Barriers to Oral Health Care for Autistic Individuals—A Scoping Review

Abstract

Background: Challenges in providing adequate dental care for individuals with Autism Spectrum Disorder (ASD) are recognised by parents, caregivers, and dental practitioners, leading to a higher prevalence of unaddressed dental needs. This scoping review aims to explore existing research on the obstacles to oral health care as perceived by individuals with ASD, as reported by their parents, caregivers, and dental professionals. Methods: Systematic searches were conducted in DOSS, Medline, and PubMed databases using relevant keywords to identify relevant studies. Barriers identified within these studies were then categorised based on themes identified. Results: The initial search yielded a total of 254 studies. Following the removal of duplicates and screening of titles and abstracts, 47 studies were further assessed against predetermined criteria, ultimately resulting in the inclusion of 16 articles in this scoping review. The identified barriers were grouped into five overarching themes: challenges in accessing appropriate care (n = 8), negative past experiences (n = 5), parental perceptions of the impact of ASD (n = 8), clinician bias (n = 2), and clinician education (n = 7). Conclusions: The findings of this review highlight the obstacles faced by individuals with ASD in obtaining routine oral health care. These results underscore the imperative for the development, testing, and implementation of tailored interventions focused on autism, as well as their integration into educational curricula for dental practitioners at various educational levels. This approach aims to enhance the delivery of equitable oral health care to individuals with ASD, starting from undergraduate through to postgraduate dental education.

A Pilot Study Exploring Caregivers’ Experiences Related to the Use of a Smart Toothbrush by Children with Autism Spectrum Disorder

“…This approach was also noted by Floríndez et al, who advocated for collaborative efforts between families and healthcare professionals to devise impactful strategies for oral healthcare [28]. This collaborative approach aims to mitigate the challenges associated with poor oral health among disadvantaged populations, ultimately striving to address oral health disparities among individuals with ASD [29]. The objective is to design interventions that effectively enhance access to dental care and improve the overall oral health experience for this population and their families.…”

Investigation of Dental and Oral Health in Children and Adolescents with Special Support Needs from a Child and Adolescent Psychiatric Perspective

“…Regarding the importance of dental and oral health issues, there are no significant differences observed among the three target groups in the overarching analysis, prompting us to dissolve the clear distinction between these subgroups and subsume them under the term “Children and Adolescents with Special Support Needs”, abbreviated as CA-SN hereafter. The subsumption of various vulnerable patient groups with disabilities or other impairments, such as physical or mental disabilities, psychological behavioral disorders or developmental disorders, like autism spectrum disorder, under the titles “special needs”, “special support needs” or “special healthcare needs” is quite common in dentistry, and the terms are also used synonymously with each other to some extent [ 11 , 12 , 13 , 14 , 15 , 16 , 22 , 23 , 24 , 25 ].…”

“…Causes for the poorer oral health status in CA-SN, from an international dental perspective, include irregular dental hygiene, often stereotypical unhealthy eating habits, decreased cooperation, a lack of dentists trained in special care dentistry, the absence of barrier-free clinics and the lack of specialized treatment concepts [ 22 , 23 , 24 , 26 , 27 ]. These dental perspectives align with the data gathered from the CAPPS and the national dental perspectives, mentioned in the introduction.…”

“…The survey illustrates that there is indeed an overlap between CAPPS and dentists in the explanatory approaches to poorer dental and oral health in CA-SN, referring to, for example, behavioral causes, illness-related causes and communication barriers [ 22 , 24 , 26 , 27 ]. Furthermore, the collected data cautiously suggest that CAPPS, in addition to the poorer dental and oral health status of CA-SN, tend to identify familial or psychosocial factors, such as the overwhelming of caregivers or the low priority given to dental health, while the dental profession is more likely to point out structural deficits, such as the lack of continuing education and training, the lack of research or the lack of financial incentives [ 22 , 23 , 24 , 26 , 27 ].…”

“…Long-term, this could lead to the development of multiprofessional and interdisciplinary preventive treatment concepts, thus enabling the early detection and treatment of dentogenic diseases to reduce the severity of such diseases and the frequency of invasive procedures under general anesthesia [ 22 , 24 , 26 ]. This would also contribute to the adequate utilization of existing (financial) resources.…”