350 - Successful Non-sedated Restorative Treatment Using Behavioral Adaptation In Autistic Child.

Abstract


Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by differences in social communication, sensory processing, and behavioral regulation. These features often complicate dental care delivery, frequently resulting in the use of pharmacologic behavior management strategies such as sedation or general anesthesia. While effective in the short term, these approaches do not address underlying behavioral barriers and may contribute to long-term dental avoidance.



Case Description: This case report describes the successful completion of extensive restorative dental treatment in a 7-year-old female with ASD (DSM-5 Level 1: requiring support) using a structured, non-pharmacologic behavioral adaptation protocol. The patient initially presented with severe dental anxiety and had previously been referred for sedation-based care. A stepwise desensitization program was implemented over eight visits spanning three months. The protocol emphasized gradual exposure, Tell–Show–Do communication, positive reinforcement, sensory and environmental modifications, consistency of provider and operatory, and active caregiver participation. Treatment progressed incrementally from familiarization and preventive care to complex restorative procedures, including pulpotomies, stainless steel crowns, restorations, and extractions, all completed without sedation or physical restraint.



Results: The patient demonstrated progressive improvement in cooperation, as reflected by increasing Frankl behavior ratings, ultimately achieving “definitely positive” behavior. All planned treatment was successfully completed in a conventional clinic setting.



Conclusion: This case highlights the potential of individualized, behaviorally based interventions as effective alternatives to sedation for selected pediatric patients with ASD. Structured desensitization, combined with caregiver involvement and sensory-aware modifications, may reduce reliance on pharmacologic management and promote more inclusive, patient-centered dental care.

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