A stepwise, eight-stage approach to desensitization and individualized dental management of a nonverbal pediatric patient with Autism Spectrum Disorder: a case report with a national interest perspective

Dental care for children with autism spectrum disorder (ASD) often requires individualized communication, environmental adaptation, and clinical management, particularly when approach, physical contact, and sensory tolerance are limited. This case report describes an 11-year-old boy with ASD and no functional verbal communication whose parents sought an alternative to sedation and treatment in a surgical center for extraction of the over-retained primary maxillary left canine (tooth 63). The initial assessment identified marked limitations regarding professional approach, physical contact, exposure to instruments and sensory stimuli, and chair tolerance. Four visits of approximately 60 to 90 minutes were conducted. The first three followed an individualized, progressive approach organized into eight interrelated stages: access, assessment, identification, adaptation, communication, care, monitoring, and reassessment, combining tablet-based augmentative and alternative communication, tell-show-do, parental participation, planned breaks, and gradual introduction of preventive procedures. At the fourth visit, the extraction was performed in an outpatient setting while maintaining the strategies previously established. The progressive approach was accompanied by increasing participation and enabled outpatient extraction after three preparatory visits. Because autism now affects one in 31 eight-year-old children in the United States and general anesthesia carries clinical, behavioral, and system-level costs, the report also discusses the national interest and scalability of this low-technology, teachable protocol, and proposes indicators for its multicenter evaluation.