Toothbrushing barriers for people with developmental disabilities: a pilot study

Evaluation of visual pedagogy teaching method for improving oral hygiene practice in children with Autism: An interventional study

BACKGROUND

Evaluation of visual pedagogy teaching method for improving oral hygiene practice in children with Autism: An interventional study: Visual pedagogy is a relatively newer approach to improve dental care in autistic children. The present study aimed to evaluate visual pedagogy in the practice of oral hygiene in autistic children.

MATERIALS AND METHODS

This interventional and prospective study was conducted in the Department of Paediatric and Preventive Dentistry. Required approval was obtained from Institutional Ethical Board. Written informed consent was obtained from parents/caregivers. The age range was 5-12 years which included 100 participants (40 males and 60 females). Improvement of oral hygiene was evaluated by recording the tooth brushing technique and ability to follow instructions as presented in the educational video shown on smartphones with Wi-Fi/mobile data. Inclusion criteria: (1) Accessibility and (2) Age range between 5 to 12 years. Exclusion criteria: (1) Non-cooperative children, (2) Children receiving medicines that influence oral health, and (3) Inability to follow-ups. Fones technique was used for brushing teeth in video recording demonstrating it in simple structured steps. Statistical analysis was performed using Chi-square and Independent t tests.

RESULTS

Statistically significant improvement was observed in oral hygiene (plaque index) after training patients with visual pedagogy.

CONCLUSION

In the present study, the use of visual pedagogy showed improvement in the oral hygiene scores of autistic children.

A bio-behavioral intervention combining task analysis with skill-based training to train toothbrushing among children with intellectual disability

AIMS

Individuals with intellectual disability (ID) have special health care needs. Teaching self-care behaviors like toothbrushing helps reduce their dependence on adult caregivers. We present a bio-behavioral intervention combining task analysis with skill-based teaching of toothbrushing behavior aimed to promote autonomy in children with various types of ID.

METHODS

One hundred twenty children with ID enrolled at a special school in the State were included in the study. After baseline measurements using task analysis, four methods were used to train the children - instruction, three-phase modeling, physical guidance, and descriptive praise. The caregiver was trained and given instructional videos for reinforcement. After 4 weeks, the children were asked to brush their teeth and performance was evaluated.

RESULTS

There was increased independence in the performance of toothbrushing behavior, the mild and moderate ID groups showing the most improvement. Steps like oral manipulation of the toothbrush showed the greatest improvement in these groups. The severe ID group showed improvement in certain skills, while requiring assistance for others that demanded dexterity.

CONCLUSION

This intervention can be implemented by special schools and special care dentistry centers to foster autonomy in oral self-care skills in the mild and moderate ID children, and complemented with other methods for severe ID children.

Visual pedagogy-guided toothbrushing training to enhance fine motor skills in individuals with intellectual disabilities and impaired fine motor skills

AIMS

To evaluate the effect of visual pedagogy-guided toothbrushing training on oral hygiene, toothbrushing ability, and fine motor skills in individuals with intellectual disability (ID) and impaired fine motor skills.

METHODS

This quasi-experimental study comprised 37 subjects aged 6-24 years. The plaque index (PI), gingival index (GI), toothbrushing ability, and fine motor skills were evaluated before and after 3 and 6 months of individual visual pedagogy-guided toothbrushing training. Friedman's post hoc test and Spearman's correlation coefficient were used for statistical analyses.

RESULTS

The PI, GI, toothbrushing ability, and fine motor skills of the 23 subjects who remained in the study at the 6-month follow-up period significantly improved from those measured at baseline (p < 0.05). A significant association was observed between the improvements in both toothbrushing ability and fine motor skills (p < 0.05).

CONCLUSIONS

Visual pedagogy-guided toothbrushing training could improve the oral hygiene and toothbrushing ability of individuals with ID and impaired fine motor skills. Moreover, improvements in the toothbrushing ability could enhance the fine motor skills of these individuals.

Efficacy, tolerability, and safety of an innovative medical device for improving oral accessibility during oral examination in special-needs patients: A multicentric clinical trial

Background

People with special needs have high unmet oral healthcare needs, partly because dentists find it difficult to access their oral cavity. The Oral Accessibility Spatula aims to improve oral accessibility. This prospective multicenter interventional open-label non-randomized patient-self-controlled trial assessed the ability of the spatula to improve the oral accessibility of special-needs patients during dental examinations.

Methods

The cohort was a convenience sample of minor and adult patients with special needs due to physical, intellectual, and/or behavioral disorders who underwent dental check-up/treatment in five French tertiary hospitals/private clinics in 2016–2018 and evinced some (Venham-Score = 2–4) but not complete (Venham-Score = 5) resistance to oral examination. After inclusion, patients underwent oral examination without the spatula and then immediately thereafter oral examination with the spatula. Primary outcome was Oral Accessibility Score (0–12 points; higher scores indicate visualization and probing of the tooth sectors). Secondary outcomes were patient toleration (change in Venham-Score relative to first examination), safety, and Examiner Satisfaction Score (0–10; low scores indicate unsatisfactory examination).

Results

The 201 patients were mostly non-elderly adults (18–64 years, 65%) but also included children (21%), adolescents (11%), and aged patients (3%). One-quarter, half, and one-quarter had Venham-Score = 2, 3, and 4 at inclusion, respectively. The spatula significantly improved Oral Accessibility Score (4.8 to 10.8), Venham-Score (3.1 to 2.6), and Examiner Satisfaction Score (3.4 to 7.2) (all p<0.001). There were no severe spatula-related adverse events.

Conclusion

The spatula significantly improved oral access, was safe and well-tolerated by the patients, and markedly improved oral examination quality.

The Effectiveness of Visual Pedagogy for Toothbrushing in Children with Autism Spectrum Disorder

Objectives

The aim of this study was to evaluate toothbrushing effectiveness in children with mild and moderate levels of severity of autism spectrum disorder (ASD) after using visual pedagogy.

Materials and Methods

This quasi-experimental study was carried out with 30 children with ASD aged 5-17 years; 21 had mild ASD and 9 had moderate ASD. Informed consent and the subject's demographic information were obtained from caregivers. All subjects were then asked to show their toothbrushing practices, which were recorded by video. The toothbrushing ability, toothbrushing cooperation, and plaque index were evaluated before the study and at 2 weeks, 4 weeks, 3 months, and 6 months after visual pedagogy had been used. Results were analyzed by the Friedman test, Pearson's chi-square test, Fisher's exact test, and Mann‒Whitney U test.

Results

Toothbrushing ability was significantly improved at all periods of follow-up. Toothbrushing cooperation and the dental plaque index were significantly better than before the study at 4 weeks, 3 months, and 6 months of follow-up. The toothbrushing ability of subjects with mild ASD was significantly better than that of subjects with moderate ASD at 4 weeks and 6 months of follow-up. The toothbrushing cooperation of the mild group was significantly better than that of the moderate group at 2 weeks, 4 weeks, and 3 months. There was no statistically significant reduction in the plaque index between the two groups.

Conclusion

Visual pedagogy is useful for improving toothbrushing effectiveness in children with mild or moderate severity ASD. However, children with moderate severity ASD take longer to improve.

Association of sensory sensitivities and toothbrushing cooperation in autism spectrum disorder

BACKGROUND

Sensory over-responsivity (SOR) is common in autistic spectrum disorder (ASD), and it leads to a more intense response to sensory stimuli.

AIM

To compare toothbrushing cooperation at home and in a dental office between SOR and sensory not over-responsivity (SNOR) children with ASD.

DESIGN

This cross-sectional observational study was conducted with 51 children with ASD aged 4-17 years. Caregivers assessed each subject's sensory response by completing a back-translation questionnaire listing eight sensitivities. Subjects who had three or more of the sensitivities were considered SOR subjects. Toothbrushing cooperation in the dental office was recorded on videos. Statistical analysis used the Spearman correlation coefficient, chi-square test, Fisher's exact test, and Mann-Whitney U test.

RESULTS

SNOR subjects (n = 10) had significantly higher scores in toothbrushing cooperation at home and in the dental office than did SOR subjects (n = 41) (P < .05). Oral sensitivity was significantly associated with toothbrushing cooperation at home, whereas oral, light, sound, and touch (face) sensitivities were significantly correlated with toothbrushing cooperation in the dental office (P < .05).

CONCLUSIONS

SOR subjects showed less toothbrushing cooperation than SNOR subjects both at home and in the dental office.

Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review

Background

People with intellectual and developmental disability (IDD) have poor oral health and need support to maintain optimal oral health outcomes. Little is known about how, when and where to intervene for this population. Thus the aim of this review was to summarise the existing evidence surrounding improving oral health outcomes for people with IDD.

Methods

A scoping literature review was conducted focusing on ‘oral health’ and ‘intellectual disability’. Systematic searches of five electronic databases were conducted in line with the study aims and two authors independently examined all records for relevance, with consensus achieved by a third author.

Results

A small number of approaches and interventions were identified to support people with IDD to independently maintain optimal oral hygiene. Identified studies highlighted that caregivers play a vital role in the provision of oral health support, emphasising the effectiveness of educational interventions for caregivers. However, there was uncertainty regarding the efficacy of specific tooth brushing interventions for people with IDD. In cases of more severe IDD and/or dental-related behavioural problems, dental treatment under general anaesthesia was often both a necessary and effective method of oral health care provision. The findings also identified outreach and exclusive oral health services as successful strategies for increasing the limited access of people with IDD to oral care services.

Conclusions

A uniform approach to supporting oral health for people with IDD is unlikely to succeed. A system-based approach is needed to address the diverse needs of the population of people with IDD, their caregivers and service context. Further high quality evidence is required to confirm these findings.

Oral Health for US Children with Special Health Care Needs

Children with special health care needs (CSHCN) are a vulnerable population subgroup, but little is known about their oral health, particularly regarding the prevalence and cause of tooth decay. This lack of knowledge is a barrier to progress in terms of developing evidence-based clinical interventions and policies aimed at promoting oral health in CSHCN. This article reviews the oral health literature pertaining to CSHCN, identifies critical knowledge gaps, highlights future research opportunities, and extends clinical recommendations to pediatric health care providers.

Perception of Special Needs Dentistry education and practice amongst Australian dental auxiliary students

INTRODUCTION

The role of dental auxiliaries in collaborative care of patients with special needs is compelling. This study was undertaken to investigate the perceptions of Special Needs Dentistry (SND) education and practice amongst students enrolled in Australian programmes in dental auxiliary, namely dental hygiene, dental therapy and oral health therapy (DH/DT/OHT).

MATERIALS AND METHODS

All Australian institutions offering DH/DT/OHT programmes (n = 14) were invited to participate in a self-administered questionnaire survey, conducted online, involving students across all academic years. Twelve institutions agreed to participate, but only five institutions were included in the final analysis, with a student response rate of 31.1%. Answers to open-ended questions were coded and grouped for measurement of frequencies. Quantitative data were analysed via chi-squared and Fisher's exact tests (significance taken as P < .05).

RESULTS

The majority of students could not define SND (87.0%) were not aware of the existence of this specialty (53.5%) and did not have clinical experience treating patients with special needs (68.9%). Nevertheless, they felt comfortable and positive about treating these patients independently. Most agreed that they should receive clinical and didactic education in SND, with many of them expressing interest in pursuing a specialty training in this field.

CONCLUSION

DH/DT/OHT students' comfort levels, positive attitudes and supportiveness for SND suggested positive implications for these practitioners to partake in multidisciplinary management of patients with special needs, thus indicating the need for standardised training requirements and practice guidelines in this area of care.

Ensuring Maintenance of Oral Hygiene in Persons with Special Needs

Patients with special needs often must rely on inadequately trained caregivers for oral health maintenance. Consequently, full compliance is often not achieved. It is crucial that dentists carefully consider restorative materials and restoration design to maximize durability and facilitate cleansing in these challenging circumstances. This article discusses materials selection, prosthetic design, and oral hygiene techniques for caregivers to ensure longevity and maintenance of oral health in the special needs population.