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Applied Behavior Analysis (ABA): Applied behavior analysis is a scientific discipline that focuses on the analysis and modification of human behavior. During the 60’s, a group of researchers at the University of Washington began to apply the principles of behavior analysis to a wide variety of human problems building useful skills in learners with autism.
A 2007 clinical report of the American Academy of Pediatrics concluded that the benefit of ABA-based interventions in autism spectrum disorder (ASD’s) “has been well documented through 5 decades of research and, children who receive early intensive behavioral treatment have shown to make substantial positive social changes”.
When a child is diagnosed with a developmental disability as Autism Spectrum Disorder, ABA intervention can teach new skills and reduce unwanted behavior. Behavior analysis focuses on the basic elements that explain how learning takes place. Positive reinforcement is one such principle. When a behavior is followed by some sort of reward, the behavior is more likely to be repeated. Visual supports help to increase understanding and creates predictability and provides a visual structure and routine of the dental visit which can help reduce anxiety and behaviors. Often children with autism have a hard time with change in routine, new people and, new sensory stimulations.
However, applying this principles to dentistry is challenging and changes do not typically occur quickly. Rather, most patients require intensive and ongoing dental instruction that builds on their step-by-step progress. Moreover, the rate of progress varies considerably from person to person depending on age, level of functioning, family goals and other factors.
At Miami Children’s Smiles, we have created a program tailored to patients within the Autism spectrum. Although we are not behavioral therapist, we are pretty confident we can help in the creation of healthy dental habits for your child.
Nitrous Oxide: Also known as “laughing gas”. It is a very mild form of sedation that consists in giving the child a relaxing gas through a mask placed on the nose. The gas is simultaneously given with oxygen. Candidates for this method are children that are anxious or afraid but willing to let us place the mask on their noses. Children more anxious or that are crying when we attempt to place the mask on the nose need a different approach.
Oral Sedation: When a child is too young, the treatment is relatively short, and his or her level of anxiety is higher or is unwilling to let us use nitrous oxide is when oral sedation comes into place. It consists in giving the child a sedative agent which comes in a liquid form that the child drinks. This sedative produces a calming state that allows the child to cooperate with the treatment needed. It causes sleepiness, drowsiness, and loss of apprehension. The vital signs are closely monitored during the entire procedure, and the child usually recovers within an hour after treatment is completed.
Intravenous Sedation: When there is a significant amount of dental treatment to be done, and the child is very young, fearful or uncooperative and an oral sedative is not enough to control the child’s level of anxiety we offer this option. It consists in performing all dental treatment while the child is safely sedated with a medicine given intravenously. This option creates a deep sleep that insulates the child from the stress and worry associated with dental procedures. For this option we create a team in our office with a pediatric anesthesiologist that is in charge of dispensing the sedative and monitor the child while the dental treatment is performed by Dr. Gabriela Rolland-Asensi. For this treatment option we partner with Pediatric Dental Anesthesia Associates as well as with Florida Dental Anestesia.
Hospital Dentistry: When the amount of dental treatment is major and complex, the child has a complicated medical history or a special need or disability we may offer to perform the dental treatment while the child is safely asleep in a children’s hospital. This provides a safe environment with a pediatric medical team at our side to properly care for the child’s dental needs. The majority of cases for dental restoration in hospital setting are performed at: Nicklaus Children’s Hospital, formerly known as Miami Children’s Hospital.