Toothbrushing in children with autism spectrum disorders: qualitative analysis of parental difficulties and solutions in France

A scoping review on parental/caregiver challenges in maintaining oral hygiene among children with autism spectrum disorder

BACKGROUND

Dental practitioners must develop feasible and evidence-based strategies to help parents/caregivers successfully implement daily oral hygiene measures among their children with autism spectrum disorder (ASD).

AIM

This scoping review aimed to explore challenges faced by parents/caregivers while performing routine oral hygiene care among their children with ASD.

DESIGN

A methodological framework recommended by Arksey and O'Malley and reporting guidelines prescribed by PRISMA-ScR were adopted. A database search was conducted across PubMed, Scopus, Web of Science, EMBASE, and ClinicalKey, to identify articles that addressed challenges faced by parents/caregivers while performing routine oral hygiene care for their children with ASD.

RESULTS

The search yielded 4934 articles. Following the inclusion/exclusion criteria, nine articles were included in this scoping review. A qualitative analysis of included articles following the PICOS coding criteria revealed major themes. These consisted of various home oral hygiene practices followed by parents/caregivers, and challenges faced by them during home oral hygiene care owing to underlying sensory, behavioral, physical, and/or functional problems experienced by their children with ASD.

CONCLUSION

Challenges experienced by parents/caregivers of children with ASD were numerous, which resulted in deviations from routine oral hygiene practices from recommended guidelines for the prevention of dental caries.

A cross-sectional study on oral hygiene practices, home care challenges, and barriers to seek dental care for children with autism spectrum disorder from the caregiver's perspective

Objectives

To collect and analyse data regarding the oral hygiene practices, home care challenges, and the barriers faced by children with autism in seeking dental care from the caregiver's perspective.

Methods

A cross-sectional study was conducted on 80 subjects comprising 40 subjects in the autism spectrum disorder (ASD) group and 40 in the comparison group of the typically developing peer (TDP) group. Caregivers of children diagnosed with ASD aged between 4 and 12 and attending therapy centres in Ahmedabad city were included. Matching was done between the ASD and TDP groups for age and sex for both children and caregivers as well as educational qualification of the caregiver. Data were collected using a self-designed, validated questionnaire and analysed using Chi-square test at a 5% level of significance.

Results

ASD individuals were brushing less frequently, needing more supervision during brushing and using fingers to clean the teeth over TDPs. Caregivers of ASD individuals display significantly lower awareness of various dental issues explored, less proactive engagement with dental professionals, and significantly more barriers in seeking dental care for their ward for all the variables explored than caregivers of the TDP group.

Conclusions

Caregivers of children with ASD were not adequately aware about their child's oral health and encountered increased difficulty in maintaining routine oral hygiene for their children at home and accessing suitable dental care compared to the caregivers of children from the TDP.

An 'explosion in the mouth': The oral health experiences of autistic children

In England, a quarter of 5-year-olds have tooth decay. For families with autistic children, establishing optimal habits (toothbrushing twice a day with fluoride toothpaste, limiting sugar intake and regular dental visits) can be difficult. Oral health experiences from the perspective of autistic children remains unexplored. Interviewing autistic children is crucial as it provides direct insights into their unique experiences and needs, ensuring their voices are represented in research. Therefore, we aimed to explore autistic children's oral health experiences, including the barriers and facilitators to optimal oral health behaviours. We sought the views of 10 autistic children (aged 7-13 years old) about toothbrushing, healthy eating and visiting the dentist, using spoken interviews and Talking Mats®. Data were analysed using reflexive thematic analysis. Two themes were identified: (1) The diverse sensory nature of oral health activities; and (2) developing trust and routine through consistency, communication and collaboration. Our inclusive methodologies enabled autistic children with diverse communication needs to participate. Such methodologies improve the representation of autistic children in oral health research and autism-related studies more generally. The findings are informing the development of a new personalised support package to help families meet their autistic children's unique needs.Lay abstractIn England, one in four children have tooth decay by the age of 5 years. Tooth decay affects many autistic children. Communication differences, sensory sensitivities and preferred routines can make dental care difficult. Daily toothbrushing, healthy eating and drinking, and attending the dentist may be challenging for autistic children. We do not know much about how autistic children feel about looking after their teeth. Learning from them directly is important to understand their needs and make sure their voices are heard. We interviewed 10 autistic children aged between 7 and 13 years to discover how they care for their teeth, what helped and what did not. We talked about toothbrushing, healthy eating and drinking and visiting the dentist. To support our conversations, we used Talking Mats® - a tool that can help with communication. Autistic children described a wide range of sensory issues related to looking after their teeth. This finding shows how important it is to tailor care to each child's needs. Children wanted to be included in conversations about their teeth at home and at the dentist. This was felt to make a big difference in building trust and making them feel comfortable and supported. Overall, we found Talking Mats® can be used in dental research to engage with autistic children. By understanding children's views, we can better help professionals and parents to support their dental needs. Our research showed that every child's experience is unique, so dental support must be tailored and inclusive to meet children's needs.

Clinical effectiveness of picture exchange communication system (PECS) on 5- to 7-year-old children's oral health

PURPOSE

To assess the impact of the picture exchange communication system (PECS) on oral hygiene motivation and practices in healthy children aged five to seven years.

METHODS

A total of 160 healthy children aged five to seven years were included in this study. At the first visit, the participants' guardians were asked to answer a questionnaire focussing on the sociodemographic, and the oral hygiene habits of the participants. All participants received a clinical examination to assess their dental caries experience using the ICDAS score, gingival condition using the gingival index (GI), and the amount of accumulated dental plaque using the Turesky Modification of the Quigley-Hein Plaque Index (TQHI), followed by comprehensive explanation of the proper oral hygiene protocol. The participants were randomly divided into two equal groups; the PECS group and the control group. The participants were re-assessed after 6 months. The collected data were statistically analysed using the Statistical Package for Social Sciences (SPSS) software version 23 at a p-value ≤ 0.05.

RESULTS

By the end of the follow-up period, the PECS group reported significantly greater adherence to regular tooth brushing (p = 0.006) with a frequency higher than twice per day (p < 0.000) and no need for parental motivation (p < 0.001), and had significantly lower mean GI and TQHI scores (p < 0.000). Most of the participants' guardians reported that the PECS cards were useful for use and that they would continue to use them 66/76 (86%).

CONCLUSION

The PECS was found to be effective in motivating children to adhere to proper tooth-brushing practices, as reflected by improvements in their oral health status and gingival condition.

Effect of Sensory Adapted Dental Environment (SADE) on physiological and behavioral parameters related to stress and anxiety in children with Autism Spectrum Disorder (ASD) undergoing dental treatment: A systematic review and meta-analysis

BACKGROUND

Children with autism exhibit a higher general and dental anxiety, due to altered sensory sensibilities.

AIM

This current systematic review aims to evaluate the effectiveness of Sensory adapted dental environment (SADE) over regular dental environment (RDE) on behavioral, physiological stress and overt anxiety in children with autism spectrum disorders (ASDs).

MATERIALS AND METHODS

Prospero registered (CRD42024508336). PubMed, Cochrane, Scopus databases are searched from years January 1, 1980-January 1, 2024 using pre-defined search strategy.

RESULTS

A total of 269 titles, were obtained from the included databases after application of filters, exclusion of duplicates and reviews and irrelevant articles led to the final inclusion of 12 articles for full text screening from which, three studies sustained the targeted PICO search.

CONCLUSION

Skin conductance level (parameter indicating physiological stress) is lower in SADE environment in children with ASD, other behavior stress related parameters there is no significant difference between SADE and RDE environments.

Dimensions of young children's toothbrushing resistance: A qualitative content analysis of discussions on the online parenting forum Mumsnet

BACKGROUND

Young children's resistant behaviour is a barrier to parental-supervised brushing. Discussions on online parenting forums offer an insight into parental experiences, behaviour and attitudes. Analysing these discussions also demonstrates how dental advice is represented and potentially resisted.

AIM

To analyse how young children's toothbrushing resistance is discussed on an online parenting forum.

DESIGN

Qualitative content analysis of threads on toothbrushing resistance retrieved from the UK parenting forum Mumsnet.

RESULTS

A search was carried out on Mumsnet in April 2022. Overall, 204 relevant threads were identified and analysed. A coding frame was developed. Posters interacted by discussing their experiences of resistance, asking for advice, making suggestions and being both supportive and critical. Thirty-seven strategies for addressing resistance were identified. Discussions reflected attitudes and concerns relating to young children and toothbrushing resistance, including the idea brushing should be 'non-negotiable'. A key issue was the acceptability of physical force or restraint to achieve adequate brushing. Posters invoked dental authority to support their views.

CONCLUSION

Understanding how toothbrushing resistance is discussed on a parenting forum helps establish what information and advice is shared, and highlights attitudes and concerns that shape how this problem is approached.

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

LAY ABSTRACT

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

Oral Health Barriers for African American Caregivers of Autistic Children

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.

Factors influencing oral health behaviours, access and delivery of dental care for autistic children and adolescents: A mixed-methods systematic review

Background

Autistic children and young people (CYP) experience oral health (OH) inequalities. They are at high risk of dental disease and show significant levels of unmet need in relation to OH and access to dental care.

Aim

This study aimed to gather evidence on the factors that influence OH behaviours, access to and delivery of dental care for autistic CYP.

Design

This was a mixed‐methods narrative systematic review.

Data Sources

Embase, Web of Science, Dentistry & Oral Sciences Source, MEDLINE, Psychinfo, Scopus, CINAHL, SocINDEX and grey literature were the data sources for this study.

Review Methods

A systematic search was conducted for qualitative, quantitative and mixed‐methods research studies from countries with a High Development Index that related to OH behaviours, access to and delivery of dental care for autistic CYP. Results were analysed using narrative synthesis.

Results

From 59 eligible studies, 9 themes were generated: (1) affordability and accessibility; (2) autism‐related factors and cognitive or motor skill differences; (3) the dental environment; (4) managing CYP's behaviour; (5) responding and adapting to the needs of the autistic CYP and their parent/carer; (6) attitude of dental health professionals (DHPs) towards autistic CYP and their parents/carers; (7) knowledge of how to care for and support CYP's OH; (8) empowerment of parents/carers and collaboration with DHPs; and (9) communication and building rapport.

Conclusion

The adoption of healthy OH behaviours and access to dental care by autistic CYP is impacted by a range of factors including those intrinsically related to a diagnosis of autism, for example, communication and those often associated with autism, for example, sensory sensitivities. Access to better OH and dental care can be facilitated by responding to the individual needs of autistic CYP through accommodation, education and adaptation. This necessitates greater awareness and knowledge of autism amongst DHPs and the provision of appropriate services. More methodologically robust intervention studies are needed to identify effective ways to support autistic CYP in achieving good OH and access to dental care.

Patient and Public Contribution

The review protocol was developed with members of the project patient and public involvement group who provided the autistic voice, contributing to the interpretation of the review findings and writing of the manuscript.