2016 Volume 37 Issue 4 Pages 419-425
We report a patient with autistic spectrum disorder whose self-injury behavior and epilepsy attack became worse following dental treatment under general anesthesia. The patient was a 36-year-old male who had been diagnosed with autistic spectrum disorder, mental retardation, and epilepsy. He regularly received oral care such as tooth-brushing at the dental clinic of a nearby general hospital, though he had no previous experience of dental treatment. Self-injury behavior, such as scratching the gingiva with his fingernails, had been observed since childhood and gingival involution was noted. His parents and staff at his facility requested a detailed intraoral inspection, because the patient showed panic when the staff attempted to brush exposed tooth roots on several occasions. Intraoral findings revealed remarkable regression of the buccal gingiva, an involution extending to the apical portion of the teeth, and multiplex teeth. We decided to perform dental treatment under general anesthesia during 3 days and 2 nights of hospitalization for the following reasons. First, multiple teeth required treatment. Furthermore, the situation was urgent because the patient was experiencing tooth-related pain. In addition, his place of residence was distant and he had a strong fear of dental treatment. Progress during the hospitalization was good. However, after returning to his facility, the self-injury behavior worsened and he ingested large quantities of water. As a result, the patient suffered from hyponatremia, which reduced the bloodstream concentration of anti-epileptic drugs, leading to several epileptic seizures. He was urgently hospitalized at a suburban general hospital for 2 weeks and treated with drip saline. Following discharge, the self-injury behavior gradually improved along with environmental maintenance at his facility, which prevented the patient from drinking water by himself. Presently, self-injury behavior incidents are fewer compared to the time before dental treatment under general anesthesia. Furthermore, the patient has accepted tooth brushing without complaint and he visits our clinic with his parents every 3 months for maintenance with an ultrasonic scaler under nitrous oxide inhalation sedation.
