Association between oral care challenges and sensory over‐responsivity in children with Down syndrome

Duker, Leah I. Stein; Martínez, Melissa; Lane, Christianne J.; Polido, José C; Cermak, Sharon A.

doi:10.1111/ipd.12933

Cited by 8 publications

(15 citation statements)

References 43 publications

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“…Historically, dental research examining SOR and oral health behaviors and outcomes has focused on clinical populations, including children with autism spectrum disorder, Down syndrome, and attention-deficit/hyperactivity disorder. In these groups, sensory sensitivities have been linked to dental-related challenges in the home and/or clinic environments [ 42 , 43 , 44 , 221 , 222 , 223 , 224 , 225 , 226 , 227 , 228 , 229 , 230 , 231 , 232 , 233 ], with the National Institute of Dental and Craniofacial Research [ 234 ] suggesting that minimizing sensory stimuli in the dental environment may support the reduction of uncooperative behaviors in children with autism spectrum disorder.…”

Section: Discussionmentioning

confidence: 99%

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

Duker

Grager²,

Giffin

et al. 2022

IJERPH

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Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.

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Section: Discussionmentioning

confidence: 99%

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

Duker

Grager²,

Giffin

et al. 2022

IJERPH

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“…The present IR clearly shows that to date, only five articles directly link PSD and clinical practices to pediatric dentistry [1,[7][8][9][10]. Nevertheless, all articles specifically discuss autism spectrum disorder (ASD), although some studies associate SPD with other diagnoses, such as attention deficit hyperactivity disorder (ADHD), Down syndrome and anxiety [11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Does the Pediatric Dentistry Know About Sensory Processing Disorder? An Integrative Review

Roriz

2023

OJDOH

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Background: Sensory processing disorder (SPD) is a limitation or difficulty in the interpretation of sensory information with reflection in the daily activities of an individual. Its clinical manifestations are represented by decreased social interaction, crying, sleep and changes in eating habits. Dental settings and clinical interventions, particularly in children, may contribute to triggering or exacerbating SPD. Methods and Results:An integrative review (IR) was performed to evaluate the knowledge of pediatric dentistry about SPD. Conclusion:It was possible to infer that pediatric dentistry has little knowledge on the subject and that studies and literature reviews with strong scientific evidence should be conducted to encourage the use of SPD in pediatric dentistry.

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“…9,[13][14][15] Despite these challenges, there are minimal clinical dental protocols designed specifically to meet the needs of autistic pediatric patients 16,17 and a reported lack of dental professionals willing and trained to serve the population. 9,10 Attention to sensory sensitivities' effect on oral care is becoming more prevalent in dentistry for autistic children, children with other disabilities, 9,13,[18][19][20][21] and neurotypical individuals. 22 Shapiro and colleagues 23,24 first proposed adapting the sensory characteristics of the dental office to reduce anxiety and enhance cooperation to facilitate oral care for children with developmental disabilities.…”

Section: Introductionmentioning

confidence: 99%

Sensory Adaptations to Improve Physiological and Behavioral Distress During Dental Visits in Autistic Children

Stein Duker,

Como,

Jolette

et al. 2023

JAMA Netw Open

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ImportanceAutistic children have poorer oral health and greater oral care challenges, which are often associated with sensory overresponsivity, than neurotypical peers. It is important to identify innovative solutions enabling dentists to successfully perform standard clinic-based procedures for this population.ObjectiveTo determine whether a sensory-adapted dental environment (SADE) reduces physiological and behavioral distress in autistic children undergoing dental cleanings, compared with a regular dental environment (RDE).Design, Setting, and ParticipantsThis randomized crossover trial was conducted at a pediatric dentistry clinic in a large urban children’s hospital between May 2016 and April 2022. Coders were blinded to study condition for physiological but not behavioral measurements. Autistic children aged 6 to 12 years were identified and invited to participate. Interested families were enrolled consecutively; after confirmation of autism diagnosis, children were randomized. Analysis for this per-protocol study were conducted from April to October 2022.InterventionEach child underwent 1 RDE and 1 SADE dental cleaning, administered in randomized and counterbalanced order approximately 6 months apart. SADE included modified visual, auditory, and tactile stimuli.Main Outcomes and MeasuresThe primary outcome was physiological stress, assessed by electrodermal activity. The secondary outcome was behavioral distress measured from video recordings.ResultsAmong 452 families invited to participate, 220 children were enrolled, and 162 children (mean [SD] age, 9.16 [1.99] years; 136 [84.0%] male) with confirmed autism were randomized, with 83 children receiving RDE first and 80 children receiving SADE first. Most children (94 children [58.0%]) had moderate autism severity. Children had significantly lower physiological stress during dental care in SADE compared with RDE (mean difference in skin conductance level, −1.22 [95% CI, −2.17 to −0.27] μS), suggesting decreased sympathetic activity and increased relaxation during SADE dental care. No significant differences were found in nonspecific skin conductance responses (mean difference, −0.30 [95% CI, −0.86 to 0.25] per min). Video-coded frequency and duration of behavioral distress (but not questionnaire) measures were significantly lower in SADE vs RDE (Cohen d = −0.84 to −1.19). Physiological stress was associated with behavioral distress during the dental cleaning (eg, nonspecific skin conductance responses associated with the Frankl Scale: β = −0.29; 95% CI, −0.39 to −0.19); age, IQ, and expressive communication moderated the intervention’s success. No participants withdrew due to adverse effects.Conclusions and RelevanceIn this randomized crossover trial of autistic children, using SADE was safe and efficacious in decreasing physiological and behavioral distress during dental care. This is important because enhancing oral care is critical for autistic children; this intervention may also be beneficial for populations beyond autism.Trial RegistrationClinicalTrials.gov Identifier: NCT02430051

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Association between oral care challenges and sensory over‐responsivity in children with Down syndrome

Cited by 8 publications

References 43 publications

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

The Relationship between Dental Fear and Anxiety, General Anxiety/Fear, Sensory Over-Responsivity, and Oral Health Behaviors and Outcomes: A Conceptual Model

Does the Pediatric Dentistry Know About Sensory Processing Disorder? An Integrative Review

Sensory Adaptations to Improve Physiological and Behavioral Distress During Dental Visits in Autistic Children

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