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Alegría PL, Landim SF, Branco BHM, Carmine F, Birditt K, Sandoval C, González MM. Dental Hygiene Challenges in Children with Autism: Correlation with Parental Stress: A Scoping Review. J Clin Med 2024; 13:4675. [PMID: 39200817 PMCID: PMC11355692 DOI: 10.3390/jcm13164675] [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: 07/02/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 09/02/2024] Open
Abstract
BACKGROUND Children diagnosed with autism spectrum disorders are shown to have poor periodontal health and dental hygiene habits. Extensive research has revealed that parents of children with autism spectrum disorder (ASD) frequently encounter heightened levels of stress, despair, and anxiety in comparison to parents of neurotypical children. The aim was to understand the relationship between the dental hygiene of children with ASD and the stress generated in their parents. Methods: A scoping review was carried out to identify any gaps or research opportunities for clinical practice concerning oral care and stress levels in parents in the PubMed, Medline, ScienceDirect, and Scopus databases. Results: A total of 139 articles were reviewed. Of these, only 10 met the selection criteria for inclusion. Our results reveal a lack of studies presenting evidence on the topic of poor dental hygiene in children with ASD and high stress levels in their parents. Discussion: There is ample evidence that children with ASD have poor dental hygiene, as well as higher levels of stress in their parents. However, little or no evidence links these two variables. Future studies should focus on this link, which could have practical implications for improving dental care for children with ASD.
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Affiliation(s)
- Pablo López Alegría
- Escuela de Terapia Ocupacional, Facultad de Psicología, Universidad de Talca, Talca 3465548, Chile; (P.L.A.); (S.F.L.)
| | - Síbila Floriano Landim
- Escuela de Terapia Ocupacional, Facultad de Psicología, Universidad de Talca, Talca 3465548, Chile; (P.L.A.); (S.F.L.)
- Graduate Program in Health Promotion, Cesumar University (UniCesumar), Maringá 87050-900, Brazil;
| | | | - Florencia Carmine
- Carrera de Medicina, Facultad de Medicina, Universidad de La Frontera, Temuco 4811230, Chile;
| | - Katherine Birditt
- Physiology Development and Neuroscience Department, University of Cambridge, Cambridge CB2 1TN, UK;
| | - Cristian Sandoval
- Escuela de Tecnología Médica, Facultad de Salud, Universidad Santo Tomás, Los Carreras 753, Osorno 5310431, Chile
- Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Frontera, Temuco 4811230, Chile
- Núcleo Científico y Tecnológico en Biorecursos (BIOREN), Universidad de La Frontera, Temuco 4811230, Chile
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Goswami M, Bhatara S, Bhatara M, Singh SR. Parental perspectives on oral health-related quality of life in children and adolescents with autism spectrum disorder: A systematic review. SPECIAL CARE IN DENTISTRY 2024; 44:700-718. [PMID: 38156791 DOI: 10.1111/scd.12951] [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: 07/26/2023] [Revised: 10/20/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) face unique challenges related to oral health, which can negatively impact their day-to-day lives, significantly compromising their overall quality of life. Primary caregivers of children with ASD have a critical role in delivering and seeking oral health care. Hence, it is vital to study their perspective towards their children's oral health and its impact on their quality of life. AIM To explore the parental perception of oral health-related quality of life in children with autism. METHODS A systematic electronic and manual search was conducted in Medline (via PubMed), Embase, Google Scholar, Scopus, and LILACS of articles published from January 2003 to May 2023 using appropriate MeSH terms, keywords, and other terms. A four-phase study selection process was followed according to PRISMA guidelines, and data extraction and synthesis were performed using an extraction form. The selected studies were critically appraised using the QATSDD and Crombie's assessment tool. The inter-reviewer agreement was assessed using the kappa with a linear weighting coefficient. RESULTS Out of the 885 results, 15 studies were included in the review after the two selection phases, and the study characteristics were summarized in tabular form. Study quality varied considerably, and out of a total possible QATSDD score of 42, scores for the individual studies ranged from 14 to 40. The risk of bias for the seven criteria was found to be low. CONCLUSION The parental perception of the OHRQoL in children with ASD is poor, and the most significant perceived impact is on the child's functional and social well-being aspects. Parental-Caregiver Perception Questionnaire was the most commonly used. The most frequent symptoms include bad breath, food lodgment, mouth breathing and night grinding. The familial impact and influence on the OHRQoL of siblings were also studied.
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Affiliation(s)
- Mousumi Goswami
- Department of Paediatric and Preventive Dentistry, ITS Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Supriya Bhatara
- Department of Paediatric and Preventive Dentistry, ITS Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India
| | - Mohit Bhatara
- College of Liberal Arts (Department of Psychology), Wenzhou-Kean University, Wenzhou, Zhejiang, China
| | - Shrey Raj Singh
- Department of Ophthalmology, ICare Eye Hospital and Post Graduate Institute, Noida, Uttar Pradesh, India
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Pastore I, Bedin E, Marzari G, Bassi F, Gallo C, Mucignat-Caretta C. Behavioral guidance for improving dental care in autistic spectrum disorders. Front Psychiatry 2023; 14:1272638. [PMID: 38034927 PMCID: PMC10682214 DOI: 10.3389/fpsyt.2023.1272638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Autism spectrum disorders (ASDs) impair many aspects of everyday life and may prevent access to dental care, often limiting it to emergencies. Impaired oral health has long-lasting negative consequences on health status and on the acquisition of oral habits (e.g., oral respiration and grinding) or competencies (e.g., proper speech production). Children with ASD may be scared in the dental setting, which is rich in sensory stimuli and requires physical contact. Due to their behavioral manifestations, they represent a challenge for dentists and hygienists. We created a dedicated pathway with behavioral support for children with ASD to allow dental care and possibly limit the use of general anesthesia. Methods We evaluated the effects of behavioral support in a quasi-experimental design by comparing two groups of children with ASD. The first group (n = 84) was visited every 2 months for 3 years and received additional support (visual aids, caregiver training, and longer visit duration). A control group, matched for age and sex, was visited at least twice a year or more, if needed, according to standard healthcare guidelines. Results Compliance with the schedule was high throughout the 3 years. The degree of collaboration significantly improved after 1 year in the supported group, while the control group did not change. At the end of the study, collaboration remained significantly higher than at the beginning in the supported group. Half of dental treatments were possible without general anesthesia in supported children. No adverse effect was apparent on collaboration due to COVID-19 restrictions. Discussion Behavioral techniques improved the compliance of ASD children to regular dentistry visits and treatment. Furthermore, oral hygiene at home was similarly improved, addressing oral health from a lifelong perspective.
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Affiliation(s)
- Irene Pastore
- Community Dentistry Department, Ospedale Immacolata Concezione, Piove di Sacco, Italy
| | - Elena Bedin
- Community Dentistry Department, Ospedale Immacolata Concezione, Piove di Sacco, Italy
| | - Giulia Marzari
- Community Dentistry Department, Ospedale Immacolata Concezione, Piove di Sacco, Italy
| | - Francesca Bassi
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Claudio Gallo
- Community Dentistry Department, Ospedale Immacolata Concezione, Piove di Sacco, Italy
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Konstantinova DA, Dimitorov LG, Angelova AN, Pancheva RZ. Components of Oral Health Related to Motor Impairment in Children With Neuropsychiatric Disorders. Cureus 2023; 15:e46093. [PMID: 37900541 PMCID: PMC10611904 DOI: 10.7759/cureus.46093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Oral health significantly influences functions such as chewing, swallowing, and overall well-being. Children with neuropsychiatric disorders (NPD) often experience compromised oral functions, escalating their risk of malnutrition. Materials and methods Our study, conducted in Varna, Bulgaria, from April to October 2017, aimed to evaluate some components of the oral health of 49 children with NPD and its relation to their motor impairments. In the studied cohort, participants were categorized based on their Gross Motor Function Classification System (GMFCS) scores into two groups: minor limitations (ML), encompassing GMFCS levels 1-3, and gross limitations (GL), which included GMFCS levels 4-5. Comprehensive oral examinations were conducted by a trained dentist. Data analysis utilized the JAMOVI v.2.2.2.0 software with a 0.05 significance threshold. Results Preliminary findings indicate that children with more pronounced motor limitations have poorer oral health compared to their mildly impaired counterparts. A mere 14.3% (n=7) of the children with NPD had recorded dental visits. The data show that 18.2% (n=6) of ML children had at least an annual dental consultation, while only a single child (6.2%) from the GL group had a dental visit, leaving a staggering 93.8% (n=15) without any. Statistical analyses indicate a significant relationship between motor activity (MA) and toothbrushing frequency (r=0.529, p=0.0001), suggesting that children with better MA have improved chances of maintaining oral hygiene. A significant correlation was observed between dental visits and toothbrushing frequency (r=0.371, p=0.0007). Conclusion Given their challenges, children with NPD require increased attention to dental care, emphasizing regular checkups and preventive oral health measures. This study prompts a reevaluation of these care standards.
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Affiliation(s)
- Desislava A Konstantinova
- Department of Dental Material Science and Prosthetic Dental Medicine, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, BGR
| | - Lyubomir G Dimitorov
- Department of Neurosurgery, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, BGR
| | - Ana N Angelova
- Department of Dentistry, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, BGR
| | - Rouzha Z Pancheva
- Department of Hygiene and Epidemiology, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, BGR
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da Silva ACF, Barbosa TDS, Gavião MBD. Parental Perception of the Oral Health-Related Quality of Life of Children and Adolescents with Autism Spectrum Disorder (ASD). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1151. [PMID: 36673908 PMCID: PMC9859466 DOI: 10.3390/ijerph20021151] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
This study evaluated the parental perception of the oral health-related quality of life (OHRQoL) of children and adolescents with autism spectrum disorder (ASD) and their family functioning. Moreover, sociodemographic factors associated with parental ratings of OHRQoL were assessed. A hundred parents/guardians of children and adolescents aged 6 to 14 years with ASD (ASD group) and 101 unaffected children and adolescents (UCA group) participated. Data collection was carried out using a Google form, containing three sections: (1st) Socioeconomic data and health history; (2nd) Oral health assessment by parental report; (3rd) The short forms of the Parental-Caregiver Perceptions Questionnaire (16-P-CPQ) and the Family Impact Scale (4-FIS). The scores of 16-P-CPQ total and subscales and 4-FIS were significantly higher for the ASD group (p < 0.02), except for the oral symptoms subscale (p > 0.05). Older ages (OR = 1.24), brushing 0/1x day (OR = 2.21), teeth grinding (OR = 2.20), gingival bleeding (OR = 3.34), parents with an elementary school degree (OR = 0.314) and family incomes less or equal to the minimum wage (OR = 3.049) were associated with a worse OHRQoL. Parents in the ASD group had a worse perception of QHRQoL when compared to the UCA group. ‘Frequency of tooth brushing’, ‘gingival bleeding’, and ‘teeth grinding’ were predictors of the worst parental perception of their children’s OHRQoL. Families with low socioeconomic conditions were more strongly affected by the oral conditions of their children.
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Affiliation(s)
- Anna Cecília Farias da Silva
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, SP, Brazil
| | - Taís de Souza Barbosa
- Department of Dentistry, Life Sciences Institute, Federal University of Juiz de Fora, Governador Valadares 35020-360, MG, Brazil
| | - Maria Beatriz Duarte Gavião
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba 13414-903, SP, Brazil
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Zerman N, Zotti F, Chirumbolo S, Zangani A, Mauro G, Zoccante L. Insights on dental care management and prevention in children with autism spectrum disorder (ASD). What is new? FRONTIERS IN ORAL HEALTH 2022; 3:998831. [PMID: 36238091 PMCID: PMC9551997 DOI: 10.3389/froh.2022.998831] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
Autistic subjects represent a severe concern to dentistry due to the considerable difficulty in managing their oral health, maintaining routine toothbrushing, and preventing dental and periodontal problems. The social and economic burden of managing dental care in autism spectrum disorder (ASD) children is particularly cumbersome for families and public and private health expenditure, especially when children reach the dentist following a late diagnosis with evident oral health problems. An early diagnosis of ASD helps dentists better address these children's oral health. Unfortunately, insufficient attention is paid to the training and education of general pediatricians, dentists, and dental hygienists, allowing them to get to approach the different clinical aspects of ASD. Usually, children diagnosed with ASD are scheduled for dental appointments like their neurotypical peers, whereas their needs are typically complex and personalized. Scant attention is also devoted to these patients by commercial manufacturers of dental products and devices for oral hygiene and prevention of caries and periodontal diseases, leaving parents without the support and often failing when they address the oral health of autistic children. The difficulties of oral care do not derive simply from the behavior of ASD patients, as is commonly assumed, and therefore cannot be overcome solely by the patience and attention of parents and dentists. Genetics, dietary habits, sensory impairments, and cognition disorders are other causes contributing in various degrees to the impact on the mood and psychological reactions of autistic children towards dentists. How can we prevent teeth caries, periodontal disorders, and other oral health impairments by properly managing ASD children? This manuscript gives an up-to-date overview of these problems and helps to provide good remarks.
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Affiliation(s)
- Nicoletta Zerman
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Francesca Zotti
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Zangani
- Department of Surgery, Dentistry, Paediatrics and Gynecology, University of Verona, Verona, Italy
| | | | - Leonardo Zoccante
- Autism Veneto Region Center, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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