Eighty percent of adults age 30 and older have some form of gingivitis. There are not currently any statistics available for the population under 30. Dental clinicians see every day how common gingivitis is in children and teenagers. Individuals with autism have a higher incidence of gingivitis and periodontitis than their typical peers. This is due to the difficulty of daily biofilm removal.
Gingivitis has previously been considered a “reversible” condition with plaque and biofilm control leading to clinical resolution. Evidence now demonstrates the chronic inflammatory response to plaque biofilm may establish a “memory” in the gingival connective tissue. The hypothesis suggests once an individual has had gingivitis the next time disease-inducing biofilm is present the memory enhances the inflammatory cascade, resulting in attachment loss and destructive periodontitis. This mechanism of action parallels those found in other chronic inflammatory diseases. Understanding this gives the clinician greater motivations to treat, discuss, and educate patients more aggressively when gingivitis is present. Gingivitis must be resolved to improve health but also to prevent periodontitis.
Periodontitis occurs in 20% of the general population, it is higher for the autism population. Periodontitis cannot be cured; it must be maintained and requires expensive, frequent, diligent visits for the patient. Many individuals on the autism spectrum rely on state funded insurance like Medicaid. This does not often cover dental procedures for those over the age of 18. This is a limitation of care not to mention the difficulty of treating patients on the spectrum when it requires subgingival and ultrasonic scaling. Prevention is absolutely critical to the health and well-being of these patients (Figure 12).