Heroic Dentistry: Severe Autism, Rampant Caries and Strip Crowns

Posted on January 3, 2017

The Heroic Dentistry series celebrates oral health care providers who, like PULPDENT founder Dr. Harold Berk, have made it their mission to save teeth and help patients live in comfort and smile with confidence.  

Special needs patients often present unique challenges for the practitioner. This was the case with Daniel, who was 19 years old when he was referred to our office.

Daniel suffers from severe autism and its associated lack of speech, and he is further compromised by a seizure disorder.  His mother has had great difficulty finding a dentist who could treat him. When he was younger, he could be restrained for treatment, but now as a strong young man, physical restraint is neither desirable nor possible.  His mother was hopeful that I would be able to sedate him and treat his needs.

Daniel had no ability to communicate with me and was completely uncooperative.  With patience I was able to get a brief look in his mouth, which revealed severe caries. His mother confirmed that there was a lot of apple juice in his diet, and so one of the causes was obvious. We had a long discussion about diet as a major caries risk factor.

Considering these obstacles, I now had to devise a treatment plan. I would have to treat him as quickly as possible, for an affordable cost, with a material that would withstand stress and not contribute to rapid recurrent marginal caries. From my experience using strip crowns in primary dentition, I knew that they offered a fast, single appointment option that could both reduce cost and the risks of extensive anesthesia. I had to plan so that I could complete the treatment in one visit. Thinking ahead, I quickly made an upper anterior alginate impression.

Using the study model, I prepared and trimmed four strip crowns in advance of Daniel’s visit. On treatment day, I placed an IV with some difficulty and sedated him with midazolam. Even with IV sedation, I knew that I wouldn’t have much time.  The caries was very deep, but there were no exposures, so I removed the decay, treated the dentin with Pulpdent Desensitizer, placed a bonding agent, and filled the strip crown forms with ACTIVA BioACTIVE-RESTORATIVE. 

Why Activa? I have been using Activa for the past two years and knew that it would be the solution for several reasons. It is esthetic, durable, and its bioactive properties and marginal integrity are more resistant to recurrent caries than any other product. It is high strength, dual cure, and it flows nicely, so it is easy to fill and apply the strip crowns. The actual treatment time was remarkably fast for treating such severe disease. Daniels’s mother was simply delighted with the outcome.

Daniel returned for a follow up the next week, and upon seeing me walk into the room, he began to smile! Although he could not express it verbally, he knew how much I had helped him. With proper planning, this seemingly impossible case had a gratifying outcome for both the patient and his family, and for me as well.

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