The Oral health status of children with autism Spectrum disorder in KwaZulu-Nata, South Africa

"We call it Bokoa jwa tlhaloganyo": Setswana parents' perspective on autism spectrum disorder

Introduction

There is a dearth of knowledge in South Africa about the incidence, prevalence, and effect of autism spectrum disorder (ASD). Consequently, national autism data is outdated, and World Health Organization (WHO) prevalence rates are being used.

Methods

This study focused on Ngaka Modiri Molema District to explore the cultural perspective of ASD in the Setswana culture from a parental or caregiver perspective, specifically those who attended the World Health Organization Caregiver Skills Training (WHO-CST) on ASD. This qualitative study used a phenomenological design and purposively sampled 6 out of 12 participants who wererecipients of WHO-CST. Semi-structured interviews, audio recordings, and field notes were used to collect data.

Results

The study found five main themes: understanding autism, indigenous perceptions of ASD, ways of interacting with children living with autism spectrum disorder, creating a friendly environment and symptoms of ASD.

Discussion

It was concluded that there is a lack of knowledge in Setswana culture about what ASD entails, and there are still some superstitious beliefs regarding ASD, resulting in late diagnoses. ASD studies with larger sample sizes, including medical professionals and policymakers, are recommended.

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.

The Unmasking of Autism in South Africa and Nigeria

This review is of interest to researchers, policymakers, and healthcare professionals working in the field of autism in Africa. The review aims to describe autism in sub-Saharan Africa, focusing on South Africa and Nigeria regarding prevalence, incidence, identification, treatment, and attitudes towards autistic children. There are several challenges, such as lack of awareness, limited access to professional support and diagnostic tools, and cultural considerations in establishing the autism prevalence in the African region compared to other parts of the world. Additionally, South Africans and Nigerians exhibit diverse perspectives and attitudes that significantly influence the provision of treatment, including stigma and misconceptions held by healthcare professionals themselves. As a result, it is difficult to determine prevalence in South Africa and Nigeria. However, research has indicated that autism prevalence is rising globally, and in these contexts. Rising prevalence highlights the need to increase access to services, rehabilitation, and provide support to families of children with autism. Furthermore, research has emphasized the inequitable support and access available to families living in low-and high-income households and the need to provide contextually relevant and responsive interventions, education and training, research and policy in these countries.

Barriers to Oral Health Care for Autistic Individuals-A Scoping Review

BACKGROUND

Challenges in providing adequate dental care for individuals with Autism Spectrum Disorder (ASD) are recognised by parents, caregivers, and dental practitioners, leading to a higher prevalence of unaddressed dental needs. This scoping review aims to explore existing research on the obstacles to oral health care as perceived by individuals with ASD, as reported by their parents, caregivers, and dental professionals.

METHODS

Systematic searches were conducted in DOSS, Medline, and PubMed databases using relevant keywords to identify relevant studies. Barriers identified within these studies were then categorised based on themes identified.

RESULTS

The initial search yielded a total of 254 studies. Following the removal of duplicates and screening of titles and abstracts, 47 studies were further assessed against predetermined criteria, ultimately resulting in the inclusion of 16 articles in this scoping review. The identified barriers were grouped into five overarching themes: challenges in accessing appropriate care (n = 8), negative past experiences (n = 5), parental perceptions of the impact of ASD (n = 8), clinician bias (n = 2), and clinician education (n = 7).

CONCLUSIONS

The findings of this review highlight the obstacles faced by individuals with ASD in obtaining routine oral health care. These results underscore the imperative for the development, testing, and implementation of tailored interventions focused on autism, as well as their integration into educational curricula for dental practitioners at various educational levels. This approach aims to enhance the delivery of equitable oral health care to individuals with ASD, starting from undergraduate through to postgraduate dental education.

Components of Oral Health Related to Motor Impairment in Children With Neuropsychiatric Disorders

Introduction Oral health significantly influences functions such as chewing, swallowing, and overall well-being. Children with neuropsychiatric disorders (NPD) often experience compromised oral functions, escalating their risk of malnutrition. Materials and methods Our study, conducted in Varna, Bulgaria, from April to October 2017, aimed to evaluate some components of the oral health of 49 children with NPD and its relation to their motor impairments. In the studied cohort, participants were categorized based on their Gross Motor Function Classification System (GMFCS) scores into two groups: minor limitations (ML), encompassing GMFCS levels 1-3, and gross limitations (GL), which included GMFCS levels 4-5. Comprehensive oral examinations were conducted by a trained dentist. Data analysis utilized the JAMOVI v.2.2.2.0 software with a 0.05 significance threshold. Results Preliminary findings indicate that children with more pronounced motor limitations have poorer oral health compared to their mildly impaired counterparts. A mere 14.3% (n=7) of the children with NPD had recorded dental visits. The data show that 18.2% (n=6) of ML children had at least an annual dental consultation, while only a single child (6.2%) from the GL group had a dental visit, leaving a staggering 93.8% (n=15) without any. Statistical analyses indicate a significant relationship between motor activity (MA) and toothbrushing frequency (r=0.529, p=0.0001), suggesting that children with better MA have improved chances of maintaining oral hygiene. A significant correlation was observed between dental visits and toothbrushing frequency (r=0.371, p=0.0007). Conclusion Given their challenges, children with NPD require increased attention to dental care, emphasizing regular checkups and preventive oral health measures. This study prompts a reevaluation of these care standards.

PREVALENCE OF GINGIVITIS IN CHILDREN WITH AUTISM SPECTRUM DISORDERS (ASD)

OBJECTIVE

The aim: To evaluate and compare the prevalence of gingivitis according to the PMA index in children aged 5 to 6 years in preschool with ASD and without disorders (Kyiv, Ukraine).

PATIENTS AND METHODS

Materials and methods: Oral assessment was conduct on 69 children with ASD and 23 children without ASD aged 5 to 6 years. To determine the periodontal status it was used the papillary-marginal-alveolar index - PMA (according to Schour, Massler, in the modification of Parma).

RESULTS

Results: Children with ASD (18.84%) were 3.7 times less likely to have a clinically healthy periodontium than children without disorders (69.57%). The average PMA index among the main group was 6.8 times higher (15.31 ± 1.49%) than in the control group (2.25. ± 0.73%), but this difference was not statistically confirmed (p> 0.05). The most common pathology of periodontal tissues was chronic catarrhal gingivitis. 49.28% of children in main group with ASD had mild catarrhal gingivitis, while just 30.47% of children in control group without ASD had this pathology. Catarrhal moderate gingivitis was diagnosed in 31.88% of children from main group, symptoms of moderate gingivitis were not detected in the control group without disorders.

CONCLUSION

Conclusions: ASD children 5-6 years old may have major risk of developing such periodontal lesions as mild and moderate gingivitis. Further investigations need to be done to clarify prevalence of other oral pathologies in ASD individuals to understand the effect of the disorder on oral health.

Malocclusion characteristics amongst individuals with autism spectrum disorder: a systematic review and meta-analysis

BACKGROUND

To estimate the prevalence of malocclusion in individuals with autism spectrum disorders (ASD) and to assess the relationship between ASD and malocclusion.

METHODS

We searched electronic databases including PubMed, Scopus, Web of Science, Cochrane, Embase, SciELO LILACS, Proquest, OpenGrey and Google Scholar. There were no language or publication dates restrictions. Two researchers independently performed selection, data extraction and quality assessment. Quality assessment and risk of bias were evaluated through the Newcastle-Ottawa scale and ROBINS-E tool. Meta-analyses using random effect models were used to estimate pooled measures of prevalence of malocclusion characteristics in individuals with ASD and pooled odds ratio (OR) on the relationship between ASD and malocclusion characteristics. Subgroup meta-analyses were conducted according to children and adolescents, history of orthodontic treatment, and occurrence of other syndromes and medical conditions.

RESULTS

Searching identified 5549 papers with 238 were selected for full assessment. Eighteen cross-sectional studies were included according to inclusion criteria. Of them, eleven studies were considered of moderate quality. A judgement of critical risk of bias occurred for thirteen studies. The most prevalent malocclusion characteristics in individuals with ASD were crowding (33%; 95% CI 22 to 44%) and increased maxillary overjet (39%; 95% CI 23 to 54%). Individuals with ASD had higher odds of Angle's Class II (OR 1.92; 95% CI 1.36 to 2.72), Angle's Class III (OR 2.33; 95% CI 1.29 to 4.23), open bite (OR 1.96; 95% CI 1.21 to 3.16), and increased maxillary overjet (OR 1.53; 95% CI 1.06 to 2.21) than individuals without ASD.

CONCLUSIONS

Angle's Class II, Angle's Class III, anterior open bite and increased maxillary overjet were more prevalent in individuals with ASD than those without ASD. Further high-quality studies are needed.

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.

Autism Spectrum Disorders and Malocclusions: Systematic Review and Meta-Analyses

Studies heretofore have shown inconsistent results on the link of ASD to malocclusion. Herein, we aimed to compare the prevalence of malocclusion among children and adolescents with ASD compared with non-ASD healthy counterparts through a systematic review. The electronic search focused on five databases, PubMed, Web of Science, EMBASE, LILACS, and OpenGrey until January 2022, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO No. CRD42022298023). Observational and intervention studies that compared occlusion characteristics of ASD individuals under 18 years old with healthy controls were included. Pairwise random effects meta-analyses of odds ratio (OR) were performed. Methodological quality was assessed by using the Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional studies. A total of thirteen studies were included for qualitative analysis, and seven for quantitative analysis. The results presented a great heterogeneity and moderate risk of bias; thus, it was not possible to state that there is a risk of malocclusion in individuals with ASD. Future studies should be carried out with strict criteria in the choice of samples, control group, and diagnosis of malocclusion in order to meet the necessary requirements for greater methodological quality.

The Development of Psycho-educational Module of Dental Management for Primary Caregivers and Teachers of Autism Children: A Qualitative Study in Special Region of Yogyakarta, Indonesia

BACKGROUND: The prevalence of autism increases globally and in Indonesia. Children with autism experience intellectual, behavioral, and anxiety disorders, including fear of dental care. These children often experience difficulty brushing teeth and are reluctant to visit dental care facilities. The poor oral and dental cleanness in children with autism may increase the risk of dental and oral diseases such as periodontal disease and caries. One preventive effort is providing psycho-education to the child and the people surrounding them (parents or caretaker and teacher). Psycho-education modules should be adequate and based on the client’s needs. AIM: The aim of the study was to explore the contents of the psycho-educational module as a guide for primary caregivers and teachers to prevent dental and oral health problems of the child with autism. METHODS: We conducted a qualitative study using focus group discussions (FGD) and in-depth interviews from 12 November to 26 December 2020. This study involved 11 primary caregivers and 14 teachers of the autism-special school in Yogyakarta, Indonesia. The FGD and in-depth interviews were recorded and verbatim transcripted and were analyzed by thematic content analysis. RESULTS: We found three topics required to maintain the dental and oral health of a child with autism, namely: Management of behavior in autistic children, oral-dental treatment, and nutrition management in dental-oral health in autistic children. Available materials used practical and straightforward language. CONCLUSION: The study findings provide an important information as a new approach contained in the module on maintaining oral health to improve the health status of autistic children.

Children with autism spectrum disorder at a dental appointment: problems, behavioral characteristics, recommendations

Relevance. Dental care is one of the principal unmet health needs of children with autism spectrum disorder (ASD). Based on the available publications, the study discusses the dental profile of a child with autism and the social factors affecting the oral health of such children.

Materials and methods. A search was performed of publications for the 15 years in the Medline database using the terms autism”, behavior management/techniques”, child”, dental care for children with other abilities”, dental education”, dental disease”, pediatric dentistry” to find relevant publications.

Results. In the found publications, the authors most frequently mention poor oral hygiene. However, they disagree regarding the caries occurrence rate in children with ASD. Insufficient specialized training of dentists on interaction with special children may be one of the reasons for the limited access to dental care.

Conclusions. Dental treatment of an autistic child requires a thorough knowledge of comorbidity, relevant behavioral management and customization of treatment protocols according to individual needs. The effectiveness, safety and rationale of the known dental treatment strategies for children with ASD require further study and improvement.

Special care dentistry perception among dentists in Jakarta: An online survey study

Special Care Dentistry (SCD) or Special Needs Dentistry is a branch of dentistry concerned with the oral health of people with a variety of medical conditions or limitations that require more than routine delivery of care. There were reports on oral status of special care patients and special interest group for SCD dentists in Indonesia has existed. However, there was not perception report on SCD amongst dentists in Jakarta. This paper will describe the perception of dentists in Jakarta towards SCD. A cross-sectional questionnaire, translated and cross adapted to Indonesian, was distributed online through Whatsapp to dentists registered in Jakarta late 2019. Quantitative data was analyzed using statistical software for proportion and correlation using Chi-Square test. The questionnaire explored dentists’ perception towards SCD. A total of 250 dentists participated in this study, of them 173 general practitioners and 77 specialist dentists. Most respondents reported that they did not have SCD component during undergraduate dental school and did not provide treatment to patients with special needs in their clinical practice. Most respondents have poor perception of SCD, however, most of the respondents showed motivation and interest towards SCD training. Dentists in Jakarta involved in this study had poor perception of SCD. More efforts should be performed to improve SCD education and awareness.

The Oral Health Inequities between Special Needs Children and Normal Children in Asia: A Systematic Review and Meta-Analysis

This meta-analysis aimed to analyze the oral health inequalities among special needs children during 2004-2019 in Asia to reveal the importance and the needs of establishing integrated and equitable special needs dentistry care system in Indonesia. PubMed, Scopus, Cochrane Library, Web of Science, and Wiley Online Library were systematically searched for full-text observational studies published from 1 January 2004 to 15 January 2020, in English in Asia. Studies that included children under 18 years of age with special needs and compared them to healthy controls were selected. Study quality was assessed using the Joanna Briggs Institute 2017 Critical Appraisal Checklist. Risk of bias was assessed using the ROBINS-E tool. The decayed, missing, and filled permanent teeth (DMFT) index indicated that special needs children who suffer from intellectual disability or autism spectrum disorder had significantly more caries than normal children (p < 0.001). The special needs children who had more caries than normal children lived in countries that had a high average DMFT value among 12 years old children (p < 0.001), and these two variables showed a positive correlation in meta-regression analysis (p < 0.001). Having an integrated and equitable care system and elevating children's oral health are important to maintain special needs children's oral health.

Parental perception of oral health-related quality of life in children with autism. An observational study

Background:

Autism is reportedly the most severe neuropsychiatric disorder affecting children. Autistic subjects can be characterized by impairments in social interactive behavior along with restricted interests and quite frequently, are seen exhibiting repetitive behavior patterns in stereotyped manner. The inability to perform routine tasks can widely impact the oral health and also, the constant care and sense of helplessness might drastically affect quality of life.

Aim:

The aim of the study was to assess the oral health status and perceptions regarding an autistic child's oral health among parents.

Materials and Methods:

Parental perception regarding the quality of life among the afflicted autistic children was done using a self-assessment questionnaire that included eight questions which were replied to in an affirmation or negative answer. 300 parents of autism affected children formed the study participants. Recorded responses were evaluated and percentage of each response was derived. Oral health status was measured by determination of dental caries prevalence and OHI-S index using chair light illumination, mouth mirror, diagnostic probe and a standard WHO periodontal probe. For statistical analysis, the calculations were performed by using the paired t test. Statistical significance, which was fixed at P < 0.05, which is statistically significant.

Results:

Approximately 18.33% of parents showed were aware that oral health can influence general health; 15% did have exhibit awareness. 15% of parents did not consider that primary teeth were important; 59.1% visited any dentist only when suffering from pain; 5% went for an annual dental examination; 15% and 24.6% parents visited dental practitioners at intervals of 3 and 6 months, respectively. 30%, 25% and 51.66% parents considered obtaining consultation and getting treatment from pediatric dentist; general dentist and general physician. 41.6% parents had taken their children for restorations. 52% reported constant stress whereas 48% reported with constant distressed emotions. No significant difference was determined between the parameters. 75% of autistic children suffered from dental caries whereas oral hygiene scores demonstrated high mean value of 4.

Conclusion:

Autism is a severely distressing condition wherein oral health along with general physical health is affected. Since parents are directly involved in upbringing of these individuals, they also subsequently show a reduction in quality of life.

Comparative Evaluation of Oral Health Status in Healthy Children and Children with Autism Spectrum Disorder

Objective Autism spectrum disorder (ASD) is regarded a severe neuropsychiatric disorder. The objective of this study was to compare the status of the oral health between children with and without ASDs.

Methods A total of 95 children (44 with ASD and 51 without ASD) were included. dmft/DMFT (d/D: decay; m/M: missing; f/F: filling; t/T: teeth) scores and plaque data of all participants were recorded. Saliva Streptococcus mutans and lactobacilli load were determined using CRT bacteria.

Results Streptococcus mutans load was >105 CFU in 54.5% of the ASD group and 43.1% in the non-ASD group. Lactobacilli load was >105 CFU in 47.70% of the ASD group and 49.0% in the non-ASD group. There was no statistically significant difference in the S. mutans or lactobacilli loads between the ASD and non-ASD groups. A total of 83.1% of the ASD group had caries, with dmft = 3.25 and DMFT = 5.10. In the non-ASD group, 81.10% of patients had caries, with dmft = 3.10 and DMFT = 4.90; 38.6% of the ASD group and 29.4% of the non-ASD group had no clinical signs of periodontal disease.

Conclusion The examination of the amount of saliva S. mutans and lactobacilli at intervals with these patients will provide quantitative data to evaluate the effectiveness of oral health care.

Oral Health Status of Children with Autism in Central Italy

Children with autism spectrum disorder (ASD) have significantly higher prevalence and caries severity compared to the average population. Knowledge about the oral health indices of children with this mental disorder is key to designing efficient plans of intervention. This paper reports the results of a study on the oral health status of children with ASD in central Italy. This is the first study of this type in Italy. The sample consists of 229 autistic children aged between 5 and 14 years, attending the Unit of Special Needs Policlinico Umberto I in Rome. Each patient received an intraoral examination to investigate decayed, missing, and filled teeth as well as periodontal status. Information on demographic attributes, dietary habits, medical history, and child’s cooperativeness at the first visit was also recorded. Of the participants, 79.26% presented signs of gingivitis and about 90% of them had plaque. Caries prevalence was 66.38%. The average of the total number of decayed, missing, and filled teeth in the permanent and primary dentition was 2.91. Among the factors considered, only dietary habits and the periodontal indices showed statistically significant association with caries prevalence and caries severity. Despite the selection bias, that prevents us to interpret the results presented as epidemiological evidence, our study suggests that children with ASD in central Italy represent a population at risk.