Applied behavior analysis

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.

Oral Healthcare Practices and Awareness among the Parents of Autism Spectrum Disorder Children: A Multi-Center Study

This study aimed to evaluate the knowledge and attitudes of the parents of autistic children toward oral health and the practice of oral hygiene habits. A questionnaire was constructed, validated, and distributed to the parents of autistic children at different autistic centers. The questionnaire was divided into three parts: demographic information on the parents of autistic children, the knowledge and attitudes of parents toward oral health, and the practice of oral hygiene habits in the current population. A total of 206 responses were collected. Irrespective of the parents' educational and employment statuses, most second children were diagnosed with autism, and most of the parents have four or more children. In terms of knowledge and attitudes toward oral health, a total of 90.30% of the patients were aware of the oral healthcare of their child, and 55.80% of parents take them to the dentist for checkups. Moreover, the response to the practice of oral hygiene habits from the parents was positive, and most of the parents assist in the oral hygiene practices of their autistic children. This study showed that most of the parents appeared to have satisfactory knowledge about oral health practices for autistic children. However, additional studies should also be conducted.

Importance of Desensitization for Autistic Children in Dental Practice

OBJECTIVES

Dental treatment in special needs patients, including children with autism, can be accomplished by reducing the behaviors that can reduce fear, as it has been demonstrated in other studies. The present study aims to examine the influence of the latency time elapsing between desensitization and the real dental situation on facilitating the access of children with autism to dental treatment.

STUDY DESIGN

Nineteen patients with autism, who were aged 3-14 years and attended the Special Education Center in Madrid but were living with their parents at home, were selected for the study. All children in the sample were subjected to a desensitization process before attending the real dental office. Two study groups were established: the latency period between the last desensitization and the real situation was one day for the first group and seven days for the second group. An experimental study was conducted to assess the child's cooperation in the dental chair; the dental examination was divided into several steps and the highest step reached by each child was recorded.

RESULTS

There is a statistical difference in the number of steps reached between the children who received the information just before the examination date and the children who experienced a longer latency period between receiving the information and experiencing the examination.

CONCLUSIONS

We would like to emphasize the importance of providing information in advance when dealing with autistic children; this information should be as close as possible to the real situation. Additionally, we would like to stress the importance of inter-cooperation between parents, educators, and pediatric dentists in order to guarantee adequate oro-dental care for autistic children. Further studies with larger sample sizes and a control group are recommended.

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.

A Scoping Review of the Healthcare and Hygiene Literature for Individuals with Intellectual and Developmental Disabilities

OBJECTIVES

Previous reviews highlight the similarities in teaching healthcare and hygiene routines to individuals with and without intellectual and developmental disabilities. Additionally, similar interventions are used when interfering behaviors occur. Although these routines are topographically distinct, there are enough similarities to suggest effective procedures for one routine may be used to inform another. This scooping review aims to identify effective teaching and intervention procedures for healthcare and hygiene routines specifically for individuals with intellectual and developmental disabilities. We also evaluated the extent to which functional analyses were conducted; a dimension not included in previous reviews.

METHODS

Eligible articles targeted compliance or tolerance within the context of a defined healthcare or hygiene routine as a dependent variable and used an experimental design with a demonstration of experimental control. Articles were identified through PsycINFO, PubMed, and Academic Search Premier databases. Additionally, a hand search of five related journals was conducted. Data were collected on dependent variables, functional analyses, baseline contingencies, teaching procedures, and additional experimental components.

RESULTS

A total of 52 articles met inclusion criteria. Most experiments produced positive outcomes. The findings show all experiments involved a treatment package with multiple components. The most common teaching procedures were graduated exposure and DRA. A lack of functional analyses and social validity was noted.

CONCLUSIONS

Component analyses are needed to identify the most effective and efficient procedures. Pyramidal training to teach medical professionals how to provide preventative pyramidal training should be explored.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s41252-022-00249-7.

Enablers and barriers in dental attendance in Rett syndrome: an international observational study

AIMS

Intellectual and developmental disabilities are heterogeneous in aetiology and presentation, and one cannot make assumptions about the oral health barriers of those with Rett syndrome (RTT) based on findings from generic studies. This study investigated caregivers' perceptions regarding access to dental care for those with (RTT), and associations of dental treatments received by those with RTT with their caregivers' perceived value of oral health and perception of their own as well as their daughter's dental anxiety.

METHODS AND RESULTS

Retrospective observational data of a subset of individuals with confirmed MECP2 mutations in the InterRett database (n = 216) were used to explore caregiver-related factors and their relationships with longitudinal data on dental service utilisation, using negative binomial regression. The main reported barriers to dental care access for individuals with RTT were primarily dentist-related in nature, regardless of dental service history. Those with reported dental nonattendance were of older age. Increasing levels of caregiver-reported dental fear were associated with less frequent dental check-ups or for any appointments for affected individuals.

CONCLUSIONS

Dentist-related barriers and caregiver-reported anxiety may both adversely affect dental attendance for those with RTT. Future research should explore caregivers' beliefs and oral health literacy.

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.

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.

The 100 most-cited papers in dentistry for individuals with neurodevelopmental disorders: Bibliometric profile of scientific research

AIM

To conduct a bibliometric analysis of the top 100 most-cited papers in dentistry for individuals with neurodevelopmental disorders.

METHODS AND RESULTS

A search strategy was constructed and conducted at the Web of Science in the category of "Dentistry, Oral Surgery, and Medicine". The following information was extracted from each paper: title, authorship, year of publication, title of the journal, study subject, study design, age range of sample participants, type of disability, institution, country and continent, number of citations and citation density. Google Scholar and Scopus were used to crosscheck the number of citations of the most-cited papers. The VOSviewer software was used to generate bibliometric network maps. The papers received 4453 citations in Web of Science, ranging from 30 to 106 citations. Most papers were published by the USA (35%), had an observational design (78%) and the main subject was epidemiology (31%). Most studies focused on individuals with Down syndrome (34%) and Autism Spectrum Disorder (18%) and were published in the Journal of Periodontology (10%) and the Pediatric Dentistry Journal (7%).

CONCLUSION

Most of the studies included in this review were characterized as epidemiological studies. Future research should focus on behavior guidance, dental education, and access to dental services.

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.

Prevalence of Malocclusion and Occlusal Traits in Children with Autism Spectrum Disorders

Background

The purpose of this cross-sectional study was to evaluate the prevalence of malocclusion in children with autism spectrum disorders (ASDs) and to determine the most common occlusal traits.

Materials and Methods

The present cross-sectional study was conducted among 7–15 years old children with ASDs and randomly selected healthy children with the same demographic characteristics. Molar relationship, lip incompetence, overbite, overjet, midline deviation, crossbite, and crowding/spacing were recorded. A descriptive analysis was performed for all variables. A comparison of the presence or absence of malocclusion traits between children with and without ASDs was assessed using the chi-square test. Univariate and multivariate logistic regressions were used to calculate odds ratio (OR) and 95% confidence intervals (95% CI) to assay various parameters between autism and non-autism group.

Results

A total of 96 patients were assessed, 47 patients in the ASD group, and 49 in the control (non-ASD) group. The results showed no significant difference between the ASD and control groups in terms of the overall prevalence of malocclusion (P>0.05). However, the prevalence of increased overjet and Class II molar relationship was significantly higher in the ASD group compared to the control group (P=0.03). Patients in the control group showed a higher prevalence of midline deviation (P=0.001).

Conclusion

Despite a higher prevalence of overjet and Class II molar relationship in children with ASDs, the prevalence of malocclusion was not higher in this group of patients.

The development and implementation of a training program for pediatric dentistry residents working with patients diagnosed with ASD in a special needs dental clinic

Oral health care is the most prevalent unmet health care need among all U.S. children age 17 and under in the U.S., and this includes those with special health care needs (SHCN). Children with SHCN experience unique barriers to receiving oral care including challenging behaviors, inadequate insurance coverage, and a lack of trained dentists. Despite the need for specialized training to successfully provide dental care to children with SHCN, few dental programs offer the necessary educational preparation. The Nova Southeastern University College of Dentistry was funded by the Health Resources and Services Administration to prepare pediatric and Advanced Education in General Dentistry (AEGD) dental residents in the care of children, adolescents, and adults with SHCN. The purpose of this paper is to describe the didactic and clinical training program and to provide data on the program's impact.

Individualised MRI training for paediatric neuroimaging: A child-focused approach

Magnetic Resonance Imaging (MRI) in paediatric cohorts is often complicated by reluctance to enter the scanner and head motion-related imaging artefacts. The process is particularly challenging for children with neurodevelopmental disorders where coping with novel task demands in an unfamiliar setting may be more difficult due to symptom-related deficits or distress. These issues often give rise to excessive head motion that can significantly reduce the quality of images acquired, or render data unusable. Here we report an individualised MRI training procedure that enables children with Autism Spectrum Disorders (ASD) to better tolerate the MRI scanner environment based on a child-focused approach and individualised familiarisation strategies, including a pre-visit interview, familiarisation package, and personalised rewards. A medical imaging mobile application was utilised to familiarise participants to multi-sensory aspects of the neuroimaging experience through a variety of themed mini-games and activities. The MRI training procedure was implemented for monozygotic twins (n = 12; 6 twin pairs; age range 7.1–12.9 years) concordant or discordant for ASD. MRI image quality indices were better or comparable to images acquired from a large independent multi-centre ASD cohort. Present findings are promising and suggest that child-focused strategies could improve the quality of paediatric neuroimaging in clinical populations.

Orthodontic Approach to Patients with Autism: A Review

Autism is a complex neurobehavioral disorder that causes problems in thinking, feeling, language, and the ability to communicate with other people. Over the past two decades, there has been a great deal of interest in autism disorder. This problem is recognized worldwide, and various measures are taken both nationally and internationally to improve the lives of affected individuals and families. The oral health care of such patients can be complicated since they cannot express their problems and can show unpredictable behaviors during treatment. The aim of the literature review was to collect information about the general oral health status of patients with autism, the difficulties that may be encountered during treatment, and the precautions that can be taken and the treatment approaches. This article reviews the dental literature from 1943 to the present.

Toothbrushing training programme using an iPad® for children and adolescents with autism

AIM

To improve the oral health of children and teenagers with autism spectrum disorder (ASD) by using an iPad^®-based training programme.

METHODS

Fifty-two children and teenagers with ASD (aged 3-19 years) educated in schools or in care centres participated in this cohort study and followed for 8 months. A training programme for teaching toothbrushing behaviours was proposed to the educational staff. Quotation grids enabled assessment of the programme's efficacy.

RESULTS

Showed an improvement in toothbrushing. The children's autonomy increased and oral care was more easily implemented when steps were taken by the caregivers. Wilcoxon analysis showed significant improvement in each variable related to toothbrushing.

CONCLUSIONS

The iPad^® is an attractive and easy device for people with ASD to use. Its use in a training programme for teaching toothbrushing behaviours was efficient.

Training children with autism spectrum disorder to undergo oral assessment using a digital iPad® application

AIM

To present a training programme for teaching children and adolescents with autism spectrum disorder (ASD), to be compliant with a dental examination.

METHODS

Fifty-two children and adolescents with ASD (age range 3-19 years) with a parent-signed consent form were enrolled. Dental examinations were performed once a month in education centres by a paediatric dentist using a visual activity schedule on an iPad^® that was created with a digital application, çATED. Achievement and anxiety were evaluated using scales and grids every 2 months for 8 months.

RESULTS

Showed an improvement in oral assessment; the children became compliant and less anxious. The percentage of individuals who underwent the entire dental exam process increased over time; it was 25% at the beginning of the study and 65.4% after 8 months. Only 7.7% of the sample was not anxious at the beginning, while 59.6% of the sample was not anxious after 8 months. Wilcoxon analysis also showed significant improvement in the studied variables.

CONCLUSIONS

Training children and adolescents with ASD to undergo dental examination was efficient. The use of the iPad^® is attractive and easy for practitioners and people with ASD.

Comparative Evaluation of the Fracture Resistance of Two Different Fiber-reinforced Composite Restorations with Particulate Filler Composite Restorations

Uncomplicated crown fractures are the most common form of traumatic dental injuries (TDIs) in children affecting their personal and social well-being.

Clinical, Radiological, and Histological Assessment of Magnetic Nanoparticles as Pulpotomy Medicament in Primary Molars

Aim and objectives

Aim of the study was to evaluate the success of magnetic nanoparticles (MNPs) as pulpotomy medicament by clinical, radiologic, and histological assessment in primary molars.

Materials and methods

The sample included 30 primary molars from 25 children aged between 3 and 9 years requiring pulpotomy treatment. Pulpotomy was carried out with MNPs. The teeth were evaluated after a period of 3, 6, and 12 months clinically and with the aid of radiographs. After 1 year, 10 teeth were extracted for histological evaluation under field emission scanning electron microscope (FE-SEM; ZEISS, Model No. Supra 55vp).

Results

Of the samples, 98% showed clinical success rate with absence of pain, swelling, mobility, and abscess formation. After 3 months, 98% radiological success with absence of periodontal ligament widening, root resorption, and inter-radicular radiolucency was noted. Histological examination carried out under FE-SEM revealed a zone of odontoblastic proliferation at the interface between MNPs and odontoblastic layer of pulp and viable pulpal cells from the canal orifice till apical foramen.

Conclusion

Magnetic nanoparticles can be recommended as an effective pulpotomy medicament with hard tissue barrier formation and preservation of vitality of remaining radicular pulp.

How to cite this article: Konyala HR, Mareddy AR, Puppala N, Reddy NV, Mallela MK, Susheela KP. Clinical, Radiological, and Histological Assessment of Magnetic Nanoparticles as Pulpotomy Medicament in Primary Molars. Int J Clin Pediatr Dent 2018;11(4):283-287.

Evaluation of Surgical Options for Supernumerary Teeth in the Anterior Maxilla

Aim

The purpose of this study was to evaluate the surgical options for supernumerary teeth (SNT) in the premaxillary region of children.

Materials and methods

A total of 69 patients with 82 partially or completely formed SNT in the anterior maxillary region were identified over a 3-year period. All selected patients were assessed for the number, location, and family history of SNT, damage to adjacent roots, and associated symptoms. The surgical approaches used for removal were recorded. Postoperative clinical sequelae (loss of vitality, periodontal problems, pain, bleeding, and enanthema) were evaluated.

Results

A total of 43, 30, and 9 SNT were extracted with palatal, buccal, and bicortical approaches respectively. Peri-odontal and vitality assessments revealed no problems in adjacent teeth at 6 months after surgery. Postoperative pain was within acceptable levels in all patients and subsided within 3 to 7 days. Mild postoperative bleeding occurred in eight patients. Enanthema subsided within 10 days in all patients.

Conclusion

Our results suggest that early diagnosis and appropriate surgical treatment of SNT are important to decrease the risk of clinical complications.

How to cite this article: Maddalone M, Rota E, Amosso E, Porcaro G, Mirabelli L. Evaluation of Surgical Options for Supernumerary Teeth in the Anterior Maxilla. Int J Clin Pediatr Dent 2018;11(4):294-298.

[Tools and techniques to improve the oral health of children with autism]

Autism spectrum disorder (ASD) is a life-long heterogeneous psychiatric disorder, characterized by impaired social interaction and communication, and the presence of repetitive and stereotyped behaviors as well as restricted interests. These features have an impact on the oral health of these individuals: high risk of dental caries, poorer periodontal status, and bruxism are often described. Children with ASD often provide limited collaboration with medical procedures, particularly those considered invasive such as dental care. Children with ASD are prone to agitation, self-injury, and emotional dysregulation; they can also present hypersensitivity to sensory input. These features make it difficult for professionals to examine and treat children with ASD; they interfere with dental care and constitute a barrier to it. Most of them are treated under general anesthesia or sedation. Therefore, children with ASD present a challenge for the dental community. Adapted and specific strategies are required to allow individuals with ASD to go beyond the barriers of dental care. Different tools and techniques of evidence-based practice can be considered: visual pedagogy, behavioral approaches, and numeric devices can be used. Pediatricians have a key role in the oral care of children with autism. The aim of this article is to present the oral health associated with ASD, to set out the possible ways to improve oral health, to enable the practitioner to detect problems, to raise awareness, and to help patients and their families in their care pathway.

Foreign Body causing Displacement of Immature Fractured Apical Root Fragment: An Unusual Case Report

Trauma is a common cause of fractured teeth with exposed canals in growing children. These children use foreign bodies like stapler pin, lead pencil, nail, etc., to explore the canal of fractured tooth. Sometimes, these foreign objects may get stuck in the canal, which the children do not reveal to their parents because of fear. These foreign objects may act as a potential source of infection. We herewith present a case of a 12-year-old boy who presented with a stick lodged in the root canal of maxillary right lateral incisor along with the displaced fractured tooth segment at the apex and the associated management. How to cite this article: Moda A, Singla R, Agrawal PM. Foreign Body causing Displacement of Immature Fractured Apical Root Fragment: An Unusual Case Report. Int J Clin Pediatr Dent 2018;11(3):247-249.

Validity and Reliability of the Hindi Version of the Modified Child Perceptions Questionnaire 11 to 14

Introduction

The study was conceived to formulate a tool to evaluate child perceptions related to oral health in 11- to 14-year-olds tailor-made for Indian children in Hindi. The original child perceptions questionnaire (CPQ_11-14) was translated into Hindi and it was tested for validity and reliability.

Materials and methods

The original CPQ_11-14 was translated into Hindi and some questions were rephrased to suit the sociocultural situation in India. The domains of self-esteem and psychological well-being were added to the questionnaire to broaden the scope of parameters to thoroughly assess the impact on child perceptions toward oral health. The English and Hindi versions of the CPQ_11-14 were administered during the first visit to test for validity and the children were recalled after 1 week and administered the Hindi questionnaire again after 1 week to check for reliability.

Results

The results showed significant positive correlation between oral symptoms, decayed, missing and filled teeth (DMFT) functional limitation and malocclusion. The mean functional limitation score was found to be higher in subjects with malocclusion in both the English and Hindi questionnaires. The test-retest samples were evaluated using the paired t-test and showed no significant difference between the first and second administration which suggested good reliability.

Conclusion

The translated and modified Hindi CPQ_11-14 was found to be valid and highly reliable for use in India. The adaptation of the original questionnaire by modifying certain questions to suit the Indian condition was found to be culturally relevant.

How to cite this article: Kumar P, Mandanna DCM, Londhe SM, Sharma M. Validity and Reliability of the Hindi Version of the Modified Child Perceptions Questionnaire 11 to 14. Int J Clin Pediatr Dent 2018;11(4):271-276.

Comparative Evaluation of Effects of Triphala, Garlic Extracts, and Chlorhexidine Mouthwashes on Salivary Streptococcus mutans Counts and Oral Hygiene Status

Aims and objectives

To determine and compare the effect of triphala, chlorhexidine gluconate, and garlic extract mouthwash on salivary Streptococcus mutans count and the oral hygiene status.

Materials and methods

Sixty children aged 9 to 12 years were randomly allocated into the study groups of triphala mouthwash, chlorhexidine mouthwash, garlic extracts mouth-wash, and distilled water mouthwash. Examination included decayed, missing, and filled teeth (dmft)/decayed, missing, filled surface (dmfs) and DMFT/DMFS, plaque index, and S. mutans count on days 1, 15, and 30.

Results

The results were statistically analyzed using Friedman test, Wilcoxon signed rank, repeated-measures analysis of variance (ANOVA), paired t-test, one-way ANOVA, post hoc Tukey’s honestly significant different (HSD), Kruskal–Wallis test, and Mann-Whitney test; all calculations were done by MEDCALC software 14.0.0 version.

Discussion

Streptococcus mutans count had significant reductions using different mouthwashes at 15 days, but the chlorhexidine group showed significant difference from the remaining three groups. Intergroup comparison for plaque index scores of triphala, chlorhexidine, and garlic groups was similar in preventing plaque build-up during the 15 days of mouthwash use.

Conclusion

All the three mouthwashes containing triphala, chlorhexidine gluconate, and garlic were comparably efficient in reducing the salivary S. mutans count as well as in limiting plaque score; however, chlorhexidine was the most effective in this aspect. In comparison of the two natural ingredients, Triphala is more effective in its antimicrobial effect.

How to cite this article: Padiyar B, Marwah N, Gupta S, Padiyar N. Comparative Evaluation of Effects of Triphala, Garlic Extracts, and Chlorhexidine Mouthwashes on Salivary Streptococcus mutans Counts and Oral Hygiene Status. Int J Clin Pediatr Dent 2018;11(4):299-306.

Comparative Evaluation of Mucosal Vibrator with Topical Anesthetic Gel to reduce Pain during Administration of Local Anesthesia in Pediatric Patients: An in vivo Study

Introduction

Usually discomfort and pain are associated with dental work, especially for young patients. Pain control can be achieved by using anesthesia. Sight of injection can terrify any patient and if the patient is a child it is really difficult to convince them for injections. Alternatives to injections have been explored. Pediatric dentists are using anesthesia in the form of jelly and patch. Recently, the concept of mucosal vibration has been put forward to enhance the effectiveness of local anesthesia.

Aim

The aim of the present study was to compare and evaluate the effectiveness of lignocaine jelly and mucosal vibration in reducing pain during administration of local anesthesia in pediatric dental patients.

Materials and methods

Thirty children in the age group 6 to 11 years who required bilateral anesthesia for dental treatment in mandible were selected for this study. Pain was compared using Wilcoxon signed-rank test at the time of injection using Sound, Eye, Motor (SEM) scale as objective criteria and facial pain rating (FPR) scale as subjective criteria after administration of injection by a trained assistant who was blinded to the procedure.

Results

Local anesthetic injection along with mucosal vibration resulted in significantly less pain (p = 0.001) in comparison with the injections without the use of mucosal vibration.

Conclusion

The result shows that mucosal vibration can be used as an effective means to reduce the intensity of pain during local anesthetic injection in dentistry.

How to cite this article: Tandon S, Kalia G, Sharma M, Mathur R, Rathore K, Gandhi M. Comparative Evaluation of Mucosal Vibrator with Topical Anesthetic Gel to reduce Pain during Administration of Local Anesthesia in Pediatric Patients: An in vivo Study. Int J Clin Pediatr Dent 2018;11(4):261-265.

Evaluation of Chemokines in the Gingival Crevicular Fluid of Children with Down Syndrome

AIM

The goal of the study was to detect the presence of macrophage inflammatory protein (MIP)-1α and MIP-1β and to estimate their levels in gingival crevicular fluid (GCF) of children with Down syndrome.

MATERIALS AND METHODS

MIP-1α and MIP-1β levels were estimated in GCF samples of 20 healthy and 20 Down syndrome individuals. Gingival status was assessed by measuring the gingival index (GI), plaque index (PI), clinical attachment level (CAL), and probing pocket depth (PPD).The GCF samples were obtained from the subjects and MIP-1α and MIP-1β levels were quantified by enzyme-linked immunosorbent assay (ELISA).

RESULTS

The mean MIP-1α concentrations in healthy and Down syndrome individuals were 209 and 1411 pg/μL respectively, and MIP-1α levels were 342 and 1404 pg/μL respectively.The levels of MIP-1α and MIP-1β in the GCF of subjects with Down syndrome were significantly higher than in the healthy individual, and statistically significant differences were present among the two groups.

CONCLUSION

The GCF showed dynamic changes according to the severity of periodontal disease, and the levels of MIP-1α and MIP-1β had a strong relationship with clinical parameters. The MIP-1α and MIP-1β can therefore be considered as novel biomarkers in the biological mechanism underlying the patho-genesis of periodontal disease.How to cite this article: Reddy VK, Kommineni NK, Padakandla P, Togaru H, Indupalli JP, Nanga SP. Evaluation of Chemokines in the Gingival Crevicular Fluid of Children with Down Syndrome. Int J Clin Pediatr Dent 2018;11(4):288-293.

Use of "Surface Analyzer" to evaluate the Effect of Two Polishing Systems on Surface Texture of Four Newer Composites

Composites polymerized with a clear matrix on the surface will leave a resin-rich surface layer that is easily abraded in the oral environment, exposing unpolished, rough, inorganic filler material. The purpose of this study was to evaluate the polishing effect of two different polishing systems: One-step (PoGo) system and Sof-Lex (multistep) system on four different resin composites: Synergy D6, Clearfil APX Esthetics, Filtek Z 350 XT, Ceram X Mono. After polishing, the specimens were analyzed for average surface roughness using a two-dimensional surface profilometer. How to cite this article: Garg S, Goel M, Verma S, Mahajan N, Kaul B, Garg V. Use of "Surface Analyzer" to evaluate the Effect of Two Polishing Systems on Surface Texture of Four Newer Composites. Int J Clin Pediatr Dent 2018;11(4):266-270.

Pedodontic Considerations in a Child with Attention Deficit Hyperactivity Disorder: Literature Review and a Case Report

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder, characterized by extremely short attention span, impulsivity with resultant behavioral problems. They are prone to trauma and frequent dental injuries. The behavioral issues, cognitive deficits, and short attention span pose a challenge to the dental health team. Management of these children requires several modifications in approach at all levels of prevention and treatment. This study reviews all the pertinent oral health issues in these children and also presents the case report of a 14-year-old boy diagnosed with ADHD.

How to cite this article: Sinha S, Praveen P, Rani SP, Anantharaj A. Pedodontic Considerations in a Child with Attention Deficit Hyperactivity Disorder: Literature Review and a Case Report. Int J Clin Pediatr Dent 2018;11(3):254-259.

Association between Obesity and Oral Health Status in Schoolchildren: A Survey in Five Districts of West Bengal, India

Introduction

Childhood obesity, dental caries, and periodontal disease are major public health problems due to their adverse impact on the growth and development of children. Obesity and oral health are associated as both share some common risk factors.

Aim

The specific aim of the study was to determine the correlation, if there is any, between obesity and oral health in children.

Materials and methods

A cross-sectional survey was conducted in five districts of West Bengal, India. A total of 1,227 school-going children of 6 to 12 years were examined from the districts of Howrah, Hooghly, West Midnapore, South 24-parganas, and North 24-parganas. Following indices were analyzed: Decayed-missing-filled teeth (DMFT), decayed, extracted, filled teeth (deft), simplified oral hygiene index (OHI-S). Depending on their nutritional status, subjects were categorized as being normal weight, overweight, and obese. Logistic regression analysis were applied to the study to find out the association between the above-mentioned dental indices and independent variables: Gender and nutritional status.

Result

A positive association was found between obesity and oral health status in children.

Conclusion

Considering the results of this study, it was concluded that obesity is related to oral hygiene status of children. In order to improve oral hygiene status in children, dietary modifications need to be done.

How to cite this article: Halder S, Kaul R, Angrish P, Saha S, Bhattacharya B, Mitra M. Association between Obesity and Oral Health Status in Schoolchildren: A Survey in Five Districts of West Bengal, India. Int J Clin Pediatr Dent 2018;11(3):233-237.

Nonsyndromic Gingival Fibromatosis: A Rare Case Report

Hereditary gingival fibromatosis (HGF) is an uncommon gingival disease of attached gingiva, which is manifested as localized or generalized form. The HGF inheritance is transmitted through both autosomal dominant and recessive modes. Here, we are discussing a rare case report of an 8-year-old child with gingival fibromatosis in mixed dentition, which caused damage to his speech, mastication, and esthetics and led to significant change in his facial profile.

The patient noticed that the gingival enlargement was simultaneous with deciduous dentition eruption and gradually covered entire dentition. Gingival enlargement covered all teeth anteriorly and posteriorly and only occlusal surfaces were visible. The enlarged tissue was resected by the external bevel gingivectomy under general anesthesia arch wise.

The postoperative healing was satisfactory, uneventful, and there was significant change in patient’s esthetics. Patient has been kept on regular recall visits.

How to cite this article: Gandhi M, Tandon S, Sharma M, Vijay A. Nonsyndromic Gingival Fibromatosis: A Rare Case Report. Int J Clin Pediatr Dent 2018;11(3):250-253.

Body Mass Index and Dental Caries: A Systematic Review

Introduction

This review was undertaken to analyze the relationship between body mass index (BMI) and dental caries with the available literature evidence.

Materials and methods

The articles were searched from Medline/PubMed and Journal of Web published between 2005 and 2016.

Results

Out of the 146 references obtained, 16 articles in English language were read in full, which fulfilled the inclusion criteria after assessing by Down and Black criteria.

Conclusion

No consensus was reached in the relationship between BMI and dental caries in the present review due to varied associations

How to cite this article: Shivakumar S, Srivastava A, Shivakumar GC. Body Mass Index and Dental Caries: A Systematic Review. Int J Clin Pediatr Dent 2018;11(3):228-232.

Squamous Papilloma on Hard Palate: Case Report and Literature Review

Most of the lesions in the oral cavity have papillary appearance. Oral squamous papilloma (SP) is one such type, which is a benign proliferation of the stratified squamous epithelium and presents as papillary or verrucous exophytic mass induced by human papillomavirus (HPV). Most of the oral mucosal lesions are often asymptomatic and have small progression. The common sites of occurrence include tongue, soft palate, and uvula. Squamous papilloma arising on hard palate is described in this article. Surgical excision of the lesion was done and sent for histopathological analyses that confirmed the clinical diagnosis. In larynx and trachea, malignant transformation of papillomas has been reported. The potentially malignant nature of SP if present needs to be explored. How to cite this article: Chaitanya P, Martha S, Punithvathy R, Reddy M. Squamous Papilloma on Hard Palate: Case Report and Literature Review. Int J Clin Pediatr Dent 2018;11(3):244-246.

[Teaching tooth brushing to children with autistic spectrum disorder : A tablet-based training programme.]

OBJECTIVE

The primary objective of this exploratory study was to evaluate the short-term (four months) impact of a tooth brushing learning programme based on pictograms generated by the çATED app for iPad designed for patients with autistic spectrum disorder (ASD).

METHODS

Fifty-two ASD patients, between the ages of 3 and 19 years, from seven educational centres, were included. A tooth brushing training programme was proposed in collaboration with the educational teams. Observation grids were used to evaluate autonomy during tooth brushing and interaction with the iPad.

RESULTS

The results showed improvement of tooth brushing. The children progressively acquired the various brushing skills, although some steps remained difficult to perform. Interactions with the iPad also improved during the programme, encouraging the use of this tool in learning of tooth brushing.

CONCLUSIONS

Daily assistance of the children improved the efficacy of tooth brushing, contributing to the preventive care of these patients. The use of an iPad in oral hygiene, especially for learning of tooth brushing, is simple and effective.

Prevalence and Risk Factors for Dental Caries among Preschool Children: A Cross-sectional Study in Eastern India

INTRODUCTION

Dental caries is one of the major widespread health issues that continue to negatively affect the oral health of children globally.

AIM

To estimate the prevalence of dental caries and its risk factors among preschool children of Bhubaneswar, Odisha, India.

MATERIALS AND METHODS

The study was a community-based cross-sectional one among preschool children with (N = 425) participants recruited from the Anganwadi centers (AWCs) of Bhubaneswar, Odisha, India. By using a cross-sectional study design, dental caries was assessed using the World Health Organization (WHO) guidelines, and other socioeconomic and risk factors data were collected through parental interview using questionnaires. Caries was identified at both tooth and surface levels through visual dental examinations by trained and calibrated dentists. Logistic regression analyses were used to identify associations among variables and caries.

RESULTS

The proportion of preschool children suffering from dental caries was found to be 47.29%. The multivariable-adjusted model depicted that longer duration of breastfeeding was a significant predictor as follows: Those who had breastfed for more than 36 months [adjusted odds ratio (AOR): 5.41; 95% confidence interval (CI): 2.97-9.85; p = 0.001], 12 to 24 months (AOR: 2.1; 95% CI: 1.04-4.36; p = 0.037), followed by increase in age 61 to 72 months (AOR: 5.39; 95% CI: 2.72-10.67; p = 0.001), 49 to 60 months (AOR: 2.53; 95% CI: 1.41-4.52; p = 0.002), more than two children in the family (AOR: 2.70; 95% CI: 1.55-4.69; p = 0.001), and children who did not brush the teeth under the parent's supervision (AOR: 2.70; 95% CI: 1.55-4.69; p = 0.001).

CONCLUSION

The study highlights the need to increase awareness about the oral health and hygiene among parents of preschool children in India.How to cite this article: Chugh VK, Sahu KK, Chugh A. Prevalence and Risk Factors for Dental Caries among Preschool Children: A Cross-sectional Study in Eastern India. Int J Clin Pediatr Dent 2018;11(3):238-243.

Management of Autistic Patients in Dental Office: A Clinical Update

Autism is an intellectual developmental disorder characterized by insidious disability in communication, social interaction, and using language and abstract concepts. This organic disorder is known to have deformities in brain, i.e., cerebellum and limbic system, showing wide spectrum of systemic and behavioral symptoms. The oral health care of such patients can be complicated as they cannot verbalize complaints about any dental problems they may be experiencing and can display a variety of behaviors and reactions to small changes also. This study summarizes etiology and diagnosis of this disorder with the special emphasis on the issues encountered while coping with children with autistic spectrum. How to cite this article: Chandrashekhar S, Bommangoudar JS. Management of Autistic Patients in Dental Office: A Clinical Update. Int J Clin Pediatr Dent 2018;11(3):219-227.

Children With Autism Spectrum Disorders can be Successfully Examined Using Dental Desensitization

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Predicting successful dental examinations for children with autism spectrum disorder in the context of a dental desensitization program. Nelson T, Chim A, Sheller BL, McKinney CM, Scott JM. J Am Dent Assoc 2017; 148(7): 485-92.

SOURCE OF FUNDING

Not available TYPE OF STUDY: Cohort study.

Evaluation of Visual Pedagogy in Dental Check-ups and Preventive Practices Among 6-12-Year-Old Children with Autism

This study was aimed to evaluate the impact of visual pedagogy in dental check-ups and preventive practices among children with autism aged 6-12. In this randomized double-blind clinical trial, the cooperation of 40 children with autism age 6-12. The selected children were equally divided into two groups of case and control (n = 20). The obtained data were analyzed by statistical tests, including Chi square and independent t test. The results of Cochran showed a significant increase in children's cooperation with regard to fluoride therapy in the case group by repeating the visit and training sessions (p ≤ 0.001). The findings of this study demonstrated, visual pedagogy was merely effective in the case of fluoride therapy in the case group.

Extraction Orthodontic Treatment in an Autistic Patient

Autism is a condition that restricts brain development. Early diagnostic criteria are as follows: less responsive to social stimuli, inability to develop natural speaking skills, lack of communication skills, and limited and repetitive behaviors. Orthodontic treatment is a challenging process for doctors in autistic patients. The clinical and cephalometric examination of a 17-year and 7-month-old autistic patient revealed class I malocclusion, increased vertical dimensions, proclined upper and lower incisors, and inconsistent lip closure. The treatment plan involved four premolar extractions from each quadrant. Upper and lower 1. premolar extraction with fixed treatment caused reduction in vertical dimensions and significant improvement in lip closure and incisor inclination. Due to the increased metabolic activity in these patients, treatment was completed in 13 months. As a result, autistic patients can be successfully treated. In this process, it is important to include communication as a major part of treatment.

Visual Schedule System in Dental Care for Patients with Autism: A Pilot Study

OBJECTIVES

A pilot study to test whether a visual schedule system using picture communication symbols can help children with autism have successful routine dental cleaning visits.

STUDY DESIGN

14 boys with autism between three- to eight-years-old presented to the dental clinic for four weekly consecutive dental appointments. Patients were randomly assigned to either the control group who received the tell-show-do method (i.e., standard of care), or the test group who received the tell-show-do method plus the visual schedule system.

RESULTS

Patients in the test group completed an average of 1.38 more steps, at 35.52 seconds per step faster, and with 18.7% lower levels of behavioral distress than those in the control group.

CONCLUSION

The use of a visual schedule system, along with repeated weekly visits, showed some promise in helping children with autism successfully complete more steps, progress at a quicker rate, and exhibit lower levels of behavioral distress within a dental appointment, compared to a traditional tell-show-do approach.

Beyond the drugs: nonpharmacologic strategies to optimize procedural care in children

PURPOSE OF REVIEW

Painful and/or stressful medical procedures mean a substantial burden for sick children. There is good evidence that procedural comfort can be optimized by a comprehensive comfort-directed policy containing the triad of nonpharmacological strategies (NPS) in all cases, timely or preventive procedural analgesia if pain is an issue, and procedural sedation.

RECENT FINDINGS

Based both on well-established theoretical frameworks as well as an increasing body of scientific evidence NPS need to be regarded an inextricable part of procedural comfort care.

SUMMARY

Procedural comfort care must always start with a child-friendly, nonthreatening environment in which well-being, confidence, and self-efficacy are optimized and maintained. This requires a reconsideration of the medical spaces where we provide care, reduction of sensory stimulation, normalized professional behavior, optimal logistics, and coordination and comfort-directed and age-appropriate verbal and nonverbal expression by professionals. Next, age-appropriate distraction techniques and/or hypnosis should be readily available. NPS are useful for all types of medical and dental procedures and should always precede and accompany procedural sedation. NPS should be embedded into a family-centered, care-directed policy as it has been shown that family-centered care can lead to safer, more personalized, and effective care, improved healthcare experiences and patient outcomes, and more responsive organizations.

Methods for acquiring MRI data in children with autism spectrum disorder and intellectual impairment without the use of sedation

BACKGROUND

Magnetic resonance imaging (MRI) has been widely used in studies evaluating the neuropathology of autism spectrum disorder (ASD). Studies are often limited, however, to higher functioning individuals with ASD. MRI studies of individuals with ASD and comorbid intellectual disability (ID) are lacking, due in part to the challenges of acquiring images without the use of sedation.

METHODS

Utilizing principles of applied behavior analysis (ABA), we developed a protocol for acquiring structural MRI scans in school-aged children with ASD and intellectual impairment. Board certified behavior analysts worked closely with each child and their parent(s), utilizing behavior change techniques such as pairing, shaping, desensitization, and positive reinforcement, through a series of mock scanner visits to prepare the child for the MRI scan. An objective, quantitative assessment of motion artifact in T1- and diffusion-weighted scans was implemented to ensure that high-quality images were acquired.

RESULTS

The sample consisted of 17 children with ASD who are participants in the UC Davis Autism Phenome Project, a longitudinal MRI study aimed at evaluating brain developmental trajectories from early to middle childhood. At the time of their initial scan (2-3.5 years), all 17 children had a diagnosis of ASD and development quotient (DQ) <70. At the time of the current scan (9-13 years), 13 participants continued to have IQs in the range of ID (mean IQ = 54.1, sd = 12.1), and four participants had IQs in the normal range (mean = 102.2, sd = 7.5). The success rate in acquiring T1-weighted images that met quality assurance for acceptable motion artifact was 100 %. The success rate for acquiring high-quality diffusion-weighted images was 94 %.

CONCLUSIONS

By using principles of ABA in a research MRI setting, it is feasible to acquire high-quality images in school-aged children with ASD and intellectual impairment without the use of sedation. This is especially critical to ensure that ongoing longitudinal studies of brain development can extend from infancy and early childhood into middle childhood in children with ASD at all levels of functioning, including those with comorbid ID.

Dental care protocol based on visual supports for children with autism spectrum disorders

Background

Subjects with Autism Spectrum Disorders (ASDs) have often difficulties to accept dental treatments. The aim of this study is to propose a dental care protocol based on visual supports to facilitate children with ASDs to undergo to oral examination and treatments.

Material and Methods

83 children (age range 6-12 years) with a signed consent form were enrolled; intellectual level, verbal fluency and cooperation grade were evaluated. Children were introduced into a four stages path in order to undergo: an oral examination (stage 1), a professional oral hygiene session (stage 2), sealants (stage 3), and, if necessary, a restorative treatment (stage 4). Each stage came after a visual training, performed by a psychologist (stage 1) and by parents at home (stages 2, 3 and 4). Association between acceptance rates at each stage and gender, intellectual level, verbal fluency and cooperation grade was tested with chi-square test if appropriate.

Results

Seventy-seven (92.8%) subjects overcame both stage 1 and 2. Six (7.2%) refused stage 3 and among the 44 subjects who need restorative treatments, only three refused it. The acceptance rate at each stage was statistically significant associated to the verbal fluency (p=0.02; p=0.04; p=0.01, respectively for stage 1, 3 and 4). In stage 2 all subjects accepted to move to the next stage. The verbal/intellectual/cooperation dummy variable was statistically associated to the acceptance rate (p<0.01).

Conclusions

The use of visual supports has shown to be able to facilitate children with ASDs to undergo dental treatments even in non-verbal children with a low intellectual level, underlining that behavioural approach should be used as the first strategy to treat patients with ASDs in dental setting.

Key words:Autism spectrum disorders, behaviour management, paediatric dentistry, visual learning methods.

Educational and therapeutic behavioral approaches to providing dental care for patients with Autism Spectrum Disorder

PURPOSE

Autism Spectrum Disorder (ASD) is a condition which most dentists will encounter in their practices. Contemporary educational and behavioral approaches may facilitate successful dental care.

METHODS

A literature review was conducted for relevant information on dental care for children with ASD.

RESULTS

Educational principles used for children with ASD can be applied in the dental setting. Examples include: parent involvement in identifying strengths, sensitivities, and goal setting; using stories or video modeling in advance of the appointment; dividing dental treatment into sequential components; and modification of the environment to minimize sensory triggers. Patients with ASD are more capable of tolerating procedures that they are familiar with, and therefore should be exposed to new environments and stimuli in small incremental steps.

CONCLUSIONS

By taking time to understand children with ASD as individuals and employing principles of learning, clinicians can provide high quality dental care for the majority of patients with ASD.

Behavioural aspects of patients with Autism Spectrum Disorders (ASD) that affect their dental management

Dental treatment in patients with Autism Spectrum Disorders (ASD) can be complicated due to the presence of behavioral alterations. In this group, there are no specific behavioral profiles that allow dentist to anticipate the attitude that a patient will show during a visit. Thus, behavioral attitudes have been described that vary from total permissiveness and collaboration during even bloody procedures, to the absolute impossibility in conducting a simple oral examination. There is no effective behavioral management technique for all ASD patients. Prior information, such as the type of ASD or the presence of certain concurrent pathologies can help predict the patient’s likely behavior. Therefore, gathering all the information in a preliminary interview with the parents/guardians of the patient is recommended. Knowing these factors will allow individualized behavioral management strategies to be designed and facilitates the planning of dental treatment.

Key words:Dentistry, autism, ASD, behavior management.

Oral health status and behaviours of children with Autism Spectrum Disorder: a case-control study

BACKGROUND

Autism Spectrum Disorder (ASD) is a lifelong neuro-developmental disorder characterized by abnormalities in social interactions and communication and by stereotyped, repetitive activities.

PURPOSE

Assess the oral health status and behaviours of children with ASD.

METHODS

The study included 100 children with ASD and 100 healthy children from Alexandria, Egypt. Data were collected using a questionnaire and clinical examination. Questionnaire assessed socio-demographics, medical history, dental history, oral hygiene, dietary habits, and presence of self-injurious behaviours. Clinical examination assessed behaviour during examination, gingival condition, plaque accumulation, caries, and other oral conditions.

RESULTS

Children with ASD had significantly poorer oral hygiene and gingival condition than healthy children (P < 0.001 for both). No significant differences were found in caries prevalence or experience in primary or permanent dentition. More children with ASD behaved 'negatively' or 'definitely negatively' (37% and 11%) than did healthy controls (11% and 2%) (P < 0.0001). Self-injurious behaviour and bruxism were more practised by children with ASD (32% of children with ASD and 2% of healthy children, P < 0.001). More children with ASD had difficulty in accessing dental care (P = 0.002).

CONCLUSIONS

The oral condition of children with ASD might increase the risk of developing dental diseases. Their behaviour and life factors may complicate provision of services and limit access to dental care. Therefore, individualized oral health education programmes should be implemented for those children.