Child oral health and preventive dental service access among children with intellectual disabilities, autism and other educational additional support needs: A population‐based record linkage cohort study

Factors Influencing the Oral Health Behaviours of Autistic Children and Young People: A Qualitative Study

BACKGROUND

Poor oral health (OH) in childhood can cause pain, affect quality of life and significantly impact adult OH. Autistic children and young people (CYP) experience inequalities in OH and are at higher risk of cavities and gum disease than neurotypical CYP.

OBJECTIVE

To provide evidence and insights into the factors affecting the OH behaviours of ACYP from the perspective of ACYP, their parents/carers and Dental Health Professionals (DHPs).

METHOD

Semi-structured online or face-to-face interviews were conducted with CYP, parents/carers and DHPs in Southwest England.

RESULTS

Nineteen ACYP (aged 5-18 years old), 20 parents/carers and 16 DHPs were interviewed. The themes identified were as follows: Sensory sensitivities and diet; Toothbrushing 'battles'; Coping with the stresses of daily life in a neurotypical world; Awareness of autism and understanding of challenges to good OH; The impact on parents of trying to care their child's OH; CYP and parent/carers difficulties in obtaining OH support; What 'good support' looks like.

CONCLUSIONS

An increased awareness among DHPs, health and social care professionals of autism and the challenges to OH that CYP face is needed. Providing early support, strategies and resources to CYP and their parents/carers has the potential to help establish positive OH behaviours.

PUBLIC CONTRIBUTION

The research team worked closely with members of the autistic community on this project. The methods used in this project were developed together with a research advisory group which included four ACYP (aged 9-17) and their parents. The team also worked with members of a youth club for ACYP aged 10-17 years old. All research documents and materials were co-produced. Members of the advisory group (T.V. and I.V.) contributed to the interpretation of the research findings and the writing of this manuscript.

Exploring the obstacles affecting the oral health of adolescents with intellectual disabilities: insights from maternal perspectives-a qualitative study

BACKGROUND

Oral health plays a critical role in overall well-being, particularly among adolescents, including those with intellectual disabilities. Caregivers, particularly mothers, play an essential role in guiding and supporting these adolescents in maintaining good oral health. This study examined the oral health problems and challenges faced by children with intellectual disabilities from the perspective of their mothers.

METHODS

Semi-structured interviews were conducted with 22 mothers of intellectually disabled adolescents aged 12-18 years in Pondicherry, India. A purposive sampling method was employed to gather information-rich insights from a diverse group of mothers. The interviews were guided by an interview protocol that included open-ended questions about the challenges in maintaining oral health, experiences with dental care providers, and perceived need for support. Thematic analysis was conducted to identify and interpret key themes.

RESULTS

The study identified six key themes affecting the oral health of adolescents with intellectual disabilities from maternal perspectives: physical and behavior challenges, limited access to specialized dental care, financial constraints, lack of professional support and education, emotional and psychological impact on mothers, and social stigma and isolation.

CONCLUSION

The identified themes highlight the need for comprehensive and multifaceted interventions to address the physical, logistical, financial, educational, and emotional challenges. By understanding and addressing these barriers, healthcare providers, policymakers, and support organizations can improve oral health outcomes and the overall quality of life for adolescents with intellectual disabilities and their families.

Hospital Dental Admissions and Caries Experience Among Children With Neurodevelopmental Disabilities: A Population-Based Record Linkage Cohort Study

BACKGROUND

Within Aotearoa | New Zealand, rates of largely preventable severe caries and dental hospitalisations among children are increasing and inequalities exist. However, little population-based empirical evidence exists describing this oral health burden among children with neurodevelopmental disabilities (NDDs). This study aimed to estimate and compare the rates of dental hospital admissions in a near-national population of children aged ≤ 14 years with attention-deficit hyperactivity disorder, autism, intellectual disability or any NDD after accounting for key confounding variables. Caries status for these children was derived from an oral health screening at 4 years and also examined.

METHODS

The cohort were children who had their B4 School Check (B4SC) national health screening assessment undertaken between 1 January 2011 and 31 December 2018 and followed until 1 January 2020 (the study end date). Linked administrative databases, which include NDD indication and dental hospital records, were utilised. Dental hospital admissions were assessed using unadjusted and adjusted Cox proportional hazard regression models treating NDD as a discrete time-varying covariate. Caries status at 4 years of age was investigated cross-sectionally and the area under the receiver operating characteristic curve used to assess predictive accuracy.

RESULTS

The eligible sample included 433 569 children (48.6% female) with a mean age of 9.3 years at the study end date. Overall, 16 359 (3.8%) children had at least one NDD indication and 38 574 (8.9%) had at least one dental hospitalisation. In adjusted analyses, the hazard ratio of dental hospitalisation admissions was 3.40 (95% CI: 3.22-3.60) for children indicated with any NDD compared to their non-NDD counterparts. At 4 years of age B4SC screening, 465 (17.6%) children out of 2640 indicated with any NDD had visible caries compared to 61 026 (14.3%) from 427 254 children without NDD indication (prevalence ratio = 1.24 [95% CI: 1.14-1.35]). However, the area under the receiver operating characteristic curve for this association was 0.52 (95% CI: 0.51-0.52), suggesting negligible predictive capacity.

CONCLUSION

Children with NDDs in Aotearoa, New Zealand suffer from substantial oral health inequities. Targeted preventive strategies and adaptation to primary oral health services are needed to meet the needs of neurodiverse children and redress this substantial inequity. However, targeting children with NDDs at the B4SC is unlikely to mitigate these oral health inequities.

An 'explosion in the mouth': The oral health experiences of autistic children

LAY ABSTRACT

In England, one in four children have tooth decay by the age of 5 years. Tooth decay affects many autistic children. Communication differences, sensory sensitivities and preferred routines can make dental care difficult. Daily toothbrushing, healthy eating and drinking, and attending the dentist may be challenging for autistic children. We do not know much about how autistic children feel about looking after their teeth. Learning from them directly is important to understand their needs and make sure their voices are heard. We interviewed 10 autistic children aged between 7 and 13 years to discover how they care for their teeth, what helped and what did not. We talked about toothbrushing, healthy eating and drinking and visiting the dentist. To support our conversations, we used Talking Mats® - a tool that can help with communication. Autistic children described a wide range of sensory issues related to looking after their teeth. This finding shows how important it is to tailor care to each child's needs. Children wanted to be included in conversations about their teeth at home and at the dentist. This was felt to make a big difference in building trust and making them feel comfortable and supported. Overall, we found Talking Mats® can be used in dental research to engage with autistic children. By understanding children's views, we can better help professionals and parents to support their dental needs. Our research showed that every child's experience is unique, so dental support must be tailored and inclusive to meet children's needs.

Access to dental care in individuals with disability: a systematic review

OBJECTIVE

This systematic review was conducted to explore the factors influencing access to oral health services and to identify and examine the strategies to improve the access.

MATERIALS AND METHODS

PubMed, Scopus and Embase databases were searched. Studies except editorials reported in English regardless of the study design were included. Risk of Bias assessment was carried out using Agency for Healthcare Research and Quality, Newcastle Ottawa Scale and The Joanna Briggs Institute tool for cross-sectional, case-control and cohort and qualitative studies, respectively.

RESULTS

In total, 11,372 records were initially identified, eventually leading to 12 relevant publications to be included in the review. Individuals valued oral health but found it difficult to access oral health services. Dental care was mainly accessed during emergencies and participants felt apprehensive in visiting dentists. Caregiver's and dentist's perspective was also reported.

CONCLUSION

There is a need for provision of education, training and increasing awareness on dental hygiene and annual dental checkups to improve access.