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Evenepoel M, Daniels N, Moerkerke M, Van de Vliet M, Prinsen J, Tuerlinckx E, Steyaert J, Boets B, Alaerts K, Joossens M. Oral microbiota in autistic children: Diagnosis-related differences and associations with clinical characteristics. Brain Behav Immun Health 2024; 38:100801. [PMID: 38882715 PMCID: PMC11180306 DOI: 10.1016/j.bbih.2024.100801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Similar to the gut microbiome, oral microbiome compositions have been suggested to play an important role in the etiology of autism. However, empirical research on how variations in the oral microbiome relate to clinical-behavioral difficulties associated with autism remains sparse. Furthermore, it is largely unknown how potentially confounding lifestyle variables, such as oral health and nutrition, may impact these associations. To fill this gap, the current study examined diagnosis-related differences in oral microbiome composition between 80 school-aged autistic children (8-12 years; 64 boys, 16 girls) versus 40 age-matched typically developing peers (32 boys, 8 girls). In addition, associations with individual differences in social functioning (SRS-2), repetitive behavior (RBS-R) and anxiety (SCARED) were explored, as well as the impact of several lifestyle variables regarding nutrition and oral health. Results provide important indications that the bacterial genera Solobacterium, Stomatobaculum, Ruminococcaceae UCG.014, Tannerella and Campylobacter were significantly more abundant in autistic compared to non-autistic children. Furthermore, the former four bacteria that were significantly more abundant in the autistic children showed significant associations with parent-reported social difficulties, repetitive and restrictive behavior and with parent-reported anxiety-like behavior. Importantly, associations among oral microbiome and quantitative diagnostic characteristics were not significantly driven by differences in lifestyle variables. This exploratory study reveals significant differences in oral microbiome composition between autistic and non-autistic children, even while controlling for potential confounding lifestyle variables. Furthermore, the significant associations with clinical characteristics suggest that individual differences in microbiome composition might be involved in shaping the clinical phenotype of autism. However, these associations warrant further exploration of the oral microbiome's potential beyond the oral cavity and specifically with respect to neuropsychiatric conditions.
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Affiliation(s)
- Margaux Evenepoel
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, Belgium
- Ghent University, Department of Biochemistry and Microbiology, Laboratory of Microbiology, Ghent, Belgium
- KU Leuven, Leuven Autism Research (LAuRes), Leuven, Belgium
| | - Nicky Daniels
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, Belgium
- KU Leuven, Leuven Autism Research (LAuRes), Leuven, Belgium
| | - Matthijs Moerkerke
- KU Leuven, Leuven Autism Research (LAuRes), Leuven, Belgium
- KU Leuven, Department of Neurosciences, Center for Developmental Psychiatry, Leuven, Belgium
| | - Michiel Van de Vliet
- Ghent University, Department of Biochemistry and Microbiology, Laboratory of Microbiology, Ghent, Belgium
| | - Jellina Prinsen
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, Belgium
- KU Leuven, Leuven Autism Research (LAuRes), Leuven, Belgium
| | - Elise Tuerlinckx
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, Belgium
- KU Leuven, Leuven Autism Research (LAuRes), Leuven, Belgium
| | - Jean Steyaert
- KU Leuven, Leuven Autism Research (LAuRes), Leuven, Belgium
- KU Leuven, Department of Neurosciences, Center for Developmental Psychiatry, Leuven, Belgium
| | - Bart Boets
- KU Leuven, Leuven Autism Research (LAuRes), Leuven, Belgium
- KU Leuven, Department of Neurosciences, Center for Developmental Psychiatry, Leuven, Belgium
| | - Kaat Alaerts
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Neurorehabilitation, Leuven, Belgium
- KU Leuven, Leuven Autism Research (LAuRes), Leuven, Belgium
| | - Marie Joossens
- Ghent University, Department of Biochemistry and Microbiology, Laboratory of Microbiology, Ghent, Belgium
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Tao K, Yuan Y, Xie Q, Dong Z. Relationship between human oral microbiome dysbiosis and neuropsychiatric diseases: An updated overview. Behav Brain Res 2024; 471:115111. [PMID: 38871130 DOI: 10.1016/j.bbr.2024.115111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/24/2024] [Accepted: 06/10/2024] [Indexed: 06/15/2024]
Abstract
The role of the gut-brain axis in mental health disorders has been extensively studied. As the oral cavity is the starting point of the digestive tract, the role that the oral microbiota plays in mental health disorders has gained recent attention. Oral microbiota can enter the bloodstream and trigger inflammatory responses or translocate to the brain through the trigeminal nerve or olfactory system. Hence, the concept of the oral microbiota-brain axis has emerged. Several hypotheses have been suggested that the oral microbiota can enter the gastrointestinal tract and affect the gut-brain axis; however, literature describing oral-brain communication remains limited. This review summarizes the characteristics of oral microbiota and its mechanisms associated with mental health disorders. Through a comprehensive examination of the relationship between oral microbiota and various neuropsychiatric diseases, such as anxiety, depression, schizophrenia, autism spectrum disorder, epilepsy, Parkinson's disease, and dementia, this review seeks to identify promising avenues of future research.
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Affiliation(s)
- Kai Tao
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Yanling Yuan
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Qinglian Xie
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China; Department of Outpatient, West China Xiamen Hospital, Sichuan University, Fujian 361022, People's Republic of China.
| | - Zaiquan Dong
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.
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Weitzman C, Nadler C, Blum NJ, Augustyn M. Health Care for Youth With Neurodevelopmental Disabilities: A Consensus Statement. Pediatrics 2024; 153:e2023063809. [PMID: 38596852 DOI: 10.1542/peds.2023-063809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/11/2024] Open
Abstract
Individuals with a neurodevelopmental disability (NDD) face significant health care barriers, disparities in health outcomes, and high rates of foregone and adverse health care experiences. The Supporting Access for Everyone (SAFE) Initiative was developed to establish principles of health care to improve equity for youth with NDDs through an evidence-informed and consensus-derived process. With the Developmental Behavioral Pediatric Research Network, the SAFE cochairs convened a consensus panel composed of diverse professionals, caregivers, and adults with NDDs who contributed their varied expertise related to SAFE care delivery. A 2-day public forum (attended by consensus panel members) was convened where professionals, community advocates, and adults with NDDs and/or caregivers of individuals with NDDs presented research, clinical strategies, and personal experiences. After this, a 2-day consensus conference was held. Using nominal group technique, the panel derived a consensus statement (CS) on SAFE care, an NDD Health Care Bill of Rights, and Transition Considerations. Ten CSs across 5 topical domains were established: (1) training, (2) communication, (3) access and planning, (4) diversity, equity, inclusion, belonging, and anti-ableism, and (5) policy and structural change. Relevant and representative citations were added when available to support the derived statements. The final CS was approved by all consensus panel members and the Developmental Behavioral Pediatric Research Network steering committee. At the heart of this CS is an affirmation that all people are entitled to health care that is accessible, humane, and effective.
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Affiliation(s)
| | - Cy Nadler
- Children's Mercy Kansas City, Kansas City, Missouri
| | - Nathan J Blum
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marilyn Augustyn
- Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, Massachusetts
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Antosh S, Drennan C, Stolfi A, Lawson R, Huntley E, McCullough-Roach R, Hill M, Adelekan T, Vachhrajani S. Use of an adaptive sensory environment in patients with autism spectrum disorder (ASD) in the perioperative environment: a parallel, randomized controlled trial. LANCET REGIONAL HEALTH. AMERICAS 2024; 33:100736. [PMID: 38645550 PMCID: PMC11031801 DOI: 10.1016/j.lana.2024.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/23/2024]
Abstract
Background Patients with autism spectrum disorders (ASD) experience higher rates of perioperative anxiety and are likely to receive premedication. Little is known about nonpharmaceutical interventions which may decrease anxiety. This study aims to evaluate the use of an adaptive sensory environment (ASE) to reduce ASD patient anxiety during the perioperative process. Methods Our feasibility study (ClinicalTrials.govNCT04994613) enrolled 60 patients in two parallel groups randomized to a control (no ASE) or intervention group (ASE). We included all surgical patients aged three to twelve years, with a formal diagnosis of ASD, Asperger's Syndrome, or pervasive developmental disorder not otherwise specified. Preoperative behaviors were recorded by an unblinded nurse utilizing the validated Modified Yale Preoperative Anxiety Scale (mYPAS). The difference in score on the mYPAS was the primary outcome, and an intention-to-treat analysis was employed. A generalized estimating equations model was used to compare mYPAS scores controlling for significant independent variables. Findings 58 patients were analyzed after 1:1 randomization of 30 patients to each group. Groups were balanced except the median number of intraoperative pain medications was significantly lower in the ASE group (1 vs. 3, p = 0.012). Mean (SD) age for all patients was 7.2 (2.9) years, range 2.6-12.7. 72.4% (42/58) were White and all were Non-Hispanic or Latino. 74% were Male (21/30 ASE and 22/28 Control) and 26% were Female (9/30 ASE and 6/28 Control). No differences were found in mYPAS scores between groups at three time periods (43.5 vs. 42, p = 0.88, 47.8 vs. 48.4, p = 0.76, and 36.4 vs. 43.8, p = 0.15, ASE vs. control group, respectively). The ASE group had a significant within-group decrease in mYPAS scores from nursing intake to transition (p = 0.030). Interpretation An ASE did not significantly reduce perioperative anxiety. However, the promising results deserve further investigation. Funding Dayton Children's Hospital Foundation Robert C. Cohn Memorial Research Grant.
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Affiliation(s)
- Sean Antosh
- Department of Anesthesia, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Chelsea Drennan
- Department of Surgery, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Adrienne Stolfi
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Robin Lawson
- Department of Surgery, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Elise Huntley
- Department of Child Life, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Reaundra McCullough-Roach
- Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Hwy., Dayton, OH, 45435, USA
| | - Madelyn Hill
- Department of Surgery, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Tahira Adelekan
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
- Division of Developmental Pediatrics, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
| | - Shobhan Vachhrajani
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
- Department of Surgery, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
- Department of Neurosurgery, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA
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France K, Urquhart O, Ko E, Gomez J, Ryan M, Hernandez M, Gabinskiy M, Corby PM, Wolff MS. A Pilot Study Exploring Caregivers' Experiences Related to the Use of a Smart Toothbrush by Children with Autism Spectrum Disorder. CHILDREN (BASEL, SWITZERLAND) 2024; 11:460. [PMID: 38671677 PMCID: PMC11049656 DOI: 10.3390/children11040460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Research on caregivers for children with intellectual disabilities, particularly those with autism spectrum disorder (ASD), has highlighted several obstacles to achieving better oral health. These include challenges with tolerating oral care, sensory processing differences, uncooperative behaviors, and communication impairments. There is limited understanding of what caregivers would consider "successful assistance" in improving oral health for these children. OBJECTIVES This pilot study aimed to examine caregivers' and user's experiences with a Kids Smart Electric Toothbrush used by children with ASD. METHODS It involved open-ended interviews and questionnaires with caregivers prior to utilization of the toothbrush and after 4 weeks of product use by the child. RESULTS Seventeen children with ASD, aged 5-12, participated. A total of 58.8% of caregivers said their child brushed more often, and all reported brushing at least twice a day by week 4. Caregivers reported that children became more independent while brushing their teeth and achieved better quality brushing. Caregivers' frustration with the brushing process, satisfaction with the device, and need to assist the child with brushing were improved. Caregivers did encounter some technical difficulties with the app. CONCLUSION This study will assist in exploring "smart" toothbrush technologies for oral hygiene in children with ASD.
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Affiliation(s)
- Katherine France
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (K.F.); (P.M.C.)
| | - Olivia Urquhart
- Center for Integrative Global Oral Health, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Eugene Ko
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (K.F.); (P.M.C.)
- Center for Clinical and Translational Research, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Juliana Gomez
- Colgate-Palmolive Company, Piscataway, NJ 08854, USA; (J.G.); (M.R.); (M.H.)
| | - Maria Ryan
- Colgate-Palmolive Company, Piscataway, NJ 08854, USA; (J.G.); (M.R.); (M.H.)
| | - Matilde Hernandez
- Colgate-Palmolive Company, Piscataway, NJ 08854, USA; (J.G.); (M.R.); (M.H.)
| | - Marta Gabinskiy
- Center for Clinical and Translational Research, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Patricia M. Corby
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (K.F.); (P.M.C.)
- Center for Clinical and Translational Research, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Mark S. Wolff
- Center Care for Persons with Disabilities, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Tan BL, Nair R, Duggal MS, Aishworiya R, Tong HJ. Development of oral health resources and a mobile app for caregivers and autistic children through consensus building. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:959-974. [PMID: 37537880 DOI: 10.1177/13623613231188768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
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.
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Affiliation(s)
| | - Rahul Nair
- Radboud University Medical Center, The Netherlands
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Yang R, Zhao R, Chaudry F, Wang T, Brunton P, Khurshid Z, Ratnayake J. Modern sedative agents and techniques used in dentistry for patients with special needs: A review. J Taibah Univ Med Sci 2024; 19:153-163. [PMID: 38047240 PMCID: PMC10692720 DOI: 10.1016/j.jtumed.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/24/2023] [Accepted: 10/18/2023] [Indexed: 12/05/2023] Open
Abstract
According to the World Health Organisation, approximately 1.3 billion people worldwide experience substantial disability due to physical, mental or sensory impairment. People with special needs require special consideration and more time or altered delivery methods when receiving dental treatments. Various factors, such as patients' lack of cooperation, cognitive impairment and complex medical status, may lead dental practitioners to recommend conscious sedation. Several pharmacological agents and administrative routes are available, which achieve varying levels of sedation ranging from minimal to deep. Pre-operative assessment and careful case selection are necessary to determine the appropriate sedative agent, route of administration and level of sedation for each patient. Thus, a thorough understanding of the pharmacokinetics, risks and benefits, and implications of various sedatives available for PSN is essential to achieve the desired clinical outcomes. This review critically presents the considerations associated with the use of various sedative agents for PSN in dentistry. Considerations include patients' pre-anaesthesia medical comorbidities, cardiorespiratory adverse effects and cooperativeness, and the viable alternative treatment modalities.
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Affiliation(s)
- Ruijia Yang
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Rusin Zhao
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Fatima Chaudry
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Tao Wang
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Paul Brunton
- Department of Prosthodontics and Dental Implantology, Curtin University, Bentley, Australia
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa, KSA
| | - Jithendra Ratnayake
- Department of Oral Science, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Castaño Novoa P, Limeres Posse J, García Mato E, Varela Aneiros I, Abeleira Pazos MT, Diz Dios P, Rivas Mundiña B. Dental desensitization by dentists and occupational therapists for autistic adults: A pilot study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:515-519. [PMID: 37272580 DOI: 10.1177/13623613231173757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
LAY ABSTRACT Managing patients with autism in the dental clinic often requires resorting to pharmacological behavioral control techniques, including general anesthesia. References in the literature to desensitization programs are scarce and focus on training children with autism to undergo oral examinations and preventive procedures. This study shows that a dental desensitization program implemented by dentists and occupational therapists could help in performing not only oral examinations but also simple dental therapeutic procedures for a considerable percentage of adults with autism, without using a pharmacological intervention (sedation or general anesthesia).
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Jones J, Roberts E, Cockrell D, Higgins D, Sharma D. Barriers to Oral Health Care for Autistic Individuals-A Scoping Review. Healthcare (Basel) 2024; 12:103. [PMID: 38201009 PMCID: PMC10779209 DOI: 10.3390/healthcare12010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/23/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
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.
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Affiliation(s)
- Jayne Jones
- Discipline of Oral Health, Oral Health School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, NSW 2258, Australia; (J.J.); (D.C.); (D.H.)
| | - Elysa Roberts
- Discipline of Occupational Therapy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Deborah Cockrell
- Discipline of Oral Health, Oral Health School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, NSW 2258, Australia; (J.J.); (D.C.); (D.H.)
| | - Denise Higgins
- Discipline of Oral Health, Oral Health School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, NSW 2258, Australia; (J.J.); (D.C.); (D.H.)
| | - Dileep Sharma
- Discipline of Oral Health, Oral Health School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, NSW 2258, Australia; (J.J.); (D.C.); (D.H.)
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Reynolds K, Chimoriya R, Chandio N, Tracey D, Pradhan A, Fahey P, Stormon N, Arora A. Effectiveness of sensory adaptive dental environments to reduce psychophysiology responses of dental anxiety and support positive behaviours in children and young adults with intellectual and developmental disabilities: a systematic review and meta-analyses. BMC Oral Health 2023; 23:769. [PMID: 37858057 PMCID: PMC10585952 DOI: 10.1186/s12903-023-03445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND People with Intellectual and developmental disabilities (IDDs) experience oral health inequality due to myriad of risk factors and complex needs. Sensory processing difficulties, maladaptive behaviours and dental anxiety contribute to difficulties in receiving preventive and routine dental treatments. This study aimed to systematically review the evidence on the effectiveness of sensory adaptive dental environments (SADE) for children and young adults (up to the ages 24 years) with IDD to address cooperation and dental anxiety. METHODS This review was reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE (Ovid), The Cochrane Library, Embase, Google Scholar, Web of Science and OT Seeker were searched using appropriate terms to identify Randomised Control Trails (RCTs) that matched inclusion criteria. Screening was conducted by two reviewers after de-duplication based on titles and abstracts followed by full text retrieval. Quality of the included studies was assessed using Cochrane Risk of Bias (ROB)-2 for crossover trials and data extracted by two reviewers. The details of the interventions and effectiveness were compared and discussed narratively, and comparable outcomes were included to meta-analyses using R software. RESULTS A total of 622 articles were identified and five articles met eligibility for inclusion. Three studies used multi-sensory adaptations and one used single sensory adaptation of music. Narrative synthesis showed some evidence of SADE reducing magnitude and duration, although, questionable for reducing the number of maladaptive behaviours. Two studies demonstrated conflicting evidence of the effect of SADE on cooperation. Three studies demonstrated significant positive impact of SADE on psychophysiological outcomes. Despite an overall tendency to favour SADE, no statistically significant difference of maladaptive behaviours was found between SADE and regular dental environment (RDE) (Standardised mean change (SMC) = 0.51; 95% Confidence Interval (CI) -0.20 to 1.22; p = 0.161). SADE was superior to RDE (SMC -0.66; 95% CI -1.01 to -0.30; p = < 0.001) in reducing psychophysiological responses of dental anxiety. CONCLUSION Current evidence suggests that adapting visual, tactile, and auditory aspects of the dental environment in a single or multi-sensory approach demonstrates small positive effects on psychophysiological responses and maladaptive behaviours of dental anxiety for people with IDD. TRIAL REGISTRATION The title of this review was registered with PROSPERO (CRD42022322083).
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Affiliation(s)
- Kaitlyn Reynolds
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
- Health Equity Laboratory, Campbelltown, NSW, 2560, Australia
| | - Ritesh Chimoriya
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
- Health Equity Laboratory, Campbelltown, NSW, 2560, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW, 2144, Australia
| | - Navira Chandio
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
- Health Equity Laboratory, Campbelltown, NSW, 2560, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Danielle Tracey
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia
- Centre for Educational Research, Western Sydney University, Kingswood, NSW, 2747, Australia
| | - Archana Pradhan
- Sydney Dental School, The University of Sydney, Surry Hills, NSW, 2010, Australia
| | - Paul Fahey
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Nicole Stormon
- School of Dentistry, The University of Queensland, Herston, QLD, 4006, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia.
- Health Equity Laboratory, Campbelltown, NSW, 2560, Australia.
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia.
- Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia.
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Salmeh A, Al-Saadi M, AlZaidi N, Al Hamwi N, Jumaah SS, Karimzadeh S, Dhafer T, Al-Rubaiay W, Al-Rawi N. Influence of parental knowledge and attitudes on the oral and dental health status of autistic children: A systematic review. SPECIAL CARE IN DENTISTRY 2023; 43:645-655. [PMID: 36707248 DOI: 10.1111/scd.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/25/2022] [Accepted: 01/05/2023] [Indexed: 01/29/2023]
Abstract
AIMS This paper aims to systematically review the current evidence surrounding the influence of parental knowledge and attitudes on the oral and dental health status of autistic children. METHODS AND RESULTS Data were sourced from EBSCOhost, ProQuest One Academic, Ovid MEDLINE, and Scopus. Additional records were manually identified through other sources. Literature search identified 610 relevant articles for screening, of which nine were ultimately selected for inclusion following full-text review. A custom data collection sheet was constructed by the authors to extract data based on selected parameters addressing the focused research question. Extracted data were combined in an evidence table based on the collection sheet parameters. Study characteristics and findings were then descriptively summarized and compared. Due to heterogenicity, meta-analysis was not viable. While all included cross-sectional studies have predominantly shown no statistically significant association between parental knowledge and oral health, three experimental studies have conversely reported significant oral health improvements following educational interventions; suggesting a strong correlation. CONCLUSION Autistic children are susceptible to oral diseases, necessitating parental attention. Current evidence regarding this topic is limited and conflicting. The present systematic review faces limitations: included studies were few and predominantly cross-sectional. Moreover, study samples were small, predominantly male, conveniently recruited, and geographically limited. This paper serves as a foundation to guide future research and inspire oral health education and wellness promotion programs.
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Affiliation(s)
- Abdulrahman Salmeh
- Department of Oral & Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Meena Al-Saadi
- Department of Oral & Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Nadia AlZaidi
- Department of Oral & Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Noura Al Hamwi
- Department of Oral & Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Sarah Safaa Jumaah
- Department of Oral & Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Shamma Karimzadeh
- Department of Oral & Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Taiba Dhafer
- Department of Oral & Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Ward Al-Rubaiay
- Department of Oral & Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Natheer Al-Rawi
- Department of Oral & Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Myhren L, Pawlowski A, Schwob A, Bull VH. Development and evaluation of an individualised dental habituation programme for children with autism spectrum disorder living in Rogaland, Norway. Eur Arch Paediatr Dent 2023:10.1007/s40368-023-00799-x. [PMID: 37081211 DOI: 10.1007/s40368-023-00799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE To develop and evaluate an individualised habituation programme for children with autism spectrum disorder (ASD) to enhance their cooperation during a routine dental examination. METHODS In collaboration with school personnel, we developed and evaluated a research-based habituation programme comprising a toolbox with aids (pictures, videos, appliances, social stories) for preparations and gradual exposure to a 10-step dental examination. The habituation programme was subjected to a small-scale evaluation involving 17 children with ASD living in Rogaland, Norway. Changes in cooperation were registered using Frankl behaviour rating scale. Further, school personnel were interviewed using semi-structured interviews, and the data obtained were analysed through content analysis. RESULTS Fourteen children (82%) completed the dental examination. Compared to previous accomplishments reported by the caregivers, an increased number of children completed the examination with a mirror and probe and were able to take an X-ray with good compliance following the habituation programme. The registration of cooperation (Frankl score) during each session indicated varying progression rates. Further, changing the dentist did not influence compliance, and most children showed a similar level of cooperation towards the dental examination one year later. Further, school personnel highlighted the need for preparations that could facilitate control and the importance of catering to individual needs. CONCLUSION An individualised approach combining preparations and behavioural methods in close collaboration with school personnel can increase cooperation during a dental examination in children with ASD.
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Affiliation(s)
- L Myhren
- Oral Health Centre of Expertise Rogaland, Torgveien 21 B, 4016, Stavanger, Norway.
| | - A Pawlowski
- Oral Health Centre of Expertise Rogaland, Torgveien 21 B, 4016, Stavanger, Norway
| | - A Schwob
- Oral Health Centre of Expertise Rogaland, Torgveien 21 B, 4016, Stavanger, Norway
| | - V H Bull
- Oral Health Centre of Expertise Rogaland, Torgveien 21 B, 4016, Stavanger, Norway
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13
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Venner S, Erwin J, Witton R, Paisi M. A partnership between occupational therapy and dentistry. Br Dent J 2023; 234:360. [PMID: 36964341 DOI: 10.1038/s41415-023-5700-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/06/2023] [Indexed: 03/26/2023]
Affiliation(s)
| | - J Erwin
- University of Plymouth, Plymouth, UK.
| | - R Witton
- University of Plymouth, Plymouth, UK.
| | - M Paisi
- University of Plymouth, Plymouth, UK.
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Pai Khot AJ, Choudhury AR, Ankola AV, Sankeshwari RM, Hampiholi V, Hebbal M, Jalihal S, Kumar RS, Kabra L, Kotha SL. Evaluation of a "Picture Assisted Illustration Reinforcement" (PAIR) System for Oral Hygiene in Children with Autism: A Double-Blind Randomized Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020369. [PMID: 36832499 PMCID: PMC9955023 DOI: 10.3390/children10020369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
This study evaluated the potential of a novel pre-validated "Picture Assisted Illustration Reinforcement" (PAIR) communication system and conventional verbal techniques for Oral Health Education (OHE) in terms of dentition status, gingival health, oral hygiene status, and practices in 7- to 18-year-old children with Autism Spectrum Disorder (ASD). A double-blind randomized controlled trial was undertaken in a school for children with autism from July to September 2022. A total of 60 children were randomly assigned into two groups: a PAIR group (n = 30) and a Conventional group (n = 30). Cognition and pre-evaluation of all the children were assessed by standardized scaling measures. A pre-validated closed-ended questionnaire was administered to caregivers of both groups. At a 12-week post-intervention, a clinical examination was performed using the World Health Organization (WHO) Oral Health Assessment form 2013, gingival and Oral Hygiene Index Simplified (OHI-S). The gingival scores in the PAIR group (0.35 ± 0.12) exhibited a statistically significant decline in scores as compared to Conventional group (0.83 ± 0.37), p = 0.043. Meanwhile, the oral hygiene scores in the PAIR group and Conventional group were 1.22 ± 0.14 and 1.94 ± 0.15, respectively (p < 0.05). A significant improvement in oral hygiene practices was observed in the PAIR group. Incorporating the PAIR technique resulted in significant progress in child cognitive ability and adaptive behavior, which reduced gingival scores and improved oral hygiene scores, consequently improving oral hygiene practices among children with ASD.
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Affiliation(s)
- Atrey J. Pai Khot
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Abhra Roy Choudhury
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Anil V. Ankola
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Roopali M. Sankeshwari
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Vinuta Hampiholi
- Department of Periodontics, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Mamata Hebbal
- Department of Preventive Dental Sciences, College of Dentistry, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Sagar Jalihal
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Ram Surath Kumar
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Laxmi Kabra
- Department of Public Health Dentistry, KLE VK Institute of Dental Sciences, KLE Academy of Higher Education and Research (KLE University), Belagavi 590010, Karnataka, India
| | - Sree Lalita Kotha
- Department of Basic Dental Sciences, College of Dentistry, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
- Correspondence: ; Tel.: +966-11-8234922
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15
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Positive Healthcare Encounters for Children With Autism Spectrum Disorder: Accommodations During Surgical Procedures. J Perianesth Nurs 2023; 38:6-11. [PMID: 35970662 DOI: 10.1016/j.jopan.2022.05.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/16/2022] [Accepted: 05/13/2022] [Indexed: 01/28/2023]
Abstract
Children with autism spectrum disorder have unique needs during medical procedures involving anesthesia. However, with early patient identification, provider champions can adapt their practice to better serve this population, thereby improving patient satisfaction and outcomes. This article describes a novel protocol developed by an anesthesia resource center to modify care for children with autism spectrum disorder and their families. This information serves as a template for perianesthesia nurses and advanced care providers to implement practice accommodations. Two case examples, based on parent interviews and chart review, are presented to exemplify this protocol.
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Sawicki CM, Pielech M, Wade SD. Practice Patterns Among Dentist Anesthesiologists for Pediatric Patients with Autism Spectrum Disorders. Pediatr Dent 2023; 45:37-53. [PMID: 36879378 PMCID: PMC10262783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
PURPOSE The purpose of this study was to evaluate practice patterns among dentist anesthesiologists for pediatric patients with autism spectrum disorders (ASD) undergoing sedation for dental procedures. METHODS An electronic nationwide survey was delivered to all members of the American Society of Dentist Anesthesiologists. The survey assessed provider training and comfort in treating pediatric patients with ASD, perioperative procedures for children with and without ASD, and preferred educational resources for the perioperative management of pediatric patients with ASD. RESULTS Respondents were 114 dentist anesthesiologists and residents (33.3 percent response rate). Respondents indicated a high comfort level for managing pediatric patients with ASD for sedation (mean equals 91.9±14.74 [SD] percent). The average number of patients with ASD who respondents treat per week was 3.48±2.44). Providers reported making scheduling and staffing accommodations for patients with ASD. More than half of respondents reported no difference between patient groups in medication dosing for sedation and medication regimens used intraoperatively; however, only 43.9 percent of providers indicated using equivalent preoperative medication regimens for both patient groups, and providers reported increased usage of preoperative anxiolytic techniques with patients with ASD. Importantly, 87.7 percent of respondents reported the same incidence of adverse events during the perioperative period between groups. CONCLUSIONS Findings from this survey suggest there are both similarities and differences in how dentist anesthesiologists practice with pediatric patients with and without autism spectrum disorders. Additional research is warranted to measure the clinical benefits of modified practices for patients with ASD and identify best practices for this vulnerable population.
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Affiliation(s)
- Caroline M Sawicki
- Dr. Sawicki is a pediatric dentistry resident and post-doctoral research fellow, Department of Pediatric Dentistry, New York University College of Dentistry, New York, N. Y., USA
| | - Melissa Pielech
- Dr. Pielech is an assistant professor and licensed clinical psychologist, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, and Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, R. I., USA
| | - Spencer D Wade
- Dr. Wade is a clinical assistant professor, Oral Health Center for People with Disabilities, and Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York, N. Y., USA
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Alvares GA, Mekertichian K, Rose F, Vidler S, Whitehouse AJO. Dental care experiences and clinical phenotypes in children on the autism spectrum. SPECIAL CARE IN DENTISTRY 2023; 43:17-28. [PMID: 35654391 DOI: 10.1111/scd.12746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 01/25/2023]
Abstract
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.
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Affiliation(s)
- Gail A Alvares
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Kareen Mekertichian
- Australasian Academy of Paediatric Dentistry, Sydney, New South Wales, Australia
| | - Felicity Rose
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Sally Vidler
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Andrew J O Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
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Como DH, Floríndez-Cox LI, Stein Duker LI, Cermak SA. Oral Health Barriers for African American Caregivers of Autistic Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17067. [PMID: 36554947 PMCID: PMC9779821 DOI: 10.3390/ijerph192417067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
The most persistent oral health disparities in the United States impact children from racial and ethnic minoritized groups and children diagnosed as autistic. This paper aims to describe barriers to oral care as depicted by Black/African American (B/AA) parents of autistic children to further explore how and why oral health disparities persist in this population. A purposeful sample of eleven caregivers of autistic children, ages 4 to 14 years, who identified as B/AA were interviewed twice for approximately 60-90 min each. Thematic analysis utilizing a narrative approach was employed. Three themes emerged from the data concerning the barriers that affect oral health experiences: (a) difficulty in maintaining good oral health practices, (b) challenges with access to care and resources, and (c) poor patient-provider relationships. Due to the limited research that examines the intersection of autism, B/AA culture, and oral health practices, this study provides a rich picture of the barriers families face when obtaining oral care. Many families raised issues that other parents of autistic children also identified. B/AA caregivers have demonstrated that despite their own negative dental experiences, they understand the value of good oral care practices and are willing to pursue oral care for their children.
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Affiliation(s)
- Dominique H. Como
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
| | - Lucía I. Floríndez-Cox
- Nursing Research and Performance Improvement Department, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Leah I. Stein Duker
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
| | - Sharon A. Cermak
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
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Como DH, Floríndez-Cox LI, Stein Duker LI, Polido JC, Jones BP, Lawlor M, Cermak SA. Oral Care Knowledge, Attitudes, and Practices of Black/African American Caregivers of Autistic Children and Non-Autistic Children. CHILDREN 2022; 9:children9091417. [PMID: 36138725 PMCID: PMC9498287 DOI: 10.3390/children9091417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Dominique H. Como
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
- Correspondence:
| | - Lucía I. Floríndez-Cox
- Nursing Research and Performance Improvement Department, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Leah I. Stein Duker
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
| | - Jose C. Polido
- USC Herman Ostrow School of Dentistry, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
- Division of Dentistry, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Brandi P. Jones
- USC Race & Equity Center, University of Southern California, Los Angeles, CA 90089, USA
- Rossier School of Education, University of Southern California, Los Angeles, CA 90089, USA
| | - Mary Lawlor
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
| | - Sharon A. Cermak
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA
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Toothbrushing and Oral Care Activities of Autistic and Non-Autistic Latino Children. CHILDREN 2022; 9:children9050741. [PMID: 35626918 PMCID: PMC9139190 DOI: 10.3390/children9050741] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 12/17/2022]
Abstract
Background: Oral care activities, e.g., toothbrushing, are habitual occupations often considered routine. However, for autistic children, performing these routine dental practices can be challenging due to the child’s sensory sensitivities, unique executive function, and the complicated way in which autistic children conceptualize structure and habits. Limited research exists exploring the nuances of oral care routines in the autistic population, and more knowledge is needed to support targeted education interventions to improve oral care and address health inequities. The purpose of this study was to examine videos of oral care routines in the home to understand how oral care activities, such as toothbrushing, were performed by autistic and non-autistic Latino/a children. Methods: Parents/caregivers from eighteen Latino/a families with children between 6 and 12 years old (n = 10 autistic children and n = 8 non-autistic children) video recorded their child’s oral care routines for three days. The research team blindly coded and analyzed these videos using an oral care observation template to understand how these activities were uniquely performed by the children. Results: Eighty-five oral care videos were analyzed for this study. In addition to noting areas of oral care that can be improved, which included length of brushing and using the correct brushing technique, we identified two themes related to the differences between oral care practices in the autistic and non-autistic children: parent involvement and modifications. Conclusions: Qualitative findings show that parental involvement was documented especially in the case of autistic children, and that two types of modifications, habitual and sensory, were observed that demonstrated parents being aware of the needs of their autistic child and modifying the oral care activity to meet those needs. By synthesizing observations from the oral care videos into suggestions for practitioners working with families, we hope to supplement knowledge about effective oral care practices for autistic and non-autistic Latino/a children, thereby improving overall oral health and reducing oral health inequities in this population.
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Modha B. Utilising dentist-dental health educator skill-mix to implement oral health promotion that better supports diverse communities. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-08-2021-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PurposeDentists may be seen as the most prominent figures within dentistry. Yet, a number of dental care professionals make significant contributions to the profession. The dental health educator (DHE) is one prime example. This teammate is typically a dental nurse who has achieved a post-registration qualification in oral health education (OHE). Through interactions with patients, members of the community and other pertinent stakeholders, the DHE empowers people through promoting the importance of good oral health. The purpose of this paper is to cast light on the unique and invaluable roles that DHEs can play within their organisations.Design/methodology/approachThis paper aims to share some examples of dentist-DHE collaborations, where OHE initiatives were implemented within an ethnically diverse London Borough in England.FindingsIt was found that such interprofessional, skill-mix efforts were more productive, when the dentist and DHE worked together, rather than the latter working independently.Originality/valueThere exists great potential for DHEs to act as ambassadors for their dental establishments, network and collaborate with other organisations and build worthwhile relations with other healthcare professionals and stakeholders.
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Sensory-Adapted Dental Environment for the Treatment of Patients with Autism Spectrum Disorder. CHILDREN 2022; 9:children9030393. [PMID: 35327765 PMCID: PMC8947452 DOI: 10.3390/children9030393] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022]
Abstract
Purpose: The importance of dental care and oral hygiene is often underestimated in people with autism spectrum disorder (ASD). Comorbidity with dental anxiety is greater in ASD subjects who also show unusual reactions to sensory stimuli. The aim of our study was to assess the efficacy for a sensory-adapted environment and targeted methods in reducing anxiety and positively influencing cooperation in children with ASD during a dental examination or specific treatments. Material and methods: The sample consisted of 50 Italian children with a diagnosis of ASD (36 males and 14 females; aged 9–10 years) presenting with mild intellectual disability (ID) and verbal language skills. The subjects enrolled in the study had at least two decayed teeth and all were treated in two different dental environments: regular dental environment (RDE) and sensory-adapted dental environment (SADE). Results: 20% of the sample was successfully treated in RDE, while 68% of subjects were successfully treated in SADE. Conclusions: Results suggest that a sensory-adapted environment positively affects the therapeutic dental treatment in patients with ASD and reaffirm that sensory dysregulation in children with ASD is a crucial factor influencing the successful outcome of oral care.
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AlHumaid J. Dental experiences related to oral care of children with autism spectrum disorders in Saudi Arabia: A literature review. Saudi Dent J 2022; 34:1-10. [PMID: 35068893 PMCID: PMC8767258 DOI: 10.1016/j.sdentj.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
The burden of autism spectrum disorder (ASD) in Saudi Arabia remains unclear with a dearth of literature, which focus on risk factors, prevalence, or interventions. This study is a review of the published literature related to dental experiences of children with ASD in Saudi Arabia. Twenty-two studies were included in this review, based on the predefined inclusion criteria which examined dental disease prevalence in children with ASD, identified the risk factors and the potential barriers to oral care. Results uncovered a lack of systematically published studies from Saudi Arabia which might have led to the limited development of effective oral health policies in the Kingdom. Identification of research gaps and potential intervention policies are needed to improve the oral health and quality of life of children with ASD in Saudi Arabia.
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Park Y, Guzick AG, Schneider SC, Fuselier M, Wood JJ, Kerns CM, Kendall PC, Storch EA. Dental Anxiety in Children With Autism Spectrum Disorder: Understanding Frequency and Associated Variables. Front Psychiatry 2022; 13:838557. [PMID: 35463526 PMCID: PMC9021783 DOI: 10.3389/fpsyt.2022.838557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Dental anxiety seems to be elevated in children with autism spectrum disorder (ASD), and may be associated with feelings of helplessness, loss of control, and sensory overload. Dental anxiety, a primary contributor to dental avoidance, can lead to unwanted long-term oral hygiene consequences. This manuscript characterizes the frequency and correlates of dental anxiety in children with ASD. Specifically, this study examined associations between child-reported dental anxiety and parent-reported autism symptom severity, anxiety symptom severity, sensory sensitivity, and internalizing/externalizing symptom severity. Participants included 76 children without cognitive impairment (age in years M = 9.9, SD = 1.8) who took part in a cognitive behavioral therapy study for children with ASD and co-occurring anxiety disorders. Elevated dental anxiety was found in 68% of participants based on a cut-off score from a dental anxiety measure, with fears related to pain being the most commonly endorsed concern; over half of youth endorsed feeling scared about pinching feelings or having a tooth pulled out at the dentist. No significant correlations between dental anxiety and other variables of interest were found, including overall anxiety severity, ASD symptoms, internalizing and externalizing symptoms, and sensory sensitivities. The findings contextualize the frequency of dental anxiety and its relationship to various variables, which may be useful in tailoring existing treatments to reduce dental anxiety in children with ASD.
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Affiliation(s)
- Ye Park
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Madeleine Fuselier
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Jeffrey J Wood
- Department of Education, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, United States
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
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Erwin J, Paisi M, Witton R, Neill S, Burns L, Vassallo I, Nelder A, Facenfield J, Devalia U, Vassallo T. Factors Influencing Oral Health Behaviours, Access and Provision of Dental Care for Autistic Children and Adolescents in Countries with a Very High Human Development Index: Protocol for a Mixed Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312346. [PMID: 34886072 PMCID: PMC8657110 DOI: 10.3390/ijerph182312346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022]
Abstract
Autistic children and adolescents are at high risk of dental disease and experience oral health inequalities. They consistently show high levels of unmet needs in relation to their oral health and access to dental care. There are no systematic reviews that bring together the evidence on the factors that influence oral hygiene behaviours, and access to and provision of dental care for autistic children and adolescents. A systematic search will be carried out in eight international databases and in grey literature of qualitative, quantitative and mixed method research studies from countries with a High Development Index which relate to oral health behaviours, and access to and provision of dental care. Only studies where participants are autistic children and adolescents aged 19 years or under, parents/guardians/caregivers, support staff, or oral health care providers will be included. Quantitative and qualitative data will be synthesized together through data transformation using a convergent integrated approach. Thematic synthesis will be used to carry out an inductive analysis of the data. The findings from the systematic review which this protocol generates will be used in the development of an appropriate local clinic care pathway for autistic children/adolescents and to inform national policies and practices. Prospero registration: CRD 42021248764.
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Affiliation(s)
- Jo Erwin
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (M.P.); (R.W.); (L.B.)
- Correspondence:
| | - Martha Paisi
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (M.P.); (R.W.); (L.B.)
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
- Peninsula Dental Social Enterprise, Plymouth Science Park, Research Way, Plymouth PL6 8BT, UK; (A.N.); (J.F.)
| | - Robert Witton
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (M.P.); (R.W.); (L.B.)
- Peninsula Dental Social Enterprise, Plymouth Science Park, Research Way, Plymouth PL6 8BT, UK; (A.N.); (J.F.)
| | - Sarah Neill
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
| | - Lorna Burns
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK; (M.P.); (R.W.); (L.B.)
| | - Isaac Vassallo
- School of Engineering, Computing and Mathematics, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
| | - Abigail Nelder
- Peninsula Dental Social Enterprise, Plymouth Science Park, Research Way, Plymouth PL6 8BT, UK; (A.N.); (J.F.)
| | - Jemma Facenfield
- Peninsula Dental Social Enterprise, Plymouth Science Park, Research Way, Plymouth PL6 8BT, UK; (A.N.); (J.F.)
| | - Urshla Devalia
- Royal National ENT and Eastman Dental Hospital, London University, 47-49 Huntley St, London WC1E 6DG, UK;
| | - Tara Vassallo
- Plymouth Institute of Education, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK;
- National Autistic Society—Plymouth & District Branch, Plymouth PL1 4QU, UK
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Parry J, Newton T, Linehan C, Ryan C. Dental Visits for Autistic Children: A Qualitative Focus Group Study of Parental Perceptions. JDR Clin Trans Res 2021; 8:23800844211049404. [PMID: 34693784 PMCID: PMC9772888 DOI: 10.1177/23800844211049404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Patient groups who pose behavioral challenges during dental attendance may be offered more restricted dental treatment options. Unsuccessful participation with dental visit tasks and demands has been commonly reported for autistic children. OBJECTIVES This study aimed to examine parental perceptions of difficulties associated with dental attendance and oral care for autistic children and young adults, to highlight reported challenges and potential adaptations, and to identify interventions that will encourage positive experiences of dental attendance. METHODS Qualitative data were gathered through 2 focus groups with parents of primary school and secondary school pupils with autism, interviewed in separate groups. Questions about parents' perceptions of dental attendance and oral care were asked. The groups were audio-recorded and transcribed verbatim. The transcripts were analyzed and initial codes generated. Development of subthemes and themes followed a process of thematic analysis. RESULTS Parental perceptions, which confirmed data from other studies, included the need for understanding and training, awareness of sensory issues, recognition of the individuality of autistic traits, time and clarity for communication, and factors affecting the confidence of parents to advocate in the clinical environment. Focus group participants identified the critical value of empathizing with an autistic perspective and highlighted the importance of positive oral health messages. They also noted the lack of understanding regarding the complexity of altering self-imposed, ritualistic dietary regimes and attempting to enact good dental preventive habits for their children. CONCLUSIONS Analysis of data from parent focus groups provided a greater understanding of the needs and responsivity required for successful dental visits for autistic children and young adults. A range of potential interventions was identified and incorporated within a model of needs. Interventions based on Partnership Working, System Change, and Training of Dental Staff could be effective in reducing challenges posed by dental attendance for many children with autism. KNOWLEDGE TRANSFER STATEMENT Sensory sensitivities, communication difficulties, comorbid intellectual disability, and dental anxiety are barriers to successful participation during dental attendance for autistic children. This research proposes that interventions supporting Partnership Working, System Change, and Training of Dental Staff can reduce challenges posed by dental attendance. The model of interventions developed as part of this project can be used by oral care teams to help reduce barriers and improve the success of dental visits for autistic children.
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Affiliation(s)
- J.A. Parry
- School of Applied Psychology, University College Cork, Cork, Ireland
- Special Care Dental Service, Sussex Community NHS Foundation Trust, Haywards Heath Health Centre, Haywards Heath, UK
| | - T. Newton
- Centre for Oral, Clinical and Translational Sciences, King’s College London, London, UK
| | - C. Linehan
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - C. Ryan
- School of Applied Psychology, University College Cork, Cork, Ireland
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Howe EG. Can Careproviders Still Bond with Patients after They Are Turned Down for a Treatment They Need? THE JOURNAL OF CLINICAL ETHICS 2021. [DOI: 10.1086/jce2021323185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Floríndez LI, Como DH, Floríndez DC, Vigen C, Floríndez FM, Cermak SA. Identifying Gaps in Oral Care Knowledge, Attitudes, and Practices of Latinx Parents/Caregivers of Children With and Without Autism Spectrum Disorders. Health Equity 2021; 5:185-193. [PMID: 33937604 PMCID: PMC8080905 DOI: 10.1089/heq.2020.0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose: This pilot study used data from a survey to examine the knowledge, attitudes, and practices about oral care of Latinx parents/caregivers of children with or without autism spectrum disorder (ASD) to identify gaps to focus future intervention. Methods: Sixty English-speaking Latinx parents/caregivers who had a child between 4 and 14 years with or without ASD (n=31 ASD, n=29 typically developing [TD]) completed a questionnaire on oral health knowledge, practices, access to care, and demographics. Caregiver responses were compared, and gaps in knowledge and practices were identified. Results: There were no significant differences in parent age, child age, income, insured status, or overall knowledge scores, only a significant difference in education (p=0.02), with the ASD group reporting less. Scores for knowledge, attitudes, access and practice were all nonsignificantly positively correlated, as was attitudes with access and practice. However, knowledge and attitudes were significantly negatively correlated. Additional significant findings were parents who had lower income and education, had lower oral knowledge scores, decreased frequency of dental visits, increased feelings of being discriminated against, children with increased fear of the dentist, and decreased ease of finding a dentist. Conclusion: Factors such as income, education, ethnicity, and having a child with ASD can influence what Latinx parents and caregivers know about oral health and how their children experience receiving dental care. Latinx parents/caregivers of children with and without ASD report barriers to dental care, including difficulty attending visits or feeling stigmatized by their dental provider due to their ethnicity. Fear of the dentist is significantly correlated with ASD diagnosis and lower social demographics of the parent, and may contribute to a reduction in preventative oral care visits as well. Health care providers should consider these perspectives when providing care to this population to mitigate further oral health inequities.
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Affiliation(s)
- Lucía I Floríndez
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Dominique H Como
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Daniella C Floríndez
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Cheryl Vigen
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | | | - Sharon A Cermak
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
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Floríndez LI, Floríndez DC, Price ME, Floríndez FM, Como DH, Polido JC, Baezconde-Garbanati L, Pyatak E, Cermak SA. Exploring Eating Challenges and Food Selectivity for Latinx Children with and without Autism Spectrum Disorder Using Qualitative Visual Methodology: Implications for Oral Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3751. [PMID: 33916808 PMCID: PMC8038332 DOI: 10.3390/ijerph18073751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/16/2023]
Abstract
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.
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Affiliation(s)
- Lucía I. Floríndez
- Department of Nursing Research, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | | | - Mia E. Price
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (M.E.P.); (D.H.C.); (E.P.); (S.A.C.)
| | | | - Dominique H. Como
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (M.E.P.); (D.H.C.); (E.P.); (S.A.C.)
| | - Jose C. Polido
- Division of Dentistry, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA;
| | | | - Elizabeth Pyatak
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (M.E.P.); (D.H.C.); (E.P.); (S.A.C.)
| | - Sharon A. Cermak
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy in the Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (M.E.P.); (D.H.C.); (E.P.); (S.A.C.)
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