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

Erwin, Jo; Paisi, Martha; Neill, Sarah; Burns, Lorna; Vassallo, Isaac; Nelder, Abigail; Facenfield, Jemma; Devalia, Urshla; Vassallo, Tara; Witton, Robert

doi:10.1111/hex.13544

Cited by 26 publications

(16 citation statements)

References 69 publications

(247 reference statements)

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“…Speci cally, those approaches may involve desensitization that is essential for children with ASD to undergo panoramic radiography to identify SNT and receive tell-show-do, visual pedagogy and social stories [50,51], behavioural management techniques [52] and pharmacological management [11]. To achieve this, access to healthcare providers with experience in working with children with ASD is essential; challenges would include the need for longer appointments for familiarization and the fact that some required procedures may not be covered by insurance [53].…”

Section: Discussionmentioning

confidence: 99%

Autism spectrum disorder and the risk of supernumerary teeth: A multi-centre cohort study

Lai,

Chan,

Misra

et al. 2023

Preprint

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Aim To assess whether children diagnosed with autism spectrum disorder (ASD) are at risk of having supernumerary teeth (SNT). Methods This was a multi-centre cohort study conducted between 2008 and 2022 to recruit children under 18 years of age who were previously diagnosed with ASD. Data on age, sex, and comorbidities history were collected and adjusted in the analyses. Cox proportional hazard models and Kaplan-Meier analyses were conducted to determine the effect of ASD on SNT. Subgroup analyses based on age and sex stratification were developed to identify at-risk subpopulations. Results A total of 3,372 cases with ASD and 25,942 controls were included. 15 children with ASD and 31 non-ASD children were diagnosed with SNT during the follow-up period. The incidence of SNT was significantly higher in the ASD group compared to the non-ASD group (1.827 vs 0.671 per 1000 person-years, adjusted hazard ratio, aHR=2.583, 95% CI=1.312-5.085). Male children with ASD (aHR=3.863, 95% CI=1.781-8.376) and children with ASD aged below 6 years (aHR= 2.655, 95% CI=1.117-6.308) presented with significant risk of having SNT. Conclusions Male children with ASD are at a significant risk of SNT. Screening for children with ASD may facilitate early detection and management of ASD-associated SNT.

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Section: Discussionmentioning

confidence: 99%

Autism spectrum disorder and the risk of supernumerary teeth: A multi-centre cohort study

Lai,

Chan,

Misra

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…After removing replicated papers and reports out of our selection criteria (n = 175 reports excluded as replicated), i.e. meta-analyses and/or systematic reviews dealing with "autism-dentistry and oral health", we were able to include an eligible number of 17 meta-analyses and systematic reviews, finally summarized in Table 1 (4,5,7,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

Section: Research Abstractmentioning

confidence: 99%

Insights on dental care management and prevention in children with autism spectrum disorder (ASD). What is new?

Zerman

Zotti²,

Chirumbolo³

et al. 2022

Front. Oral. Health

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Autistic subjects represent a severe concern to dentistry due to the considerable difficulty in managing their oral health, maintaining routine toothbrushing, and preventing dental and periodontal problems. The social and economic burden of managing dental care in autism spectrum disorder (ASD) children is particularly cumbersome for families and public and private health expenditure, especially when children reach the dentist following a late diagnosis with evident oral health problems. An early diagnosis of ASD helps dentists better address these children's oral health. Unfortunately, insufficient attention is paid to the training and education of general pediatricians, dentists, and dental hygienists, allowing them to get to approach the different clinical aspects of ASD. Usually, children diagnosed with ASD are scheduled for dental appointments like their neurotypical peers, whereas their needs are typically complex and personalized. Scant attention is also devoted to these patients by commercial manufacturers of dental products and devices for oral hygiene and prevention of caries and periodontal diseases, leaving parents without the support and often failing when they address the oral health of autistic children. The difficulties of oral care do not derive simply from the behavior of ASD patients, as is commonly assumed, and therefore cannot be overcome solely by the patience and attention of parents and dentists. Genetics, dietary habits, sensory impairments, and cognition disorders are other causes contributing in various degrees to the impact on the mood and psychological reactions of autistic children towards dentists. How can we prevent teeth caries, periodontal disorders, and other oral health impairments by properly managing ASD children? This manuscript gives an up-to-date overview of these problems and helps to provide good remarks.

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“…Autistic children face numerous risks for poor oral health, including difficulties implementing home-based oral care practices [6][7][8] and barriers accessing and tolerating in-office care [9][10][11][12] ; both are associated with overresponsivity to sensory stimuli. 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.…”

Section: Introductionmentioning

confidence: 99%

“…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%

“…Autistic children face numerous risks for poor oral health, including difficulties implementing home-based oral care practices 6 , 7 , 8 and barriers accessing and tolerating in-office care 9 , 10 , 11 , 12 ; both are associated with overresponsivity to sensory stimuli. 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 …”

Section: Introductionmentioning

confidence: 99%

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

Abstract: Background: Autistic children and young people (CYP) experience oral health (OH) inequalities. They are at high risk of dental disease and show significant levels of unmet need in relation to OH and access to dental care.

Cited by 26 publications

References 69 publications

Autism spectrum disorder and the risk of supernumerary teeth: A multi-centre cohort study

Autism spectrum disorder and the risk of supernumerary teeth: A multi-centre cohort study

Insights on dental care management and prevention in children with autism spectrum disorder (ASD). What is new?

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

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