Autism Spectrum Disorder: Patients’ Oral Health Behaviors and Barriers in Oral Care from Parents’ Perspectives

Abstract

To assess the oral health behaviors of children with Autism Spectrum Disorder (ASD) and explore attitudes and barriers in providing oral care by their parents. A cross-sectional, mixed method study design, which comprised of quantitative and qualitative sections was conducted. The quantitative part assessed the oral health behavior through a parent-proxy report questionnaire whilst the qualitative part assessed parents' overall perspective on maintenance of oral health in children with ASD through an in-depth interview using semi-structured questions. All children below the age of 16 who have been clinically diagnosed with ASD and registered at the Pediatric Dental Clinic were included. The sample consisted of twenty children with ASD. Most of the sample were male and between 5-8 years old. Majority had good oral health behaviors but some exhibited self-injurious behaviors that may affect oral health. Severe characteristics of ASD, co-morbid conditions and incompetent health professionals were reported as barriers in oral care by parents of these children. Despite having good oral health behaviors, several barriers and challenges were expressed by these parents with ASD when providing home oral care or bringing them for dental appointment. Continuous support for parents with ASD child by dental professionals is essential to help overcome the real challenges and barriers in providing oral care among these parents.

Factors influencing oral health behaviours, access and delivery of dental care for autistic children and adolescents: A mixed‐methods systematic review

“…Changing routines to include OH care can also be challenging 25 . Some autistic CYP also have cognitive and motor skills difficulties that can affect their ability to carry out OH behaviours and depend on parents/carers to help them maintain oral hygiene 46 . Parents/carers may have to help their autistic children with a range of daily living tasks and can be overwhelmed when meeting their children's needs, such that OH care falls low on the priority list 41,46 .…”

“…Difficulty in managing children's behaviours, including non‐co‐operation and compliance with dental procedures, was one of the most frequently reported barriers to dental care access cited by parents and dentists. 25 , 27 , 28 , 30 , 32 , 33 , 35 , 36 , 37 , 42 , 43 , 46 , 48 , 53 , 54 , 55 , 56 A US study 33 found that autistic children with more behavioural difficulties had an increased odds of unmet dental needs compared to those with autism who showed behaviours similar to same‐aged peers (odds ratio: 3.35, 95% confidence interval: 1.69, 6.67). The uncooperative behaviours of some autistic children affect the ability of practitioners to carry out the dental procedures needed to care for their teeth, 25 with obvious implications for OH.…”

“…Modelling expected behaviour at a visit to the dentist by the parent and other members of the family is useful. 26 The modelling of toothbrushing at the dentist and at school, 25 , 41 behavioural techniques including positive re‐enforcement 24 , 46 and incorporating it into the daily home and school routine 41 , 69 can help children adopt beneficial OH behaviours.…”

“…25 Some autistic CYP also have cognitive and motor skills difficulties that can affect their ability to carry out OH behaviours and depend on parents/carers to help them maintain oral hygiene. 46 Parents/carers may have to help their autistic children with a range of daily living tasks and can be overwhelmed when meeting their children's needs, such that OH care falls low on the priority list. 41 , 46 Sensory sensitivities, 11 , 25 , 26 , 28 , 31 , 34 , 36 , 37 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 cognitive and physical challenges 33 , 49 , 50 and the degree/level of required support and adjustment 49 were all identified as barriers to dental care access.…”

“… 46 Parents/carers may have to help their autistic children with a range of daily living tasks and can be overwhelmed when meeting their children's needs, such that OH care falls low on the priority list. 41 , 46 Sensory sensitivities, 11 , 25 , 26 , 28 , 31 , 34 , 36 , 37 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 cognitive and physical challenges 33 , 49 , 50 and the degree/level of required support and adjustment 49 were all identified as barriers to dental care access. Children may also experience fear and/or dental anxiety.…”