Dietary Sugar Exposure and Oral Health Status in Children with Autism Spectrum Disorder: A Case-control Study

Oral hygiene practice and home-care challenges in children with autism spectrum disorder in San Francisco: Cross-sectional study

INTRODUCTION

Autism spectrum disorder (ASD) is characterized by challenges in social interaction, communication, and stereotypical patterns of behavior. They are more likely to have tooth brushing issues and need help with routine dental care. Children with ASD could face difficulty in accessing dental care as the parents have a challenging task in finding a dentist that would treat the child with special needs. As a result, dental care is often neglected. The aims of this study are to evaluate oral hygiene practices and challenges in children with ASD and compare it with typically developing peers (TDP).

METHOD

The sample size of the study was 60. Parents of children aged 3-10 were recruited and divided in 2 groups with 30 in each group. Age and gender of children were matched. ASD group included children with medical diagnosis of ASD only and no other co-morbidities. Children in TDP group had no diagnosis of ASD, and reported no disability, or any other diagnosis. Parents were asked to complete the questionnaire which asked about their demographic information, child's oral care regimens, and their knowledge about dental care. Chi-squared tests and t-test were used for statistical analysis. A p-value of .05 was used for determining statistical significance.

RESULTS

Many children with ASD (47%) had to travel more than 20 miles for their dental home compared to 13% with TDP (p < .05). Only 60% of children with ASD brushed twice a day with 70% of parents reporting that it is difficult to brush their child's teeth compared to TDP with 93% of children brush twice daily (p < .05). Significantly a smaller number of children with ASD (47%) allowed their parent to brush their teeth as compared to 93% of TSD children (p < .001).

CONCLUSION

Parents of children with autism spectrum disorder travel longer distance to find a dental home and face more difficulty in maintaining their child's daily oral hygiene.

Parental Perception of the Oral Health-Related Quality of Life of Children and Adolescents with Autism Spectrum Disorder (ASD)

This study evaluated the parental perception of the oral health-related quality of life (OHRQoL) of children and adolescents with autism spectrum disorder (ASD) and their family functioning. Moreover, sociodemographic factors associated with parental ratings of OHRQoL were assessed. A hundred parents/guardians of children and adolescents aged 6 to 14 years with ASD (ASD group) and 101 unaffected children and adolescents (UCA group) participated. Data collection was carried out using a Google form, containing three sections: (1st) Socioeconomic data and health history; (2nd) Oral health assessment by parental report; (3rd) The short forms of the Parental-Caregiver Perceptions Questionnaire (16-P-CPQ) and the Family Impact Scale (4-FIS). The scores of 16-P-CPQ total and subscales and 4-FIS were significantly higher for the ASD group (p < 0.02), except for the oral symptoms subscale (p > 0.05). Older ages (OR = 1.24), brushing 0/1x day (OR = 2.21), teeth grinding (OR = 2.20), gingival bleeding (OR = 3.34), parents with an elementary school degree (OR = 0.314) and family incomes less or equal to the minimum wage (OR = 3.049) were associated with a worse OHRQoL. Parents in the ASD group had a worse perception of QHRQoL when compared to the UCA group. ‘Frequency of tooth brushing’, ‘gingival bleeding’, and ‘teeth grinding’ were predictors of the worst parental perception of their children’s OHRQoL. Families with low socioeconomic conditions were more strongly affected by the oral conditions of their children.

Autism spectrum disorder and dentoalveolar trauma: A systematic review and meta-analysis

OBJECTIVES

Patients with autism spectrum disorder (ASD) may be more predisposed to oral pathology, including dentoalveolar trauma. Our aim was to assess the risk of dentoalveolar trauma in patients with ASD.

MATERIALS AND METHODS

Meta-analysis methodology was used to compare the prevalence of dentoalveolar trauma in individuals with ASD compared to individuals without ASD. A literature search was carried out, with predefined inclusion and exclusion criteria, to identify controlled studies evaluating dentoalveolar trauma in individuals with ASD. Data were combined using the random-effects meta-analysis model.

RESULTS

Out of an initial 154 studies, 14 were selected for inclusion in the meta-analysis, resulting in a total of 1488 individuals with ASD. Meta-analysis results showed significant difference in the overall risk of dentoalveolar trauma between individuals with ASD versus a control group (RR = 1.45). Looking at specific types of dentoalveolar trauma, individuals with ASD were found to be more at risk for partial or total (avulsion) luxation injuries (RR = 3.02) than healthy individuals.

CONCLUSIONS

Individuals with ASD are more at risk for dentoalveolar trauma than those without ASD, especially for more severe dentoalveolar trauma such as luxation and avulsion injuries.

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

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.

Autistic spectrum disorder children and adolescents' oral health characteristics - scoping review

This study aimed to conduct a scoping review to know children and adolescents' main oral health concerns with Autism Spectrum Disorder (ASD) and thus identify any oral characteristic that stands out, aiming at preventive and interceptive clinical conduct. A search was performed in the three electronic databases and the gray literature; in September 2021. A total of 562 studies were identified, and after applying the eligibility criteria, 73 articles were included in the synthesis of this scoping review. The mean decayed, lost, and restored teeth index (DMFT/dfmt) ranged from 0 to 12.37; the mean DMFT index (permanent dentition) from 0.06 to 6.2; and the average dmft index (deciduous dentition) ranged from 0.29 to 9.91. The mean simplified oral hygiene index (OHIS) ranged from 0 to 3.4; gingival index (GI) from 0.29 to 2; and plaque index (PI) from 0.005 to 3.15. Plaque prevalence was 25.9% to 90%; dental calculus from 4.7% to 59.41%; gingivitis from 36.7% to 100%. Bruxism was 10.3% to 73%, and dental trauma was 4.7% to 100%. This disparity in the results shows the heterogeneity of this population, with different degrees of socio-behavioral impairment, which can directly influence oral hygiene and the consequent accumulation of biofilm.

Oral health and dental caries experience among students aged 7–15 years old with autism spectrum disorders in Tehran, Iran

Background

Autism spectrum disorders (ASD) are a set of developmental, psychological, and neurological disorders that occur in early childhood. The most important characteristic of individuals with autism is difficulty in social interactions and communication. Researchers in the field of oral health have not paid enough attention to these individuals due to their specific behavioral characteristics. Therefore, due to the limitations of the studies in this field in Iran, increasing prevalence of autism, and importance of oral health in people with ASD, this study was conducted to evaluate the oral health status of primary school students with autism (7–15 years old) in autism schools in Tehran.

Methods

Students from seven governmental special primary schools in Tehran were selected for this study. Data about oral health behavior and the presence of each of the seven barriers of tooth brushing task was collected via questionnaires completed by parents. During the dental examination, the cooperation level according to the Frankle Index, oral hygiene status according to the Simplified Oral Hygiene Index, and caries experience (DMFT) of the students were recorded by a calibrated dentist. A psychologist assessed the level of ASD using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM5). Data analysis including descriptive and regression analysis was done using the SPSS software version 24.

Results

Two hundred and seventeen students aged 7–15 years participated in this study, of whom 65.4% brushed their teeth once or more every day, 85.7% had sugary snacks twice or less per day, 73.7% used fluoridated tooth paste, and 80% brushed their teeth with parents’ help. The most common barrier to tooth brushing was difficulty in brushing (51.6%). The cooperation level was definitely positive in 46.1%. The mean Simplified Oral Hygiene Index (OHI-S) and caries experience (DMFT) scores were 1.92 ± 0.55 and 2.36 ± 2.38, respectively.

Conclusion

The clinical indices of OHI-S and caries experience (DMFT) were used to evaluate the oral health status in the students with ASD in Tehran, Iran. A better oral hygiene status was related to higher brushing frequency and lower sweet snack consumption. The findings of the present study indicate that educational interventions regarding oral hygiene and healthy diet may improve oral self-care in individuals with ASD.

Malocclusion complexity and orthodontic treatment need in children with autism spectrum disorder

OBJECTIVES

This study aimed to investigate the malocclusion complexity and orthodontic treatment need among children with and without autism spectrum disorder (ASD) referred for orthodontic treatment by quantifying the Discrepancy Index (DI) and Index of Orthodontic Treatment Need (IOTN).

MATERIALS AND METHODS

Dental records of 48 ASD and 49 non-ASD consecutive patients aged between 9 and 18 years (median age 13.0 years) referred for orthodontic treatment were reviewed and compared. The Discrepancy Index (DI) was quantified to determine the malocclusion complexity, and the Index of Orthodontic Treatment Need (IOTN), including the Dental Health Component (IOTN-DHC) and Aesthetic Component (IOTN-AC), was quantified to determine the orthodontic treatment need. Statistical analysis included descriptive analysis, Pearson chi-square tests, Fisher's exact test, Mann-Whitney U tests, and several univariate and multivariate regression analyses. The statistical analysis used descriptive analysis, Pearson chi-square test, Fisher's exact test, and multivariate logistic regression.

RESULTS

The results show that both malocclusion complexity (DI, p = 0.0010) and orthodontic treatment need (IOTN-DHC, p = 0.0025; IOTN-AC p = 0.0009) were significantly higher in children with ASD. Furthermore, children with ASD had a higher prevalence of increased overjet (p = .0016) and overbite (p = .031).

CONCLUSIONS

Malocclusion complexity and orthodontic treatment need are statistically significantly higher among children with ASD than children without ASD, independent of age and sex.

CLINICAL RELEVANCE

Children with autism may benefit from visits to a dental specialist (orthodontist) to prevent, to some extent, developing malocclusions from an early age.