: Three key themes were identified from the parent focus groups: (1) What makes a good dentist, (2) Flexibility and techniques: strategies used by the dentist, and (3) Preparation: strategies for parents and caregivers of children with ASD. Four themes emerged from the dentist groups: (1) Parents know best, (2) Practice, (3) Flexibility, and (4) Network of colleagues. Areas of overlap between the parents and dental providers included the importance of preparation, the necessity of flexibility and creativity, and the value of collaboration.
Conclusions: Findings provide insight into techniques perceived by parents and dental providers to facilitate successful dental encounters for children with ASD.

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Mangione, F., Bdeoui, F., Monnier-Da Costa, A., & Dursun, E. (2019). Autistic patients: a retrospective study on their dental needs and the behavioural approach. Clinical oral investigations, 1-9.

Abstract
Introduction Autism spectrum disorder (ASD) is a lifelong heterogeneous psychiatric disorder that represents a challenge for dentists. The aim of this retrospective study was to analyse ASD patients’ dental needs and to investigate key factors influencing the behavioural management.
Materials and methods One hundred eighteen ASD subjects (levels 2 and 3 of the DSM-5), adults and children, treated at university dental hospital, were included. For each of them, an index card was created to record general and medical information, dental care progress and treatment management. Data were analysed to characterize this specific population in terms of dental needs, technical approach and follow-up. The relationships between care approach and age (ANOVA test), care approach and concomitant pathologies as well as care approach and required treatment (chi-square test) were evaluated.
Results Almost all patients required oral care. No treatment could be provided under conscious conditions. Oral premedication and/or nitrous oxide/oxygen inhalation was significantly more efficient in children and allowed conservative procedures. In adults, general anaesthesia was significantly more employed. Few patients were followed up over a long period.
Conclusions The variety of autism spectrum disorders complicates the statement of guidelines for dental care. The development of the collaboration between psychiatrics and dentists emerges as a key factor to improve the quality and the success of oral
outpatient treatment. Clinical relevance Oral premedication and/or nitrous oxide/oxygen inhalation at high dose represented a good way to carry out conservative dental cares, with a significant efficiency in children. Nevertheless, in a considerable number of ASD patients,
especially in adults, general anaesthesia could not be avoided.

Liu, J., Amat, M., Song, R., & Kong, X. (2019). Missing Components in Current Management of Autism Spectrum Disorder (ASD): Nutrition, Dental Care, and House-Call Programs. Review Journal of Autism and Developmental Disorders, 1-7.

Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder and systemic disease with multiple comorbidities and largely fragmented clinical care. In this article, we discuss three important components frequently missing from the current ASD standard care routine: oral health, nutrition, and house-call programs. Both ASD centers associated with tertiary-care hospitals and community ASD providers do not regularly offer these services. In this review, we address the benefits of and rationale behind incorporating dental care, nutrition, and house-call programs into ASD management.We also explain why these
three services are closely intertwined, with potentially synergistic effects to improve health care outcomes for patients with ASD. Finally, we discuss strategies for service implementation and envision ways in which these three branches of ASD care can be
best integrated into a primary care routine.
Carter, L., Harper, J. M., & Luiselli, J. K. (2019). Dental Desensitization for Students with Autism Spectrum Disorder through Graduated Exposure, Reinforcement, and Reinforcement-Fading. Journal of Developmental and Physical Disabilities, 31(2), 161-170.

Abstract
Many persons with intellectual and developmental disabilities resist basic dental care leading to poor oral health. The present study evaluated the effects of a dental desensitization intervention for two students who had autism spectrum disorder and would not tolerate tooth cleaning and examination. Intervention consisted of gradually exposing the students to steps within a desensitization hierarchy, reinforcing compliance, and progressively fading-eliminating reinforcement. Familiar care-providers implemented intervention within a simulated dental setting at their school. Both students completed intervention successfully and one of them was able to tolerate procedures during visits to a dentist’s office. We discuss the clinical and research implications of these findings.
Herrera-Moncada, M., Campos-Lara, P., Hernández-Cabanillas, J. C., Bermeo-Escalona, J. R., Pozos-Guillén, A., Pozos-Guillén, F., & Garrocho-Rangel, J. A. (2019). Autism and Paediatric Dentistry: A Scoping Review. Oral health & preventive dentistry, 17(3).

Abstract

Purpose: The objectives of this scoping review were: first, to pose a research question; second, to identify relevant studies to answer the research question; third, to select and retrieve the studies; fourth, to chart the critical data; and finally, to collate, summarise, and report the results from selected articles on the dental management of children
affected with autism.
Materials and Methods: Relevant articles (randomised controlled trials, reviews, observational studies, and clinical case reports) published over an 11-year period were identified and retrieved from five internet databases: PubMed, Embase/Ovid, Cochrane Library, Google Scholar, and EBSCO.
Results: By title and abstract screening and after removing duplicates, 25 articles were finally included in the present scoping review. According to the extracted data, the following four clinical issues were found to be most important: patient behavioural control, prevalence/incidence of dental caries, adverse effects and interactions with medications, and orthodontic management. Additionally, several useful clinical recommendations are provided.
Conclusions: Paediatric dentists should bear in mind that early diagnosis and treatment, effective communication skills, and a long-term follow-up of children with autism continue to be the best approaches for achieving enhanced patient psychological well-being and consequently a better quality of life.

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