Effect of Culturally Adapted Dental Visual Aids on Anxiety Levels in Children with Autism Spectrum Disorder: A Randomized Clinical Trial

Abstract

Autism spectrum disorder (ASD) prevalence has risen dramatically in recent decades; it is now common for children with ASD to seek dental care. Because their distinct behavioral patterns prevent them from receiving dental care in a traditional dental clinic, structured dental visual aids are required to help prepare them for their dental appointment. This study aimed to test the effect of “culturally adapted dental visual aids” in decreasing anxiety levels during dental visits in children with autism spectrum disorder (ASD). A randomized, controlled, blinded clinical trial was performed. Sixty-four children with ASD ages 6–12 years were assigned randomly into test and control groups based on the type of dental visual aids they received. The test group received “culturally adapted dental visual aids” created especially for the study, and the control group received “regular dental visual aids”. Anxiety levels were assessed before and after using both dental visual aids. All data were processed using SPSS version 25.0. The test group had a significant decrease in anxiety levels compared to the control group (p < 0.001). The “culturally adapted dental visual aids” have effectively reduced anxiety levels in children with ASD during dental visits.

Effectiveness of picture‐based interventions of toothbrush training on improvement of oral hygiene in children with autism spectrum disorders: A systematic review and meta‐analysis

“…Ten studies (four RCTs and six non-randomized clinical studies) sustained the final rigorous PICO search and were included for the qualitative and quantitative synthesis, 1,11,[28][29][30][31][32][33][34][35] among them four studies are randomized control trials; [32][33][34][35] Control group is not there in few studies. 1,11,[28][29][30]…”

“…28,33 Plaque index (PI) was measured in few studies. 1,[29][30][31]35 Gingival Index (GI) is evaluated in few studies. 1,30,31 Other outcomes that were evaluated in the studies were Debris Index (DI-S), Calculus Index (CI-S), 33 Oral Hygiene practice score, 32 Childs behavior and attitude towards brushing was evaluated in the study by Sallam et al (2013).…”

“…31 Irrespective of acronyms used across the included studies, intervention was picture based, that is, colored prints of series of toothbrushing steps were used to reinforce the children with ASD in all the studies except the study by Ala-Aljubour et al (2022) who used picture based colored drawings to represent the sequential steps of toothbrushing. 35 Reinforcement of the toothbrushing steps is an important component in learning related to the practice of toothbrushing in children with ASD. Daily reinforcement of the picture based learning for the entire study duration was performed in few studies.…”

“…Daily reinforcement of the picture based learning for the entire study duration was performed in few studies. 1,11,[29][30][31][33][34][35] Daily reinforcement of picture based toothbrushing was not performed in the study by Renuka et…”

“…Cochrane ROB2 and ROBINS-I was used to evaluate the risk of bias of randomized control trials and non-randomized control trials, respectively. Among the ten studies included for this current systematic review four studies [33][34][35][36] are randomized control trials and six studies were non randomized trials. 1,12,28,[30][31][32] There was overall high risk of bias in the randomized control trials, and serious concerns related to risk of bias in non-randomized control trials.…”