2021 Volume 42 Issue 3 Pages 264-270
Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders defined by interpersonal relationship and communication problems and limited and repetitive behavioral patterns. It is characterized by a tendency to suffer because of even small environmental changes. In dental settings, these patients are not receptive to treatment due to their inability to adapt to environmental changes, which can worsen symptoms. Here, we report a case of an ASD patient with severe intellectual disabilities who developed an external dental fistula on the cheek, which was surgically removed along with the tooth responsible using intravenous sedation (IVS) and general anesthesia (GA). The patient was a 15-year-old male who visited our hospital in July 2017 with a chief complaint of swelling and pus discharge from the lower left cheek. At a different dental clinic, he had undergone four root canal treatments under IVS and took oral antibiotics, but no improvement was observed and the patient was referred to our hospital. At the initial examination, the patient strongly resisted sitting in the unit and it was difficult to persuade him to do so, which also made it impossible to perform an oral examination or obtain a panoramic X-ray. Because the external dental fistula of the left cheek could have caused jaw inflammation, we believed that an oral examination, diagnosis, and treatment needed to be performed without delay. First, an oral examination, digital X-ray, and computed tomography were performed under IVS. Based on the diagnosis that tooth extraction was indicated, the tooth responsible was removed on the same day. Although the external dental fistula healed without causing jaw inflammation, scarring and contraction of the fistula tract created a depression in the cheek. As the patient’s parents wanted the cheek depression fixed, fistulectomy was performed under GA. Removal of the fistula improved the depression, and the patient’s course has been uneventful since.
