Autism and dentistry.
Understanding autism spectrum disorder (ASD)
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Autism spectrum disorder (ASD) is a complex developmental disorder that affects communication, social interaction, and behaviour. It is estimated that around 1 in 100 people in the UK have ASD, making it one of the most prevalent developmental disorders.
ASD is a spectrum disorder
This means that it affects individuals in different ways and to varying degrees. Some individuals with ASD may have mild symptoms and require minimal support, while others may have more severe symptoms and require significant support throughout their lives.
Range of symptoms
The signs and symptoms of ASD may be noticeable by the age of 2-3 years, although some children may not receive a diagnosis until later. The range of symptoms and their severity can vary widely among individuals with ASD.
Common symptoms of ASD include:
- Difficulty with social interaction, such as difficulty with eye contact, facial expressions, and nonverbal communication
- Difficulty with verbal and nonverbal communication, such as delayed or absent speech, lack of gestures, and difficulty understanding sarcasm or humour
- Repetitive or restricted behaviours, such as repeating words or phrases, lining up objects, and becoming upset by changes in routine
- Sensory sensitivities, such as being sensitive to bright lights, loud noises, or certain textures of clothing or food
- Intellectual disability or delayed cognitive development (in some cases)
Rarer symptoms of ASD include:
- Self-injurious behaviour, such as head-banging or biting oneself
- Aggressive behaviour, such as hitting or biting others
- Catatonic behaviour, which involves a lack of movement or responsiveness to stimuli
- Hyperactivity or hypoactivity, which involves either excessive or reduced levels of activity and movement
- Seizures or epilepsy, which can occur in a small percentage of individuals with ASD
- Sleep disturbances, including difficulty falling asleep, staying asleep, or waking up early
- Eating disorders, such as picky eating or a restricted diet
- Gastrointestinal problems, such as constipation, diarrhoea, or abdominal pain
The causes of ASD
The causes are not fully understood, but research suggests that a combination of genetic and environmental factors may be involved.
Paracetamol, Pregnancy, and Autism
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In September 2025, public attention was focused by President Trump on whether paracetamol (acetaminophen) use in pregnancy might increase the risk of autism in children. This has been investigated in large, high-quality population studies.
- The largest study to date (Sweden, 2.4 million births) initially showed a small increase in autism diagnoses among children whose mothers reported paracetamol use during pregnancy.[1]
- However, when researchers compared siblings within the same families (where one child was exposed in utero and another was not), the association disappeared.
Why sibling-comparison studies matter
Sibling-comparison (or “within-family”) studies are powerful because they automatically control for many shared factors, including:
- Genetic influences (siblings share ~50% of genes on average)
- Family environment (socio-economic circumstances, parental health behaviours, access to care)
By comparing children born to the same mother, this design reduces the risk that an observed association is really due to these underlying shared factors. In this case, the complete disappearance of the difference in sibling analyses suggests that earlier links between paracetamol and autism were most likely due to the reasons for taking paracetamol - such as infection, pain, or maternal age - all of which are themselves associated with autism risk.
It is not known whether not treating these symptoms (for example, allowing fever or pain to escalate) might adversly influence autism outcomes.
In other words, the underlying conditions are more likely to explain the association, rather than the drug itself.
Current guidance from the NHS, WHO, ACOG, and EMA remains that paracetamol can be used by dentists in pregnancy at the lowest effective dose for the shortest time needed, and that it remains the analgesic/antipyretic of choice for pregnant patients.
Reference
[1] Axelsson O, Cesta CE, Iliriani K, Stephansson O, D’Onofrio BM, Hultman CM, Magnusson C, Sjölander A, Sujan AC, Öberg AS, Sandin S. Association of Acetaminophen Use During Pregnancy With Risk of Autism Spectrum Disorder in Offspring. JAMA Psychiatry. 2024;81(12):1163–1173. doi:10.1001/jamapsychiatry.2024.3594
Treatment for ASD
There is currently no cure for ASD, but early intervention and appropriate treatment can significantly improve outcomes for individuals with ASD.
The importance of understanding ASD for dental professionals
As dental professionals in the UK, it is important to have a good understanding of ASD and how it can affect our patients. This knowledge can help us provide better care and support to individuals with ASD, and help to create a more inclusive and accommodating dental environment. In the following pages, we will look at some of the key considerations and best practices for treating patients with ASD in the dental office in the UK.