Online information about oral health in autism spectrum disorder: Is it good enough?

INTRODUCTION

The use of the internet has surged significantly over the years. Patients and caregivers of patients with autism spectrum disorder (ASD) might consult the internet for oral health-related information. Hence, this study aimed to assess the quality and readability of online information available in the English language regarding oral health in ASD.

METHODS

Online search using Google.com was conducted using the terms "Autism and dental care," "Autism and oral health," and "Autism and dentistry". The first 100 websites for each term were screened. Quality of information was assessed using the Patient Education Materials Assessment Tool for printed material (PEMAT-P) and the Journal of American Medical Association (JAMA) benchmarks. A PEMAT score higher than 70% is considered acceptable for readability and actionability. The JAMA benchmarks are authorship, attribution, disclosure, and currency. Readability was evaluated using the Flesch reading ease score and Simple Measure of Gobbledygook (SMOG) readability formula.

RESULTS

Out of the 300 screened websites, 66 were eventually included. The mean PEMAT understandability and actionability scores were 77.13%, and 42.12%, respectively. Only 12.1% of the websites displayed all four JAMA benchmarks. The mean Flesch score was 10th-12th grade level, and the mean SMOG score was 10th grade level.

CONCLUSION

While the understandability of the information was acceptable, the readability and actionability were too challenging for lay people. Health care professionals and organizations involved in patient education should place more efforts in promoting the quality of online information targeting patients with ASD.

Barriers and mediators for routine dental care visits from the experiences of immigrant parents of autistic children living in the United States

INTRODUCTION

Immigrants are reluctant to attend routine dental care visits. Moreover, children with autism have a higher chance of developing periodontal disease. In this study, we describe the experiences of immigrant parents with autistic children and the barriers and mediators to routine dental care visits for their children in the United States.

METHOD

We conducted semistructured interviews with 19 immigrants who have children with autism.

RESULTS

We found that lack of transportation, support system, and insurance; prioritization of basic needs; and a mistrust of healthcare providers are the main barriers to attending routine dental care visits for autistic children of immigrant parents. Moreover, staff who consider the needs of children with autism, spend ample time with children with autism, and help with navigating the health system can improve access to routine dental care visits for autistic children with immigrant parents. This study found that despite their immigration status, all parents want to see improvements in the oral health of their children with special needs.

CONCLUSION

This study aimed to unpack the structural barriers and mediators to routine dental care visits for autistic children of immigrant parents. We found that removing structural barriers to care and utilizing mediators will enhance the outcome of routine dental care, resulting in healthier oral hygiene.

qPCR assay optimisation for a clinical study comparing oral health risk in Rett syndrome

PURPOSE

This study aimed to validate qPCR assays for specific microbiota, for use on dental plaque samples stored on Whatman FTA cards to compare relative oral health risk in Rett syndrome.

METHODS

Supragingival dental plaque samples were collected, using a sterile swab, (COPAN FLOQswab™) swabbed onto Whatman FTA™ cards. DNA extraction was performed using a modified Powersoil™ protocol. Where published assays were unsuitable, species-specific qPCR assays for caries-associated, gingivitis-associated and oral-health-associated bacteria were designed using multiple sequence alignment, Primer3Plus and PrimerQuest. Assays were run using absolute quantification. Limit of detection (LOD) and limit of quantification (LOQ) were calculated, and PCR products verified by Sanger sequencing.

RESULTS

Most assays allowed detection using real-time qPCR with high specificity on samples collected on FTA cards. Several assays showed low or even single gene copy numbers on the test samples.

CONCLUSION

Assays were optimised for detection and evaluation of oral health risk in dental plaque samples stored on FTA cards when cold storage is not feasible, except for F. nucleatum. Several assays showed gene copy numbers less than the LOQ or outside the range of the standard curve, so there is merit in optimising these assays using digital droplet PCR.

Effect of dental hygienists' self-efficacy on intention to provide dental care to autistic individuals

AIMS

The study aimed to investigate the influence of dental hygiene providers' self-efficacy and the factors affecting self-efficacy on their intent to provide care for autistic individuals.

METHODS AND RESULTS

A cross-sectional survey was conducted using a nonprobability sample of dental hygienists (n = 1075), yielding a completion rate of 70.6%. The survey included validated measures to assess participants' demographics, autism training and experience, autism knowledge, self-efficacy, environmental factors, and intention to treat the autistic population. Participants' self-efficacy scores (r = 0.416; p < .001) and support from dental offices (r = [0.174; 0.465]; p < .001) had the greatest influence on intent. Clinicians who had more experience treating (r = 0.280; p = .005) and received more hours of training/education on treating autistic patients (r = 0.344; p < .001) showed a stronger inclination to provide care to this population. Notably, autism knowledge had a weaker impact on intent when compared to self-efficacy and training/education.

CONCLUSION

Autism-focused education and training have a positive effect on provider self-efficacy when caring for autistic individuals. Increased emphasis on such interventions is necessary at all levels of dental hygiene education. The findings from this study can help overcome barriers to preventive dental care for the autistic community.

Parental perspectives on oral health-related quality of life in children and adolescents with autism spectrum disorder: A systematic review

BACKGROUND

Children with autism spectrum disorder (ASD) face unique challenges related to oral health, which can negatively impact their day-to-day lives, significantly compromising their overall quality of life. Primary caregivers of children with ASD have a critical role in delivering and seeking oral health care. Hence, it is vital to study their perspective towards their children's oral health and its impact on their quality of life.

AIM

To explore the parental perception of oral health-related quality of life in children with autism.

METHODS

A systematic electronic and manual search was conducted in Medline (via PubMed), Embase, Google Scholar, Scopus, and LILACS of articles published from January 2003 to May 2023 using appropriate MeSH terms, keywords, and other terms. A four-phase study selection process was followed according to PRISMA guidelines, and data extraction and synthesis were performed using an extraction form. The selected studies were critically appraised using the QATSDD and Crombie's assessment tool. The inter-reviewer agreement was assessed using the kappa with a linear weighting coefficient.

RESULTS

Out of the 885 results, 15 studies were included in the review after the two selection phases, and the study characteristics were summarized in tabular form. Study quality varied considerably, and out of a total possible QATSDD score of 42, scores for the individual studies ranged from 14 to 40. The risk of bias for the seven criteria was found to be low.

CONCLUSION

The parental perception of the OHRQoL in children with ASD is poor, and the most significant perceived impact is on the child's functional and social well-being aspects. Parental-Caregiver Perception Questionnaire was the most commonly used. The most frequent symptoms include bad breath, food lodgment, mouth breathing and night grinding. The familial impact and influence on the OHRQoL of siblings were also studied.

Public Dental Service Access Policies for People with Autism Spectrum Disorder (ASD) in Salvador, Bahia, Brazil: A Pre-Evaluation Study

This study sought to carry out a systematic and preliminary evaluation of the policies on access to public dental services for people with ASD in a Brazilian city. The study, conducted between November/2019 and February/2020, was developed through document analysis, the design of the theoretical logical model of the policies, and seven semi-structured interviews with key informants. The sample was intentionally selected. We also considered the answers to 108 questionnaires from a pilot study on the access of people with ASD to dental services applied to caregivers, dentists, and non-dental professionals. No refusals were recorded. The availability study showed that the policies' objectives were not being achieved in terms of care network organization: there were no institutional flows, personal contacts were used between professionals to guarantee access to secondary attention, there was no specific training for the dentists about ASD, and the oral health care network was unknown to non-dentist professionals and caregivers. Most people with ASD have visited the dentist at least once in their lives, but a large percentage of those within this study did not do so in the last year. This study identified difficulties in implementing policies and suggested possible strategies for overcoming them as dimensions and subdimensions for evaluation.

Development of oral health resources and a mobile app for caregivers and autistic children through consensus building

LAY ABSTRACT

Caregivers of autistic children often lack knowledge regarding oral homecare and when and where to see the dentist. To address this need, we developed a series of information on oral health. An autistic child assisted in developing two social stories to showcase a dental visit. A mobile app was developed to deliver the above mentioned. Other features include creation of customised social stories and visual schedule and an inbox to allow dentists to send messages to parents. The developed information and social stories were reviewed by experts and parents. The app also underwent anonymous and independent testing by parents. Overall the information and app were well received by the experts and parents.

Autistic individuals have worse oral status than neurotypical controls: a systematic review and meta-analysis of observational studies

OBJECTIVE

To compare dental caries, oral hygiene, periodontal status, bruxism, malocclusion, tooth loss, and salivary alterations between autistic and typical developing individuals.

MATERIAL AND METHODS

Observational studies presenting clinical measures of oral outcomes between autism spectrum disorder (ASD) individuals and controls. EMBASE, LILACS, PubMed, PsycINFO, Scopus, Web of Science, Google Scholar, and ProQuest were searched up to June 26, 2023. Pairs of reviewers independently conducted study selection, data extraction, and assessments of methodological quality and certainty of evidence. Meta-analyses of standardized mean differences (SMD) and risk ratio (RR) were performed.

RESULTS

A total of 47 studies comprising 6885 autistic individuals were included in the review. Autistic individuals had significantly higher severity of dental-caries experience in primary teeth (SMD 0.29, 95%CI 0.02, 0.56), of dental plaque presence (SMD 0.59, 95%CI 0.24, 0.94), and of gingivitis (SMD 0.45, 95%CI 0.02, 0.88). Autistic individuals showed higher probability of occurrence of gingivitis (RR 1.34, 95%CI 1.08, 1.66,), bruxism (RR 4.23, 95%CI 2.32, 7.74), overjet (RR 2.16, 95%CI 1.28, 3.64), overbite (RR 1.62, 95%CI 1.02, 2.59), crossbite (RR 1.48, 95%CI 1.02, 2.13), and openbite (RR 2.37, 95%CI 1.46, 3.85), when compared to neurotypical individuals. Most estimates showed a small effect size with very low certainty of evidence.

CONCLUSION

Autistic individuals show worse oral health status than controls.

CLINICAL RELEVANCE

The findings reported herein can help to build health policies to better serve autistic individuals including prevention actions and access to specialized dental care.

Oral habits, sociopsychological orthodontic needs, and sociodemographic factors perceived by caregivers impact oral health-related quality of life in children with and without autism?

BACKGROUND

Caregivers play a crucial role in assessing the oral health-related quality of life (OHRQoL) of young individuals with autism spectrum disorder (ASD).

AIM

This study assessed the impact of sociodemographic and oral conditions on OHRQoL and family dynamics in young individuals with and without autism, as perceived by guardians.

DESIGN

This comparative cross-sectional study included young individuals aged 6 to 14 years and their guardians. Data were collected at a specialized institution and dental schools. Guardians completed the Parental-Caregiver Perceptions Questionnaire (P-CPQ), Family Impact Scale (FIS), and sociodemographic and oral habits questionnaires. The sociopsychological need for orthodontic treatment was assessed using the Index of Orthodontic Treatment Need (IOTN).

RESULTS

The sample included 144 youths and caregivers. The ASD group had higher P-CPQ and FIS scores. Factors associated with poorer perceived OHRQoL included higher youth age, lower caregiver education, higher IOTN scores, teeth clenching (RR = 1.20; 95% CI: 1.01-1.41), and lip sucking. Lower parental education (RR = 1.75; 95% CI: 1.10-2.80) and higher IOTN scores from the caregiver's perspective impacted family dynamics.

CONCLUSION

Caregivers of young individuals with ASD perceived a lower OHRQoL, and families in this group were more affected by sociodemographic and oral conditions.

Oral Health Statuses of Children and Young Adults with Autism Spectrum Disorder: An Umbrella Review

This study aimed to comprehensively evaluate the oral health statuses of children and adults within the autism spectrum disorder (ASD) population through an umbrella review approach. The prevalence of dental caries, periodontal disease, and associated variables were investigated across selected studies. A systematic search was conducted across databases including PubMed, Scopus, EMBASE, Science Citation Index, Science Direct, Web of Science, MEDLINE, and Wiley Online Library to identify relevant studies. The assessed variables included dental caries prevalence, periodontal disease prevalence, oral hygiene indicators, and the necessity of dental treatment. The pooled prevalence rates, odds ratios, and standardized mean differences were calculated where applicable. The pooled prevalence of dental caries among ASD individuals ranged from 60.6% to 67.3%, while the periodontal disease prevalence ranged from 59.8% to 69.4%. High rates of dental treatment under general anesthesia were reported. Heterogeneous dental caries and periodontal disease prevalence rates were identified, highlighting the need for collaboration and preventive care. Several studies also reported higher prevalence rates of dental trauma and self-inflicted oral injuries among individuals with ASD. However, the review also identified significant methodological limitations in the included studies, including inconsistency in oral health assessment methods and potential bias. The necessity for targeted policies due to high prevalence rates and the requirement for integrated care systems in high DMFT regions were also observed. The umbrella review synthesized diverse findings, revealing variations in dental caries and periodontal disease prevalence among ASD individuals. This review underscores the need for tailored interventions and policies to address oral health disparities. It highlights the necessity of integrated care systems, methodological improvements, and longitudinal studies to comprehensively address the multifaceted oral health challenges within the ASD population.

Saliva: a challenging human fluid to diagnose brain disorders with a focus on Alzheimer's disease

Biomarkers are molecules of biological processes that help in both the diagnosis of human diseases and in follow-up assessments of therapeutic responses. Biomarkers can be measured in many human fluids, such as blood, cerebrospinal fluid, urine, and saliva. The -omics methods (genomics, RNomics, proteomics, and metabolomics) are useful at measuring thousands of markers in a small volume. Saliva is a human fluid that is easily accessible, without any ethical concerns. Yet, saliva remains unexplored in regard to many human disease biomarkers. In this review, we will give an overview on saliva and how it can be influenced by exogenous factors. As we focus on the potential use of saliva as a diagnostic tool in brain disorders (especially Alzheimer's disease), we will cover how saliva is linked to the brain. We will discuss that saliva is a heterogeneous human fluid, yet useful for the discovery of biomarkers in human disorders. However, a procedure and consensus that is controlled, validated, and standardized for the collection and processing of saliva is required, followed by a highly sensitive diagnostic approach.

Evidence-based analysis of multi-pronged approaches for education and behavior management of autistic patients in a dental setting

BACKGROUND

Autism spectrum disorder is a neurodevelopmental condition which has posed a challenge to carers, pediatricians and dentists through the years. Over the last four decades, the disorder has been better understood and management techniques have evolved. In the field of dentistry, the autistic child presents difficulty in management, even for the simplest dental procedures. A comprehensive understanding of other psychoeducational and behavioral approaches to manage autism is very important. This article aims to introduce various important key techniques such as Applied Behavior Analysis, TEACCH, Sensory Adapted Dental Environment, Picture Exchange Communication System, and Animal Assisted Therapy and analyze their application in dentistry.

METHODS

A search of literature was carried out in Clinicaltrials.gov, Medline and Scopus with the search terms "Applied Behavior Analysis," "TEACCH," "Sensory Adapted Dental Environment," "Picture Exchange Communication System," and "Animal Assisted Therapy" along with "autism OR autistic," "dental OR dentistry OR oral health." After the screening for inclusion and exclusion criteria, 10 eligible articles were included, in English, published within the last 10 years.

RESULTS

Limited research was available regarding these lesser-known behavioral approaches in dentistry. The few that were available showed encouraging results. The different techniques proved useful in increasing acceptance of dental treatment and reducing behavioral disturbances. The patients experienced reduced dental anxiety, lesser discomfort, improved communication, and knowledge.

CONCLUSION

Pediatric and special care dentists are likely to benefit by incorporating the recommended comprehensive behavior management techniques in their practice. There is evidence that these techniques will reduce behavioral disturbances in autistic children thereby making primary dental care possible without the need for sedation or general anesthesia.

Optimizing Parent Training to Improve Oral Health Behavior and Outcomes in Underserved Children with Autism Spectrum Disorder

A randomized controlled trial established initial efficacy of a novel parent training (PT) intervention for improving oral hygiene and oral health in underserved children with ASD (Fenning et al., 2022), a population at risk for unmet dental needs. The present study describes our emic approach to PT development alongside treatment outcome data examining feasibility, acceptability, and engagement. Families with Medicaid-eligible children with ASD ages 3 to 13 years (85% male, 62% with intellectual disability) were assigned to receive PT (n = 60) or a psychoeducational toolkit (n = 59). Results indicate strong retention, fidelity, and adherence, with quantitative and qualitative metrics revealing high treatment satisfaction and utilization. Discussion focuses on implications for individualizing treatment to optimize engagement of underrepresented families.

Promoting openness to autism amongst dental care professional students

INTRODUCTION

Autism spectrum disorders (ASD) is a lifelong condition affecting communication and social interaction, characterised by repetitive or repeated patterns of behaviour. People with ASD experience poor systemic and oral health. They face reduced access to dental care related to provider barriers associated with lack of understanding of ASD, lack of training and a consequent reluctance to treat people with ASD.

MATERIALS AND METHODS

The effectiveness of training given by a person with autism to student dental care professionals was evaluated by measuring change in 62 students' openness to autism scale scores and confidence treating a person with autism. These students included third year dental students and second year dental nursing and hygiene students. This cohort was recruited as part of their curriculum and opted in for inclusion in the study. Data were analysed using SPSS®.

RESULTS

An increase in openness scale scores of 7.6% (p < .05) and in confidence of 4.9% (p < .05) between pre- and post-training was observed. Openness scale score predicted level of confidence at baseline (OR = 0.21 (95% CI = 0.02-0.39)).

CONCLUSION

An educational intervention delivered by a person with autism promoted modest increases in openness towards autism and confidence amongst dental care pre-service professionals. Whilst the results suggest that peer-led dental care professional teaching by people with autism may be beneficial, more research is needed.

Autism spectrum disorder and periodontitis risk: A cohort study of 38,203 adolescents

BACKGROUND

People with autism spectrum disorder (ASD) may have poor oral health status because they often experience challenges with daily oral hygiene and have inadequate access to oral health care services. This study explored periodontitis risk in adolescents with ASD compared with those who did not have a diagnosis of ASD.

METHODS

Data from 2001 through December 31, 2011 from the Taiwan National Health Insurance Research Database on 3,473 adolescents with ASD and 34,730 age- and sex-matched people who did not have a diagnosis of ASD were obtained, and subsequent periodontitis was identified from enrollment through December 31, 2011.

RESULTS

Adolescents with ASD (hazard ratio, 2.01; 95% CI, 1.84 to 2.20) were more likely to develop periodontitis at follow-up than those who did not have a diagnosis of ASD. Findings remained consistent in subanalyses stratified by sex and intellectual disability. People with ASD had periodontitis onset at an earlier mean (SD) age than those who did not have a diagnosis of ASD (17.97 [3.12] vs 21.86 [2.28] years; P < .001).

CONCLUSIONS

ASD is an independent risk factor for subsequent periodontitis development.

PRACTICAL IMPLICATIONS

Oral health should be closely monitored in adolescents with ASD. Future investigation of the common pathogenesis between periodontitis and ASD is warranted.

Dental care experiences and clinical phenotypes in children on the autism spectrum

AIMS

Children diagnosed with autism spectrum disorder may be at higher likelihood of experiencing poorer oral health and difficulties accessing dental health care. However, identifying which children on the autism spectrum may be more vulnerable to experiencing dental care difficulties is still unknown. This study investigated parental reports of oral health and dental service needs of children diagnosed with autism and explored relationships with clinical phenotypes.

METHODS AND RESULTS

Participants (n = 140) were parents of children on the autism spectrum who had participated in a large national biobank study, the Australian Autism Biobank, invited to complete additional surveys about oral health, service use, and barriers to care. One third of parents reported their child's oral health was worse than other children the same age, with 26% reporting untreated dental problems. A third of children were reported to have undergone general anaesthesia at least once for dental procedures. Children who had undergone general anaesthesia were more likely to have intellectual disability and greater functional difficulties. Parents of children with greater functional limitations and sensory challenges reported experiencing barriers to accessing dental care more frequently.

CONCLUSION

These results have important implications for paediatric dentists working with children diagnosed with autism with co-occurring intellectual, functional, and sensory challenges. Findings may inform the development of more personalised autism-specific supports.

Are adults with autism receiving regular preventive dental services?

PURPOSE/AIM

To investigate the frequency of preventive dental care among adults with autism and explore factors associated with receiving regular preventive care.

MATERIALS AND METHODS

De-identified data was collected from electronic health records of 18-year-old or older patients with autism that had at least one preventive dental procedure recorded. The data was then analyzed to describe the frequency of preventive dental procedures provided for this population and investigate what variables are associated with regular care.

RESULTS

Sample size was 119, 67% were males, average age was 30.8 years, and 58% had Medicaid. Average BMI was 42.8, the prevalence of diabetes and heart disease were 16% and 34%, respectively, and 86% reported mental health problems. Recreational drug use was 6.8%, alcohol use was 19%, and tobacco use 16%. Xerostomia was reported by 32%, and the average number of medications was 7.2 ± 5.5. The average number of preventive dental visits was 7.9 ± 10.6, and 35% of the patients had at least one preventive dental visit per year. Only number of medications had a statistically significant association with number of preventive dental visits.

CONCLUSIONS

Only one in every three adults with autism had at least one preventive dental visit per year.

Dental procedures in children with or without intellectual disability and autism spectrum disorder in a hospital setting

BACKGROUND

This population-based cohort study investigated dental procedures in the hospital setting in Western Australian children with or without intellectual disability (ID) and/or autism spectrum disorder (ASD) aged up to 18 years. Considering previously reported disparities in dental disease between Indigenous and non-Indigenous Australian children, this study also investigated the effect of Indigenous status on dental procedures.

METHODS

Data on Western Australian live births from 1983 to 2010 from the Midwives Notification System were linked to the Intellectual Disability Exploring Answers database and the Hospital Morbidity Data collection. Primary admissions for relevant dental diagnoses were identified, and treatment procedures for dental hospitalization were investigated. Descriptive statistics and Pearson's chi-squared test of independence were used for analysis.

RESULTS

Overall, 76 065 episodes of dental hospitalization were recorded. Amongst children with ID and/or ASD, Indigenous children experienced more extractions and fewer restorations (68.7% and 16.2%) compared to non-Indigenous children (51.5% and 25.9%). After 6 years, extraction occurred less often in children with ID and/or ASD than in those without, where most surgical dental extractions were in the age group of 13-18 years.

CONCLUSIONS

This study indicates a need for further improvements in access to dental services and the quality of care provided in hospitals for children with ID/ASD. There is also concern that more vulnerable Indigenous and all disadvantaged children are receiving an inadequate level of dental services resulting in more emergency dental hospitalization and invasive treatment.

The Oral Health Status and Treatment Needs of Pediatric Patients Living with Autism Spectrum Disorder: A Retrospective Study

BACKGROUND

The objective of this retrospective study was to assess the oral health status and treatment needs of children with ASD and to explore the differences in risk factors and oral health care status and the risk factors for treatment under GA.

METHODS

Dental charts of children between 6 and 14 years of age who were examined at a dental facility associated with the College of Dentistry, University of Saskatchewan between 2016 to 2019 were assessed. Children who were identified as having ASD, as well as an age- and gender-matched control group consisting of otherwise healthy children were included in the study.

RESULTS

The sample included 346 dental records, with 173 children having a diagnosis of ASD. Children diagnosed with ASD had significantly higher experience with caries (91.3% vs. 65.9%, p = 0.003) and severity (mean DMFT/dmft = 8.18 ± 1.62 vs. 4.93 ± 0.58 p = 0.007). Children with ASD were also older when visiting the dentist for the first time (age of 5.97 ± 1.18 vs. 2.79 ± 1.09, p = 0.02)). Children with ASD were less likely to brush once a day (66.5% vs. 88.4%, p = 0.02), were more likely to have bruxism (35.8% vs. 10.4%, p = 0.003) and were less likely to have class I occlusion (64.7% vs. 80.9%, p = 0.03). Findings from the logistic regression analysis revealed that children with ASD were also 2.13 times more likely to receive a referral for general anesthesia when all other variables were held constant (p = 0.03).

CONCLUSIONS

This research demonstrates that children diagnosed with ASD may face more barriers with access to oral health care, leading to poorer outcomes and greater treatment dental needs.

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

OBJECTIVE

Inequalities in child oral health are a global challenge and the intersection of socioeconomic factors with educational additional support needs (ASN), including children with intellectual disabilities or autism, have thus far received limited attention in relatively small clinical studies. We aimed to address this evidence gap by investigating oral health and access to preventive dental services among children with ASN compared to the general child population.

METHODS

Cohort study linking data from six Scotland-wide health and education databases compared: dental caries experience and tooth extraction via general anaesthetic; receipt of school-based dental inspection; access to primary care and hospital dental services; and access to the Childsmile national oral health improvement programme between children with a range of ASN (intellectual disabilities, autism, social and other) and their peers for the school years 2016/17-2018/19 (n = 166 781).

RESULTS

Children with any ASN had higher rates of caries experience than those with no ASN, however, after adjustment for socioeconomic deprivation, sex, year, and school type only those with a social or other ASN remained at increased risk. Rates of tooth extraction under general anaesthesia in hospital were higher among children with intellectual disabilities (aRR = 1.67;95% CI = [1.16-2.37]). School-based dental inspection access improved for children with intellectual disability and/or autism from 2016/17 onwards, although higher rates of child refusal on the day were observed in these groups (no ASN refusal: 5.4%; intellectual disability: 35.8%; autism: 40.3%). Children with any ASN were less likely to attend primary dental-care regularly, and in those who attended, children with intellectual disability or autism were less likely than their peers to receive prevention (fluoride varnish, oral-hygiene instruction, or dietary advice). Childsmile nursery-supervised toothbrushing programme access among children with any ASN was similar to children with no ASN and children with intellectual disability (aRR = 1.27;95% CI = [1.12-1.45]) or autism (aRR = 1.32;95% CI = [1.19-1.45]) were more likely to receive support from Childsmile dental health support worker.

CONCLUSIONS

We have identified inequalities in oral health and dental care for children with different ASN in Scotland with both a greater burden of disease among some groups and higher complexity of care; compounded by reduced and variable access to preventive dental services. Further efforts are needed to develop and improve preventive care pathways for children with ASN and integrate oral health to wider healthcare systems for these children to mitigate against oral health inequalities.

A cross-sectional study on dietary assessment, oral hygiene behavior, and oral health status of adolescent girls

Adolescents are a population group that is vulnerable to nutritional problems other than toddlers, especially young women. Special attention to the dietary issues of adolescent girls needs to be obtained along with the increase in the adolescent population in Indonesia because this affects the growth and development of the body and will impact adult nutrition problems. The purpose of the study was to analyze the relationship between diet assessment and oral health status of adolescent girls, the relationship between oral hygiene behavior and oral health status of adolescent girls, and the simultaneous relationship between dietary assessment and oral hygiene behavior with the oral health status of adolescent girls. Analytical research using the survey method was conducted on 96 young women in two junior high schools in Bandung. Assessment of diet seen from eating behavior and anthropometric examination. Eating behavior using the Adolescent Food Habit Checklist Index questionnaire and anthropometric investigations were carried out by looking at body height, body weight, and Mid Upper Arm Circumference using the standards from the Indonesian Minister of Health Regulation 2020. Oral hygiene behavior using the Oral Hygiene Behavior Index questionnaire. Oral health status using the Dental Health Status Assessment. The results were statistically analyzed with Spearman's Rank Correlation, and Multiple Linear Regression tests showed no significant relationship between dietary assessment and oral health status (eating behavior with a p-value = 0.429 and anthropometric examination with a p-value = 0.262). A significant association between oral hygiene behavior and oral health status, with a p-value of 0.003, while there is no simultaneous relationship between diet assessment and oral hygiene behavior with oral health status, with multiple r 2 = 13.2%.

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.

Oral Care Knowledge, Attitudes, and Practices of Black/African American Caregivers of Autistic Children and Non-Autistic Children

Oral health is a vital component of overall health. Children from underserved, minoritized populations (i.e., Black/African Americans, autistic children) are at even greater risk for experiencing oral health disparities. This study aims to illuminate the oral health knowledge, attitudes, and practices of Black/African American caregivers of autistic and non-autistic children. Black/African American caregivers of children (4-to-14 years) on the autism spectrum (n = 65) or not on the autism spectrum (n = 60), participated in a survey, with input from literature reviews, interviews, previous research, and reviews by experts. Caregivers demonstrated basic knowledge of oral health with significantly lower scores for caregivers of autistic children. Caregivers care about oral health and would like to increase their knowledge. Significant differences in oral care practices were found between the autistic and non-autistic groups. Caregivers reported they can access dental services with relative ease, including finding their child a dentist, scheduling a dental appointment, and accessing transportation (personal or public) to attend the visit. Black/African American caregivers of autistic children and children without autism seem to have foundational knowledge about oral health and basic practices; however, they are interested in learning more. Therefore, tailored oral health education programs may help mitigate oral health disparities for Black/African American families.

Oral Hygiene Practices among Adults with Intellectual Disabilities-A Pilot Study

It is known that the oral health status of people with intellectual disabilities (IDs) is likely to be compromised as compared with the general population. Until recently, the trend of oral hygiene among the adult population with intellectual disabilities in Brunei Darussalam had yet to be studied. Thus, the aim of this study was to determine the oral hygiene practices, oral health knowledge and dental appointment patterns among the adult population with IDs in Brunei Darussalam. A cross-sectional study was conducted at different service providers in Brunei Darussalam for adults with IDs. An easy-to-read questionnaire was distributed to the participants. The responses of the questionnaire for IDs were analyzed. A total of 34 participants were recruited. It was found that all participants were practicing their daily oral hygiene routine. In terms of dental visits, more than half visit the dentist at least once a year. The majority of the participants agreed that visiting the dentist every 6 months was essential. This study showed that adults with IDs in Brunei Darussalam were aware of the importance of oral health and were maintaining their daily oral hygiene, although not with the ideal method. It is important for clinicians to not only educate the individuals with IDs but also their carer(s) when it comes to oral health knowledge, as carers play a key role in the oral health of the people under their care.

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.

Use of Visual Pedagogy to Help Children with ASDs Facing the First Dental Examination: A Randomized Controlled Trial

Autism Spectrum Disorders (ASDs) are neurodevelopmental disorders that don’t have a direct effect on oral health, but severe difficulties in oral hygiene and dental procedures expose people with ASDs to an increased risk of oral diseases. This RCT aimed to evaluate which pedagogical tool was the best to prepare children with ASDs for their first dental examination, either video or photo aids. Two different criteria were used to evaluate their efficacy: the achieved steps into which the procedure was divided (n = 8), and the level of cooperation according to the Frankl Behavioral Scale. One hundred-thirteen subjects were randomly assigned to the two groups and 84 subjects completed the trial (Video group n = 41; Photo group n = 43). A predictive model for the achievement of the Preliminary (1–4) or Dental (4–8) steps was performed using a multivariate logistic regression procedure. Children in the Video group achieved more steps, but the comparison between groups was statistically significant only for the Preliminary steps (p = 0.04). The percentage of subjects judged as cooperating was similar in the two groups. The results of this study underline that behavioural intervention should be used as an effective strategy to prepare subjects with ASDs for a dental examination.

Parent Training for Dental Care in Underserved Children With Autism: A Randomized Controlled Trial

OBJECTIVE

Children with autism spectrum disorder (ASD) have difficulty participating in dental care and experience significant unmet dental needs. We examined the efficacy of parent training (PT) for improving oral hygiene and oral health in underserved children with ASD.

METHOD

Families of Medicaid-eligible children with ASD (ages 3-13 years, 85% boys, 62% with intellectual disability) reporting difficulty with dental care participated in a 6-month randomized controlled trial comparing PT (n = 60) with a psychoeducational dental toolkit (n = 59). Primary outcomes were parent-reported frequency of twice-daily toothbrushing and dentist-rated visible plaque. Secondary outcomes included parent-reported child behavior problems during home oral hygiene and dentist-rated caries. Dentists were blind to intervention assignment. Analyses were intention to treat.

RESULTS

Retention was high at posttreatment (3 months, 93%) and 6-month follow-up (90%). Compared with the toolkit intervention, PT was associated with increased twice-daily toothbrushing at 3 (78% vs 55%, respectively; P < .001) and 6 (78% vs 62%; P = .002) months and a reduction in plaque at 3 months (intervention effect, -0.19; 95% confidence interval [CI], -0.36 to -0.02; P = .03) and child problem behaviors at 3 (-0.90; 95% CI, -1.52 to -0.28; P = .005) and 6 (-0.77; 95% CI, -1.39 to -0.14; P = .02) months. Comparatively fewer caries developed in children receiving the PT intervention over 3 months (ratio of rate ratios, 0.73; 95% CI, 0.54 to 0.99; P = .04).

CONCLUSIONS

PT represents a promising approach for improving oral hygiene and oral health in underserved children with ASD at risk for dental problems.

Occurrence of bruxism in individuals with autism spectrum disorder: A systematic review and meta-analysis

AIMS

To investigate bruxism in individuals with autism spectrum disorder (ASD) and neurotypical individuals.

METHODS AND RESULTS

Searches were conducted in the MedLine via Ovid, Embase via Ovid, Cochrane Database of Systematic Reviews, Scopus, Web of Science, Latin American and Caribbean Health Sciences (LILACS), Brazilian Library of Dentistry (BBO) and SciELO databases, grey literature and a hand search up to December 2020 with no restrictions imposed regarding language or year of publication (CRD42020211307). For the meta-analysis, the frequency of bruxism was extracted, with the calculation of odds ratios (OR) and 95% confidence intervals (CI) using a random effects model in RevManager. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Seventeen case-control studies were included in the qualitative synthesis and 15 were included in the meta-analysis, totaling a population of 3850 individuals. The ASD group was more likely to develop bruxism than the controls (OR: 3.80; 95% CI: 2.06-7.01). The certainty of the evidence was classified as "very low" for the occurrence of bruxism between ASD and control individuals.

CONCLUSION

It is uncertain whether individuals with ASD are more likely to have bruxism than healthy controls.

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.

Salivary flow and salivary proteins in male and female children with autism spectrum disorder: pilot study

Abstract Introduction autism spectrum disorder is a neurodevelopmental condition that affects the establishment of bonds and communication. Dental care is more difficult for people with this disorder, because in addition to communication difficulties, non-cooperation with respect to oral hygiene and continuous use of medication are common. Greater predisposition to caries, as well as alterations in the flow and concentration of salivary proteins were reported in these individuals. Objective considering that sex can affect salivary flow and protein concentration, our objective was to analyze these parameters in the saliva of children with autism. Material and method total unstimulated saliva was obtained from 12 boys and 12 girls aged between 5 and 15 years, with the aid of a catheter, after 2 hours of fasting and oral hygiene. Salivary flow was determined by estimating the mass of saliva. Total protein was determined in the supernatant obtained after centrifugation at 10,000 x g, for 10 minutes, by the Lowry method, with bovine albumin as standard. The results are expressed as mean and standard deviation. The data were submitted to the Shapiro-Wilk and Mann Whitney tests, with a significance level of 5%. Result salivary flow values for boys (0.3555 ± 0.24 ml/min) and girls (0.2522 ± 0.1727 ml/min), and protein values for boys (1.430 ± 0.7480 mg/mL) and girls (1.075 ± 0.3702 mg/mL) were not significantly different between sexes. Conclusion in children with autism spectrum disorder, sex does not influence unstimulated flow and salivary protein values.

Analysis of oral health care delivery in patients with autism

Background/Aim: Autism spectrum disorder (ASD) is pervasive neurodevelopmental condition with raising prevalence over the last decades. Oral health related problems arise mostly due to challenging behavior, communication limitation, and resistance to receiving dental treatment. The aim of this retrospective study was to investigate the frequency, quality and type of dental care during routine appointments and under general anesthesia (GA) in persons with ASD. Matreial and Methods: The data were obtained in retrospective cross-sectional study by analyzing patients' records from the central electronic database of the Clinic for Dentistry of Vojvodina. Demographic, medical and dental data were analyzed employing Mann Whitney U test, Kruskal Wallis test and CATREG regression analysis. Results: A total of 51 patients from 4.2-47.6 years of age had an average of 13.2 ±13.5 dental appointments, with 2.27±4.23 treatments done under GA in a period of 7 years. The average number of restored teeth was 3.64±4.42 and 4.64±5.95 teeth were extracted. Only 21.5% of participants regularly attended scheduled appointments. Patients who started oral health care earlier had more teeth restored and extracted during RDT, and were less subjected to treatment under GA. Conclusions: Dental services to patients with ASD are commonly limited to more radical approach comprising multiple teeth extractions and repeated treatment under GA. It is of utmost importance to tailor comprehensive plan for dental care provision in individuals with ASD at earliest possible age.

Cochrane's risk of bias tool for non-randomized studies (ROBINS-I) is frequently misapplied: A methodological systematic review

OBJECTIVES

We aimed to review how 'Risk of Bias In Non-randomized Studies-of Interventions' (ROBINS-I), a Cochrane risk of bias assessment tool, has been used in recent systematic reviews.

STUDY DESIGN AND SETTING

Database and citation searches were conducted in March 2020 to identify recently published reviews using ROBINS-I. Reported ROBINS-I assessments and data on how ROBINS-I was used were extracted from each review. Methodological quality of reviews was assessed using AMSTAR 2 ('A MeaSurement Tool to Assess systematic Reviews').

RESULTS

Of 181 hits, 124 reviews were included. Risk of bias was serious/critical in 54% of assessments on average, most commonly due to confounding. Quality of reviews was mostly low, and modifications and incorrect use of ROBINS-I were common, with 20% reviews modifying the rating scale, 20% understating overall risk of bias, and 19% including critical-risk of bias studies in evidence synthesis. Poorly conducted reviews were more likely to report low/moderate risk of bias (predicted probability 57% [95% CI: 47-67] in critically low-quality reviews, 31% [19-46] in high/moderate-quality reviews).

CONCLUSION

Low-quality reviews frequently apply ROBINS-I incorrectly, and may thus inappropriately include or give too much weight to uncertain evidence. Readers should be aware that such problems can lead to incorrect conclusions in reviews.

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

This case-control study compared dietary sugar exposure and oral health status between children with and without Autism Spectrum Disorder (ASD), aged 5-12 years (n = 136, each). Data regarding socio-demographics, child's oral hygiene practices and behavior, diet-related behavior, oral habits and dental trauma were obtained. Child's diet on the previous day was recorded using 24-h recall method and sugar exposure was calculated using Dental Diet Diary (D3) mobile application. Oral Hygiene Index-Simplified (OHI-S), deft and DMFT were recorded. Results showed no significant differences in sugar exposure, deft and DMFT between the groups. Although oral hygiene practices were significantly better in children with ASD, their OHI-S was significantly worse. Significantly more children with ASD reported mouth-breathing, bruxism and self-injurious habits.

Factors associated with dental hospitalisations in children with intellectual disability or autism spectrum disorder: a Western Australian population-based retrospective cohort study

PURPOSE

This study investigated dental hospitalisations in Western Australian (WA) children with intellectual disability (ID) and/or autism spectrum disorder (ASD) aged up to 18 years.

METHODS

Data on WA live births from 1983 to 2004 from the WA Midwives Notification System were linked to the Intellectual Disability Exploring Answers database, the WA Hospital Morbidity Data System, and the Western Australian Birth Defects Registry databases. Children were followed from birth to 2010 and the data grouped into three age-groups. Primary and secondary admissions for relevant dental diagnoses were identified and factors associated with having a dental hospitalisation investigated.

RESULTS

There were 1366, 1596, and 780 dental hospitalisations amongst 1122, 1154, and 609 children with ID and/or ASD in the 0-6, >6-12, and >12-18 year age groups, respectively. Children with severe ID were much more likely to be hospitalised than those with mild/moderate ID. More socioeconomically disadvantaged children were less likely to be hospitalised than children whose parents were socially advantaged.

CONCLUSIONS

There is concern that more vulnerable children in the WA community with ID or ASD are receiving an inadequate level of dental services compared with other groups resulting in potentially preventable hospitalisations, a situation in need of urgent remediation.Implications for rehabilitationLittle is known about why some children with intellectual disability (ID) or autism are being hospitalised for their dental care and others are not.Children with disability whose families are socioeconomically disadvantaged should have equivalent opportunity to receive optimal dental care.Dental practitioners at all levels need training and confidence in treating children with ID.

Oral health care and service utilisation in individuals with Rett syndrome: an international cross-sectional study

BACKGROUND

There is a dearth of literature available on the comparative oral health status of those with Rett syndrome (RTT) despite diurnal bruxism being a supportive diagnostic criterion for the disorder. This study was designed to investigate the dental experiences of individuals with RTT in terms of perceived at-home and professional dental care.

METHODS

Using data in the InterRett database, provided by English-speaking families of individuals with a confirmed MECP2 genetic mutation, the study investigated relationships between dental problems, oral care, child factors including bruxism and use of gastrostomy, and socioeconomic indicators. The study also explored relationships between dental presentations and socioeconomic, child, and family-related factors.

RESULTS

Individuals with RTT exhibiting bruxism were more likely to access dental treatment. Those who had full oral feeding had a higher incidence rate of dental treatment than those with full tube feeding. A conservative (under) estimation of the overall dental caries progression rate revealed that this may be similar to that of the normal population.

CONCLUSIONS

Drivers for dental treatment in RTT include bruxism as well as dental caries. Those who have full oral feeding experience more dental treatment than those with full tube feeding. A higher maternal education level may confer a protective effect for oral health outcomes in those with RTT. Nevertheless, families generally tended to value the importance of oral health despite reported difficulties in day-to-day mouth care.

Oral parafunction and bruxism in Rett syndrome and associated factors: An observational study

OBJECTIVES

To explore patterns of parafunction, and bruxism, and its relationships with genotype and snoring in individuals with Rett syndrome (RTT).

METHODS

Retrospective observational data of those with confirmed MECP2 mutations in the InterRett database (n = 216) were used to investigate experience of parafunctional habits, and bruxism and their relationships with genotype and snoring using multivariable linear regression.

RESULTS

The prevalence of parafunction was 98.2%. Bruxism was reported (66.2%) with the patterns mostly both diurnal and nocturnal (44.1%) and exclusively diurnal (42.7%). Compared to individuals with C-terminal deletion, individuals with p.Arg106Trp mutations were less likely to have bruxism reported (aOR = 0.15; 95% CI 0.02-0.98, p = 0.05) and those with p.Arg168* mutation were more likely to have frequent bruxism than none or occasional bruxism reported (aROR 3.4; 95% CI 1.1-10.7 p = 0.04). The relative odds of having nocturnal bruxism constantly, compared to none/occasionally, were higher among those 'always' snoring (aROR 6.24; 95% CI 2.1-18.2, p = 0.001) than those with no snoring.

CONCLUSIONS

There appeared to be genotypic association with bruxism in p.Arg168* and p.Arg106Trp mutations and association between nocturnal bruxism and frequent snoring in an international sample of individuals with RTT. Clinical significance of the high prevalence of bruxism should be highlighted in relation to difficulty communicating pain and increased dental treatment need in RTT.

Types of dental procedures provided to adults with autism spectrum condition: A descriptive study

PURPOSE/AIM

To investigate demographic and systemic health characteristics, and the types of dental procedures performed for adults with autism that had sought care at a dental school.

MATERIALS AND METHODS

De-identified data were collected from the records of patients aged 18+ who have self-reported autism. Each patient's age, gender, BMI, mental health, heart disease, xerostomia, tobacco use, alcohol use, diabetes, use of drugs, seizures, and total number of medications, as well as the type and number of dental codes used in the care of that patient within each code category were included as variables.

RESULTS

The sample was composed by 244 patients. Mean age was 29.8 years (±12.3), 64.8% were males, and mean BMI was 29.9 (±8.1). Mental health condition was reported by 79.9%, heart disease by 25.4%, xerostomia by 21.7%, 20.9% reported using tobacco, 18.9% reported using alcohol, 14.8% reported having diabetes, 10.2% reported using drugs, and 3.7% reported having seizures. The median number of dental procedures per patient was nine, and exams, preventive, operative, and surgical procedures were the most common ones.

CONCLUSIONS

Adult patients with autism were overweight/obese young males. Most common dental procedures were exams, followed by preventive, operative, and surgical procedures.

Dental disease risk in children with autism: a meta-analysis

Introduction Pi and colleagues reviewed eight case-control studies comparing the oral health (decayed, missing and filled teeth [DMFT], Plaque Index [PI], Gingival Index [GI] and salivary pH) of children with autism (n = 475) to children without autism (n = 565).Method The search strategy involved the use of PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang and Chinese Scientific and Technological Journal (VIP) to find case-control studies which met pre-defined inclusion criteria and were published before September 2018. The quality of each study was evaluated using the Newcastle-Ottowa Scale and only high-quality studies were included. Means and standard deviations for outcomes measured by each included study were presented. Data were pooled using the random-effects model via Review Manager 5.3, and presented as mean differences and 95% confidence intervals. Consistency was measured using I2. Sensitivity analysis was performed by removing one study with a large sample to explore effects on heterogeneity.Results The authors found eight eligible case-control studies conducted in Asia (n = 7) or South America (n = 1). Six of the eight compared DMFT of children with autism to those without and three of the eight compared PI, GI and/or salivary pH. While a meta-analysis is presented for each of the oral health outcome areas, there are discrepancies in the reporting. The included studies in each of the meta-analysis do not correspond with the characteristics of the studies provided.Conclusions The authors suggest from their meta-analyses that children with autism experience a higher prevalence of dental disease than children without autism. However, as currently presented, the study lacks internal validity and findings are not reliable.

Exploring Eating Challenges and Food Selectivity for Latinx Children with and without Autism Spectrum Disorder Using Qualitative Visual Methodology: Implications for Oral Health

Diet and food choices significantly impact teeth, including enamel quality and development of dental caries. However, studies focusing on diet and its relation to oral care in Latinx children with and without Autism Spectrum Disorders (ASD) have been minimally addressed in research. This qualitative study used an inclusive visual methodology to explore what Latinx caregivers learned about their child's diet preferences and food routines in relation to their oral health. As a secondary aim, the study sought to explore whether notable differences in diet emerged between Latinx children with and without ASD. Participants were 32 Latinx caregivers from 18 families with children with and without Autism (n = 8 with a typically developing child and n = 10 with a child with ASD) who completed a food journal activity and photo elicitation interview. Interviews were thematically coded for themes pertaining to parents' perceptions of their child's diet and oral health. Findings of this study indicate that the process of taking photos helped Latinx caregivers to better situate the barriers and behaviors influencing everyday food routines in their children within the context of relating to their overall oral health. Via their active participation in the research process, parents were empowered to note strategies they could employ that would directly impact their child's oral health outcomes, such as reducing juice intake and monitoring sugar consumption. Therefore, visual research methodologies are an important strategy for researchers to consider in order to empower participants to be part of the research process and part of the outcomes, and to offer better understanding of the lived experience of populations underrepresented in the literature, such as Latinx children with and without ASD and their families.

Developing a Toothbrushing Visual Pedagogy (TBVP) for Preschool Children with Autism Spectrum Disorder

Visual pedagogy and social stories have been widely used to assist children with Autism Spectrum Disorder (ASD) in learning various skills. A toothbrushing visual pedagogy (TBVP) was developed adapting existing toothbrushing social stories for children with ASD. This TBVP consists of 13 toothbrushing steps with scripts describing the toothbrushing technique. To evaluate its feasibility, a review panel was formed to provide feedback on the TBVP and three other published toothbrushing social stories. Effectiveness of the TBVP was further evaluated among 119 preschool children with ASD with significant improvements in toothbrushing skills observed at 3-month and 6-month follow-ups. It is concluded that TBVP is a feasible and an effective educational means that assists children with ASD in learning toothbrushing skills.

Correlates of oral health fatalism in caregivers of children with autism spectrum disorder

AIMS

To study correlates of oral health fatalism (OHF) in caregivers of children with autism spectrum disorder (ASD).

METHODS AND RESULTS

This exploratory analysis used baseline data from 118 Medicaid-eligible families of children with ASD in a multi-site randomized clinical trial of a parent training intervention supporting home oral hygiene and dental visits. About half (46%) of caregivers agreed with the statement "most children eventually develop dental cavities," endorsing OHF. Hispanic caregivers more strongly endorsed OHF than non-Hispanics (cumulative odds ratio = 2.4, 95% confidence interval [CI]: 1.2-4.7, P = .014). Caregivers living alone with children less strongly endorsed OHF than caregivers cohabitating with other adults (cumulative odds ratio = 0.39, 95% CI 0.17-0.86, P = .019). Multivariable analysis maintained significance of ethnicity (P = .030) but not living situation (P = .052). Additional analyses included demographics, parenting beliefs, and children's oral hygiene and oral health status.

CONCLUSION

About half the caregivers endorsed OHF, with Hispanic caregivers more strongly endorsing OHF. OHF was not significantly associated with oral health behaviors or status, consistent with emerging literature suggesting fatalism is not necessarily linked to health behavior. Further exploration of OHF correlates in families of children with ASD is needed; ethnicity, living situation, child age, and caries status are of interest.

Evaluation of visual pedagogy in improving plaque control and gingival inflammation among preschool children with autism spectrum disorder: An interventional study

BACKGROUND

Visual pedagogy (VP) is a behavioural intervention used to facilitate learning among autistic children. Limited studies have evaluated VP when applied to dentistry.

AIM

To evaluate the effectiveness of VP in improving oral hygiene and gingival health status of autistic children.

DESIGN

The interventional study was conducted among 122 autistic preschool children and their parents in Hong Kong. Toothbrushing visual pedagogy (TBVP) was provided to parents for supervising their children with toothbrushing at home. The children's sociodemographic background, developmental profile, and clinical parameters were obtained via parental questionnaire, standardised assessment form, and clinical examination, respectively. The change in plaque and gingival indices over time and potential confounding factors were evaluated with Friedman's two-way analysis of variance and logistic regressions, respectively.

RESULTS

Significantly lower level of plaque and gingival inflammation was found at 3 months and 6 months than baseline. The oral health status of children with poorer baseline oral hygiene status and gingival health was more likely to improve with TBVP. Other developmental and socio-economic backgrounds had insignificant associations on the improvement of these clinical parameters.

CONCLUSION

The findings suggest TBVP is effective in promoting oral hygiene maintenance and improving the periodontal conditions among individuals diagnosed with ASD.

Verhaltensbedingte dentale und orale Befunde bei Menschen mit Autismus-Spektrum-Störung – eine ausgewählte Übersicht

Hintergrund

Charakteristisch für Menschen mit einer Störung aus dem Autismusspektrum (ASS) sind qualitative und quantitative Störungen der Kommunikation und sozialen Interaktion, stereotypes Verhalten und ggf. auch Sonderinteressen.

Ziel der Arbeit

Der vorliegende Artikel blickt auf unterschiedliche ASS-assoziierte Verhaltensmuster und deren Auswirkungen, die sich im Mundraum oder an den Zähnen darstellen.

Ergebnis

Im klinischen Alltag wird vermehrt ein Zusammenhang zum Mundraum festgestellt. Konkret sind Aspekte der einseitigen Ernährungsgewohnheiten, der Selbststimulation oder Selbstverletzung zu nennen, die einen Einfluss auf die Entstehung oraler und dentaler Erkrankungen wie Karies, Gingivitis haben können.

Diskussion

Mittel- und langfristig können sich abnorme, repetitive Verhaltensweisen in dentalen oder oralen Erkrankungen manifestieren. Der dadurch verursachte Krankheitswert kann letztlich die Lebensqualität der Person und des sozialen Umfelds negativ beeinflussen.

Schlussfolgerung

Folglich ist es wichtig zu wissen, dass eine orale Beteiligung einer individuellen Verhaltensauffälligkeit bei einem Menschen mit einer ASS häufig gegeben ist. Im klinischen Alltag der Kinder- und Jugendmedizin ist dieses Wissen für Diagnose und Therapie, aber auch für die interdisziplinäre Zusammenarbeit mit dem (Kinder‑)Zahnarzt hilfreich.

Restoration of an Upper Anterior Tooth in an Adolescent with Autism Spectrum Disorder-A Student Case Report

BACKGROUND

Patients with autism spectrum disorder (ASD) or other mental or physical limitations experience an imbalance in the frequency of dental treatment as compared with the general patient population, in part, due to inadequate pre-graduate training of future dentists.

CASE PRESENTATION

This case report describes a successful anterior tooth restoration, in awake state, in a 15-year-old boy with early childhood autism. The procedure was carried out independently by students of dentistry within the scope of their integrated clinical training semesters. Desensitization sessions were used as a preparatory measure and elements of behavioral facilitation (tell-show-feel-feel-do) were applied during the treatment.

CONCLUSIONS

To avoid discrimination of this group of patients in the provision and quality of dental care, a structured approach to the transfer of theoretical and practical knowledge in the field of special care dentistry is indispensable. To this end, treatment strategies for special care patients should be taught to pre-graduate dental students as a fundamental part of their university curriculum.

Barriers to Professional Dental Care among Children with Autism Spectrum Disorder

Aims were to: (1) investigate the parental difficulties toward their ASD children dental care and, (2) analyze factors influencing their access to such services. Questionnaires were completed by 142 mothers of ASD children. Children aged between 2.5 and 14 years old, with 3.9:1 male to female ratio. 68.3% perceived difficulties in finding dental care. Most barriers were: Cost (75.4%), finding a dentist to treat ASD child (74.6%), and behavior of their ASD child (45.1%). There was no difference among age and "difficulty finding dental care" (p = 0.429). Having medical insurance and previous bad experience showed significant effects on the difficulty in finding dental care (p < 0.05). Children with ASD and their parents encounter various barriers to dental services.

Oral Health Status of Chinese Children With Autism Spectrum Disorders

OBJECTIVES

To assess and compare the oral health status of children with and without autism spectrum disorders (ASD) in China.

METHODS

This study recruited 144 children with ASD and 228 unrelated children with typical development (TD) aged 3-16 years from China. Data were collected using parent-reported questionnaires. Oral problems (oral symptoms and habits), oral health measures (oral hygiene practice and dental care experience), and the impact on the child's quality of life (based on a modified version of the Parental-Caregiver Perception Questionnaire) were assessed and compared between the two groups.

RESULTS

Children with ASD had worse oral health status than children with TD. Oral symptoms were more prevalent in the ASD group, especially halitosis (p < 0.001), food impaction (p < 0.001), and oral lesions (p < 0.001), than the TD group. The rate of damaging oral habits, including mouth breathing (p < 0.001) and object biting (p < 0.05), was also high in the ASD group. Compared with the TD group, more children with ASD did not brush their teeth independently and frequently (p < 0.001), had difficulty accessing dental care (p < 0.01), and reported unpleasant dental experiences (p < 0.001). The presence of ASD was associated with decreased oral health-related quality of life (p < 0.001) in these children and their families.

CONCLUSION

Oral problems such as halitosis and bad oral habits are more prevalent among children with ASD. These children also lack oral hygiene practice and dental visits. This situation negatively impacts their quality of life, and must be brought to the attention of their treating dentists.