Behavioral management approaches in dentistry and stress management for a patient with salt-wasting congenital adrenal hyperplasia and autism spectrum disorder: a case report

Abstract

Introduction: Congenital Adrenal Hyperplasia (CAH) refers to a group of autosomal recessive disorders characterized by a deficiency that prevents or hinders cortisol biosynthesis. The most frequent and severe form is the salt-wasting type, which involves a significant decrease in cortisol and aldosterone levels resulting in potentially fatal shock due to insufficient cortisol response to stress. On the other hand, Autism Spectrum Disorder (ASD) is one of the most prevalent and complex neurodevelopmental disorders. It is characterized by difficulties in communication and social interaction, and by restricted and repetitive patterns of behavior, interests, and activities. Objective: To present a case of dental treatment in which behavioral management was used to reduce stress in a patient with salt-wasting CAH and ASD, as an alternative to pharmacological management.
Case Report: This report presents the case of an 11-year-old male patient diagnosed with salt-wasting CAH and Autism Spectrum Disorder (ASD). Reason for consultation: the patient’s parents requested an alternative treatment for caries that would not require general anesthesia. The patient shows negative behavior towards dental care. The parents reported the inability to manage his son’s behavior during a previous dental experience in an operating room under general anesthesia. The patient was treated at the Special Patients Clinic, Faculty of Dentistry, Universidad de Concepción, Chile, between the years 2015 and 2023. Restorative and preventive dental treatment was planned. The frequency of care varied from once a week to every two weeks during the adaptation and restorative stage; and every three months in the preventive and maintenance stage. The treatment was carried out using behavioral modeling strategies in dental care as an alternative to pharmacological management for stress control. In the initial interventions, a negative behavior was observed. However, after a year of dental treatment involving psychoeducational techniques, the patient gradually progressed to a definitely positive behavior.
Conclusion: This case shows that the use of psychoeducational techniques and strategies in dental treatment was a beneficial and effective alternative to pharmacological methods to manage stress and medical crises. An improvement in the patient’s behavior was achieved throughout the course of treatment.