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

Developing a Prototype Home-Based Toothbrushing Support Tool for Families in Scotland: A Mixed-Methods Study With Modified Delphi Survey and Semi-Structured Interviews

BACKGROUND

Scotland's National Oral Health Programme for Children, Childsmile, provides targeted home toothbrushing support for families of young children (0-3 years) in the home setting. The study describes the adaptation of an existing dental practice-based intervention from the Netherlands using pictorial cards (Uitblinkers) for use in the programme. The aims were to modify Uitblinkers for the setting and context in Scotland by: (1) identifying the barriers that parents/carers in need of extra support face in implementing supervised toothbrushing; (2) explore consensus about behaviour change techniques that are appropriate and valid to address these; and (3) making recommendations for the design of a co-produced home-support tool and identifying facilitators for implementation in practice.

METHODS

A modified Delphi study was carried out consisting of two survey rounds with a purposively recruited expert panel (n = 21) to develop consensus on home toothbrushing barriers (aim 1), behaviour change techniques (aim 2) and considerations for implementation (aim 3). Proposition statements for the Delphi were derived from literature, discussions with project advisors and from Uitblinkers, an existing behaviour change intervention for parents developed by the Academic Centre for Dentistry Amsterdam (ACTA) and delivered in dental practice. Then 12 in-depth, semi-structured interviews were conducted with Dental Health Support Workers in Scotland (delivering the home support toothbrushing intervention) to gather the views on the proposed toothbrushing barriers, behaviour change techniques and considerations for implementation (aim 1 to 3). Delphi results are presented descriptively in terms of percentage agreement and priority ratings. Interview transcripts were analysed using Template Analysis.

RESULTS

From the Delphi study, a final set of 11 overlapping child, parent and environmental/social toothbrushing barriers was agreed upon (aim 1), to be addressed through a tool based on applied Motivational Interviewing, and a combination of Operant Conditioning, Stimulus Control and Goal-Setting techniques (aim 2). Experts supported the tool as realistic for delivery in the home setting, provided staff were trained. A physical 'paper' tool was preferred to a proposed electronic version (aim 3). Themes from interviews were: (1) the barriers present an exhaustive set and are valid from staff experience with families; (2) Motivational interviewing is appropriate and fits with usual practice; (3) the included behaviour change techniques are workable; (4) the tool is generally feasible within the operation of Childsmile home visits; (5) the tool is not less applicable for children with additional support needs.

CONCLUSIONS

A card-based conversational intervention to provide targeted home toothbrushing support for families of young children (0-3 years) in the home setting in Scotland, drawing from a template from the Netherlands, has been deemed worthy of further testing based on expert consensus and staff views on barriers faced, appropriate behaviour change techniques to address these and the design of a physical tool.

Pilot rural-urban comparison of health care experiences among autistic adolescents and young adults

Autistic adolescents and young adults face barriers to accessing health care, particularly during the pediatric-to-adult care transition. This study compared health care access, utilization, and provider interactions between rural and urban autistic adolescents and young adults. Autistic adolescents and young adults (N = 180) aged 14-25 were recruited through autism registries and community agencies across multiple US states from October 2022 to June 2023. They completed the Health Care Transition Experience Survey, a 51-item questionnaire evaluating health care experiences. Rural-urban differences were analyzed through descriptive and inferential statistics. Rural autistic adolescents and young adults (n = 84) relied more on a single health care location, while urban autistic adolescents and young adults (n = 96) more often used multiple providers (72.6% vs 56.3%, p = 0.046). Rural autistic adolescents and young adults reported greater challenges with providers lacking autism-specific knowledge (40.5% vs 24.0%, p = 0.017) and limited nearby providers (57.1% vs 26.0%, p < 0.001). They also encountered more issues with dental insurance acceptance (46.4% vs 12.5%, p = 0.015), while urban autistic adolescents and young adults more often lacked dental insurance (33.3% vs 3.6%, p = 0.008). Significant rural-urban disparities were found in health care experiences, particularly provider availability and autism expertise in rural areas. Targeted interventions addressing rural health care barriers and enhanced provider training in autism care are needed.Lay abstractHealth care can be especially challenging for young autistic people, particularly when they move from child to adult health care. Our pilot study looked at whether the health care experiences are similar or different for autistic young people living in rural areas versus urban areas. We surveyed 180 autistic people aged 14-25 years about their health care experiences, including 96 from urban areas and 84 from rural areas. The survey asked about their experiences in finding providers, getting appointments, working with providers, and how well their providers understood autism. The results showed that rural young autistic people face some unique challenges. They often had to travel farther to find providers. They were more likely to work with one provider and report that their providers did not understand autism well compared to urban young autistic people, who often could choose between different providers. Interestingly, both rural and urban participants felt similarly about how well they could talk with their providers once they started working with them. Dental care stood out as particularly challenging among different health care services-rural participants had trouble finding dentists who accepted their insurance, while urban participants were more likely to have no dental insurance at all. These findings highlight important areas for improvement. Rural communities need more autism-trained providers and better access to nearby health services. In urban areas, addressing gaps in insurance coverage is critical. Together, we should improve care for all young autistic people, no matter where they live.

Reviewing Mobile Dental Apps for Children with Cognitive and Physical Impairments and Ideating an App Tailored to Special Healthcare Needs

Background/Objectives: Children with special healthcare needs (SHCNs) face various physical, developmental, sensory, behavioral, or cognitive challenges affecting oral health and highlighting the need for specialized and more accessible oral and dental care. Mobile health (m-health) applications have emerged as a promising solution to bridge oral health education gaps and improve dental care access. This narrative review aimed to examine the available dental m-health applications designed for children with cognitive and physical impairments, exploring the perspectives of children, parents/caregivers, and dentists regarding their use and potential contribution to oral health. Based on these insights, a concept for a tailored dental m-health app is proposed, considering the interactions between children, caregivers, and dentists to support oral care. Methods: A literature search was conducted using MEDLINE/PubMed, Scopus, and Web of Science to identify studies on the use of m-health apps in pediatric dentistry for SHCN children. Results: Six studies were included in this review. M-health applications helped manage anxiety, behavioral issues, and compliance in children and were generally well received by parents and caregivers, thus improving oral hygiene practices and regular dental visits, and having the potential to reduce oral health disparities in children with cognitive and physical impairments and their families. However, current apps designed for children are limited and may not fully accommodate the diverse sensory needs of these SHCN children. Conclusions: The development of a tailored dental m-health app that adapts to the individual characteristics of SHCN children could enhance oral health awareness and support better compliance among children, parents/caregivers, and dentists.

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.

Tooth brushing behavior and oral health care of people with early childhood autism in Germany

OBJECTIVES

Only a little is known about the tooth brushing behaviors and oral health care of people with early childhood autism (P-EA). To remedy this, a survey was carried out with P-EA of all ages.

MATERIALS AND METHODS

In summer 2021, an online survey questionnaire with 124 questions, addressed only at caregivers of P-EA, was sent to all members of the Bundesverband Autismus Deutschland e.V. Our present study evaluated the 20 survey questions related to dental self-care.

RESULTS

In total, 130 questionnaires were evaluated. The mean age of the P-EA was 22.7 years (min: 3y; max: 60y; SD ± 14.1y). Only 17.7% (n =23) of the P-EA were female, while 82.3%(n =107) were male. Overall, 54.6% (n = 71) of P-EA are always actively assisted in tooth brushing. Although 57.7% (n = 75) of P-EA brushed teeth twice daily, 39.2% brushed for one to two minutes (n = 51). P-EA younger than 18 years old selected toothpaste primarily for taste reasons (32.7%;n = 18). Only 9.3% (n = 7) of adult P-EA selected toothpaste because of the fluoride content. Manual toothbrushes were preferred by 40.8% (n = 53) of the P-EA, and electric toothbrushes by 34.6% (n = 45). Almost three quarters (71.5%;n = 93) did not use additional dental care implements. The same number (75.4%;n = 98) of P-EA had not practiced supervised brushing in a dental office.

CONCLUSIONS/CLINICAL RELEVANCE

Active support in dental self-care is crucial for a majority of the P-EA in Germany, regardless of their age. Professional support needs to be fundamentally improved. Clinical concepts for practical instruction in dental hygiene should be developed for P-EA.

Oral Health and Behavioral Management of Children with Autistic Spectrum Disorder: A 30-year Retrospective Study

PURPOSE

This article aims to determine the oral health status, the dental treatment, the behavioral management techniques, and the follow-up of pediatric autistic spectrum disorder (ASD) patients treated at the Clinic for Pediatric Patients with Disabilities (CPPD) at a public university in Brazil.

METHODS

The medical records of all the patients seen between 1990 and 2020 were evaluated. Data were collected on the autistic patients' medical and dental conditions, treatments, behavior during dental visits, behavioral management techniques used, and the entire follow-up period at the clinic. The Student's t-test and chi-square tests were used to perform the statistical analysis (α = 0.05%).

RESULTS

Sixty-six records of ASD children were analyzed from a total of 656 dental records. The majority were male (80.3%). The mean age was 7.39 ± 2.75 years. All the children had a cognitive deficit, and 62.5% used medication. Most of the children arrived with caries lesions (56.1%), and the mean number of decayed, missed and filled teeth in both the deciduous (dmft-d) and permanent dentition (DMFT) was 2.45 ± 3.13 and 0.87 ± 1.51, respectively. The restorative technique was the most commonly used procedure (54.5%), and protective stabilization was the most frequently used behavioral management technique (18.2%). Of the children who sought treatment, 86.4% were discharged, and 15.2% abandoned the procedure. The majority (those discharged) continued to undergo regular follow-up at the clinic (86%), and the incidence of new caries lesions observed was 33.33% Conclusions: Although our ASD patients had a high frequency of caries and dental treatment needs, we observed good adherence to the treatment, with a low dropout rate, and high discharge rate.

Oral Hygiene in Children with Autism: Teaching Self-Toothbrushing via Behavioural Intervention Including Parents

BACKGROUND/OBJECTIVES

Children on the autism spectrum experience more oral hygiene issues than peers, and tooth-brushing behavior seems particularly challenging for them since it includes diverse skills and collaboration. In this study, the efficacy is explored of a behavioral intervention mediated by staff and parents in teaching self-brushing teeth in eight autistic children. First, we wanted to examine whether the intervention improved self-brushing teeth skills in a short-term period. Second, we evaluated the long-term outcomes of the intervention. Finally, we analyzed the individual differences which might predict better outcomes.

METHODS

The training started during an ABA summer school with a supervised behavioral staff and lasted for eight sessions. The training package included several behavioral procedures such as prompting, fading, task analysis, chaining, differential reinforcement, direct instructions, visual aids, pictograms, and video modeling. According to a pre-and post-test design, we measured the frequency of independent self-brushing behaviors and interviewed the parents about the hygiene routines.

RESULTS

The results indicate a significant improvement in children's self-brushing teeth behavior and maintenance, where 33.7% of the steps were achieved by children at baseline and 77.5% at post-training, and with four children, 100%. The parent questionnaires reported significant improvement in autonomy of self-brushing and times a day dedicated to oral hygiene. The severity of symptoms, sensory hypersensitivity, and lower IQ levels of the children negatively correlated with the outcome.

CONCLUSIONS

These results point to relevant practical suggestions for families and clinical staff to address oral hygiene in the autism population.

The impact of community engaged healthcare education on undergraduate students' empathy and their views towards social accountability; a mixed methods systematic review

BACKGROUND

Many non-communicable diseases are rooted in social factors that determine health outcomes. Complex topics such as the social determinants of health are difficult to teach through traditional didactic methods. Since the introduction of the social accountability of medical schools' framework in 1995 by the World Health Organisation, healthcare education institutions are encouraged to shift their traditional education models towards a socially accountable approach. Community engagement can facilitate a deeper understanding of health inequity, barriers to health care, and the social determinants of health whilst enabling institutions to meet their obligation to the communities they serve. This systematic review aimed to answer the following question: ''What is the impact of community engaged healthcare education on undergraduate healthcare students' empathy and their views towards social accountability?''.

METHODS

This is a mixed-methods systematic review. The protocol was registered with PROSPERO (CRD42022306181). The following databases were searched: Scopus, MEDLINE, Embase, CINAHL, ERIC, BEI for primary research studies published from 1995 to September 2024. Grey literature was also searched via EThOS and Google. Studies recruiting undergraduate students of regulated healthcare professions in countries of very high development were included. A convergent integrated approach to synthesis was followed.

RESULTS

Out of the 19,590 papers yielded from the literature search, 76 met the inclusion criteria and were included in the review. The following subthemes were generated under three overarching themes: Social accountability (advocacy for action; giving back to the community; bigger picture-identifying social determinants of health and barriers to healthcare; barriers to social accountability), Empathy (humanise community members-everybody has a story; overcome bias and challenge attitudes, assumptions and stereotypes; cultural competence and sensitivity; empathetic communication and interpersonal skills; feeling sympathy and sadness), and Shaping the future workforce (future professional demeanour; professional interests; interprofessional education and collaboration).

CONCLUSIONS

Community engaged education can help students better understand community needs, social determinants of health, improve empathy and cultural sensitivity, and build advocacy for social justice and change.

Factors Influencing the Oral Health Behaviours of Autistic Children and Young People: A Qualitative Study

BACKGROUND

Poor oral health (OH) in childhood can cause pain, affect quality of life and significantly impact adult OH. Autistic children and young people (CYP) experience inequalities in OH and are at higher risk of cavities and gum disease than neurotypical CYP.

OBJECTIVE

To provide evidence and insights into the factors affecting the OH behaviours of ACYP from the perspective of ACYP, their parents/carers and Dental Health Professionals (DHPs).

METHOD

Semi-structured online or face-to-face interviews were conducted with CYP, parents/carers and DHPs in Southwest England.

RESULTS

Nineteen ACYP (aged 5-18 years old), 20 parents/carers and 16 DHPs were interviewed. The themes identified were as follows: Sensory sensitivities and diet; Toothbrushing 'battles'; Coping with the stresses of daily life in a neurotypical world; Awareness of autism and understanding of challenges to good OH; The impact on parents of trying to care their child's OH; CYP and parent/carers difficulties in obtaining OH support; What 'good support' looks like.

CONCLUSIONS

An increased awareness among DHPs, health and social care professionals of autism and the challenges to OH that CYP face is needed. Providing early support, strategies and resources to CYP and their parents/carers has the potential to help establish positive OH behaviours.

PUBLIC CONTRIBUTION

The research team worked closely with members of the autistic community on this project. The methods used in this project were developed together with a research advisory group which included four ACYP (aged 9-17) and their parents. The team also worked with members of a youth club for ACYP aged 10-17 years old. All research documents and materials were co-produced. Members of the advisory group (T.V. and I.V.) contributed to the interpretation of the research findings and the writing of this manuscript.

Parental Stress in Autistic Children with Poor Oral Hygiene: A Pilot Study to Develop and Validate a Measurement Scale

Background/Objectives: Research indicates that children with autism spectrum disorder (ASD) exhibit a deficiency in skills and initiative when it comes to adhering to daily oral hygiene routines. This, in turn, increases the likelihood of oral pathologies, thereby placing a significant emotional strain on their parents. In addition to the typical stress they already experience, parents of children with ASD are also burdened with pediatric oral health issues. However, a review of the literature reveals a lack of studies measuring stress in parents of children whose oral health affects their autistic condition. This research aimed to design and to validate a stress scale for parents of autistic children with poor oral hygiene. Methods: The study used an exploratory, non-experimental design to validate and determine the reliability of the scale. Scale reliability was assessed through a cross-sectional pilot test to evaluate internal scale consistency, with a focus on item similarity. We used Aiken's V to estimate the validity of the scale, and Cronbach's α for calculating scale reliability. Calculations, estimations, and statistical analysis were conducted using SPSS. Results: Expert validation, a pilot test, and a cross-sectional, non-experimental design established the reliability of the scale. Conclusions: We conclude that the 20-item scale exhibits validity (0.95) and reliability (0.965), ensuring its applicability in future research.

Effectiveness of two visual-pedagogical methods for toothbrushing skills in autistic children: A randomized clinical trial

AIM

This study aimed to compare the effectiveness of two visual pedagogy methods, video modeling and educational posters, on improving tooth-brushing autonomy in 10-12-year-old children with mild autism.

METHODS

Sixty-four autistic children were randomly assigned to either the video or poster groups using the Rand function in Excel. Toothbrushing skills were divided into five stages: preparation, buccal, occlusal, lingual surfaces, and the end. These five stages comprised a total of 20 steps, with each step scored from 1 (not done at all) to 5 (done independently). The final score was calculated by averaging the scores of the five stages. The FONES method of toothbrushing was used for training. Follow-up assessments were conducted after 1 and 3 months. The data were analyzed using SPSS V26, including t-tests, Mann-Whitney U tests, and repeated-measures ANOVA.

RESULTS

After 3 months, there were significant improvements in autonomy scores for both groups, with the video group showing greater benefits (4.37 ± 0.43) compared to the poster group (4.11 ± 0.49) (p = .03), with an effect size of η2 = .07.

CONCLUSION

Both video and poster methods were effective in improving tooth-brushing skills, but video modeling was associated with a higher total autonomy score.

The use of air abrasion method to treat caries in autistic patients at the age of 6 years: A non-randomized controlled trial

BACKGROUND

Autism Spectrum Disorders (ASD) encompass a range of conditions characterized by difficulties in social interaction and communication. Managing dental treatment for children with autism presents challenges due to their reluctance to interact with dentists, which can be as high as 65%.

OBJECTIVES

This prospective non-randomized study, conducted at the Kazakh-Russian Medical University from January 15, 2023, to June 20, 2023, aimed to assess the efficacy of air abrasion caries treatment (AAbCT) compared to the standard method.

INTERVENTION

The intervention involved applying air abrasion (AAb) treatment without anesthesia using aluminum oxide powder in the AAbCT group, while the control group received cavity preparation with local anesthesia.

RESULTS

In this study, it was noted that the AAb method of tooth preparation was not different in efficacy from the traditional method for a population of children with autism, and could be used without anesthesia. A greater willingness to cooperate was noted (p = .0372).

CONCLUSION

The AAb is an effective and safe treatment for children with ASD. Further studies needed to investigate its efficacy and safety in combination with behavioral interventions.

Level of support/commitment and behavior during mealtime and dental care negatively impact the dental caries prevalence in autistic individuals: cross-sectional study

OBJECTIVE

To verify whether factors associated with Autism Spectrum Disorder (ASD) would have impact on the dental-caries prevalence.

MATERIALS AND METHODS

All ASD-individuals receiving care in a specialized center with minimum of 4y old were recruited. Demographic, socioeconomic and behavioral characteristics, level of support/commitment (Childhood Autism Rating Scale), mealtime behavior (Brief Autism Mealtime Behavior Inventory) and medication use were answered by ASD-individual's parents. Behavior during dental care was evaluated from Frankl scale. Dental-caries prevalence was the primary outcome. Three examiners calibrated/trained collected the data. Chi-square test was used to compare the variables impact on the dental-caries prevalence.

RESULTS

61 ASD-individuals were potentially eligible, and the all parents/guardians consent to participate. Dental-caries prevalence was 42.9%, which was statistically associated with lower toothbrushing frequency, higher level of support/commitment, and worse behavior at meals and during in dental care. Dental-caries prevalence was approximately higher twice in ASD-individuals: (i) uncooperative with dental care when compared those cooperative (62% versus 32%, respectively); (ii) with severe level of support when compared to those with mild/moderate level (58% versus 28%, respectively); and (iii) with worse mealtime behavior when compared to those with better behavior (59% versus 28%, respectively). A medium statistical correlation was observed between support level and mealtime behavior (rS=0.39). The BAMBI component statistically associated with dental-caries prevalence was the food refusal (capture problem when a child rejects a presented food, crying, spitting out food).

CONCLUSION

higher required level of support, worse mealtime behavior and uncooperative profile in dental care negatively affect the dental-caries prevalence.

CLINICAL RELEVANCE

our findings provide evidence of the need of specialized, preventive and individualized dental care among ASD-individuals.

Oral Health Behaviour, Care Utilisation, and Barriers among Students with Disabilities: A Parental Perspective

BACKGROUND

Oral health is a critical component of overall well-being. However, students with disabilities (SWDs) face unique challenges in maintaining oral hygiene and accessing dental care. This study aims to explore oral health behaviours, dental care utilisation, and barriers to accessing dental care among SWDs in Al-Ahsa, Saudi Arabia, from the perspectives of their parents.

METHODS

A descriptive cross-sectional study was conducted among parents of SWDs in Al-Ahsa, Saudi Arabia. Data were collected using a validated questionnaire covering oral health behaviours, dental care utilisation, and barriers to care. The sample size was determined based on the SWDs population in the region. Data were analysed using descriptive and analytical statistics, with significant associations identified at p < 0.05.

RESULTS

Findings revealed that 45.7% of SWDs brushed irregularly, with only 16.8% brushing twice a day or more. Dental flossing was reported by just 4.3% of SWDs. Emergency-based dental visits were common (51.9%), and 29.5% of SWDs had never visited a dentist. Significant associations were found between maternal education and tooth brushing frequency (p = 0.004) and between parental education and the frequency of dental visits (p = 0.035). The most reported barriers included fear of treatment (47.1%), difficulty finding willing dentists (45.5%), and long wait times for appointments (44.7%).

CONCLUSIONS

The study emphasises the pressing need for targeted interventions to improve oral hygiene practices and enhance accessibility to dental services for SWDs.

The Use of Audiovisual Distraction Tools in the Dental Setting for Pediatric Subjects with Special Healthcare Needs: A Review and Proposal of a Multi-Session Model for Behavioral Management

BACKGROUND

A Special Health Care Need (SHCN) is characterized by any type of physical, mental, sensorial, cognitive, emotional, or developmental condition that requires medical treatment, specialized services, or healthcare interventions. These conditions can negatively impact oral health as SHCN children can hardly cooperate or communicate and experience higher levels of dental fear/anxiety, which interfere with regular appointments. The present narrative review aims to analyze the use of audiovisual (AV) tools in dental setting for the management of SHCN children during dental treatment and to evaluate their effectiveness in anxiety/behavior control from the child, dentist, and care-giver perspectives. This analysis leads to the proposal of a new multi-session model for the behavioral management of SHCN pediatric subjects.

METHODS

An electronic search on the MEDLINE/Pubmed, Scopus, and Web of Science databases was carried out and through this analysis, a new model was proposed, the "UNISA-Virtual Stepwise Distraction model", a multi-session workflow combining traditional behavior management and the progressive introduction of AV media to familiarize the SHCN child with dental setting and manage behavior.

RESULTS

AV tools helped in most cases to manage SHCN behavior and decreased stress in both the dentist and child during dental treatments. Care-givers also welcomed AV distractors, reporting positive feedback in using them during future treatments.

CONCLUSIONS

The present narrative review found increasing evidence of the use of AV media for SHCN pediatric subjects as distraction tools during dental treatment. In the majority of the studies, AV tools proved to be effective for the management of anxiety, dental fear, and behavior in dental setting.

Dental Hygiene Challenges in Children with Autism: Correlation with Parental Stress: A Scoping Review

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.

Barriers and mediators for routine dental care visits from the experiences of immigrant parents of autistic children living in the United States

INTRODUCTION

Immigrants are reluctant to attend routine dental care visits. Moreover, children with autism have a higher chance of developing periodontal disease. In this study, we describe the experiences of immigrant parents with autistic children and the barriers and mediators to routine dental care visits for their children in the United States.

METHOD

We conducted semistructured interviews with 19 immigrants who have children with autism.

RESULTS

We found that lack of transportation, support system, and insurance; prioritization of basic needs; and a mistrust of healthcare providers are the main barriers to attending routine dental care visits for autistic children of immigrant parents. Moreover, staff who consider the needs of children with autism, spend ample time with children with autism, and help with navigating the health system can improve access to routine dental care visits for autistic children with immigrant parents. This study found that despite their immigration status, all parents want to see improvements in the oral health of their children with special needs.

CONCLUSION

This study aimed to unpack the structural barriers and mediators to routine dental care visits for autistic children of immigrant parents. We found that removing structural barriers to care and utilizing mediators will enhance the outcome of routine dental care, resulting in healthier oral hygiene.

Use of an adaptive sensory environment in patients with autism spectrum disorder (ASD) in the perioperative environment: a parallel, randomized controlled trial

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.

Dental core training in community dental services

Community dental services (CDS) provide dental treatment for patients who cannot gain access or have treatment with their general dental practitioner. This includes groups of patients who are dentally phobic, medically compromised, or with physical or learning disabilities.This paper provides insight into the experience and the challenges of working in CDS as a dental core trainee (DCT). The post involves an equal split in the management of paediatric and special care dental patients.Patients seen in CDS can be split into cohorts such as paediatric, special care adults, dental anxious and others. Case discussions throughout the paper will illustrate commonly seen scenarios and exemplify patient management pathways though the service.NHS England Education provide training for DCTs through study days which focus on dental disciplines specific to their post.

A Scoping Review of the Oral Health Status, Oral Health Behaviours and Interventions to Improve the Oral Health of Children and Young People in Care and Care Leavers

BACKGROUND

Children and young people (CYP) in care experience poorer physical health and overall wellbeing in comparison to their peers. Despite this, relatively little is known about what their oral health needs and behaviours are. The aim of this scoping review was to provide a global perspective on the oral health status and behaviours of CYP in care and care leavers. It also aimed to synthesise interventions that have been trialled in this population to improve oral health.

METHODS

Five databases were searched, Ovid Embase, Ovid MEDLINE, CINAHL (EBSCOhost), SocINDEX (EBSCOhost) and Dentistry and Oral Sciences Source (EBSCOhost), alongside grey literature sources up to January 2023. Eligibility criteria were studies that (i) reported on children and adolescents aged 25 years or younger who are currently in formal/informal foster or residential care and care leavers, (ii) pertained to oral health profile, behaviours or oral health promotion interventions (iii) and were published in the English language. Thematic analysis was used to develop the domains for oral health behaviours and interventions.

RESULTS

Seventy-one papers were included. Most papers were published from very high or medium Human Development Index countries. CYP in care were found to experience high levels of decay, dental trauma, periodontal disease and poorer oral health-related quality of life. Oral health behaviours included limited oral health self-care behaviours and a lack of oral health-based knowledge. The trialled interventions involved oral health education, supervised brushing and treatment or preventative dental care.

CONCLUSIONS

This scoping review reveals that CYP in care experience poorer oral health in comparison to their peers. They are also less likely to carry out oral health self-care behaviours. This review highlights a scarcity of interventions to improve the oral health of this population and a paucity of evidence surrounding the oral health needs of care leavers.

Oral Health Statuses of Children and Young Adults with Autism Spectrum Disorder: An Umbrella Review

This study aimed to comprehensively evaluate the oral health statuses of children and adults within the autism spectrum disorder (ASD) population through an umbrella review approach. The prevalence of dental caries, periodontal disease, and associated variables were investigated across selected studies. A systematic search was conducted across databases including PubMed, Scopus, EMBASE, Science Citation Index, Science Direct, Web of Science, MEDLINE, and Wiley Online Library to identify relevant studies. The assessed variables included dental caries prevalence, periodontal disease prevalence, oral hygiene indicators, and the necessity of dental treatment. The pooled prevalence rates, odds ratios, and standardized mean differences were calculated where applicable. The pooled prevalence of dental caries among ASD individuals ranged from 60.6% to 67.3%, while the periodontal disease prevalence ranged from 59.8% to 69.4%. High rates of dental treatment under general anesthesia were reported. Heterogeneous dental caries and periodontal disease prevalence rates were identified, highlighting the need for collaboration and preventive care. Several studies also reported higher prevalence rates of dental trauma and self-inflicted oral injuries among individuals with ASD. However, the review also identified significant methodological limitations in the included studies, including inconsistency in oral health assessment methods and potential bias. The necessity for targeted policies due to high prevalence rates and the requirement for integrated care systems in high DMFT regions were also observed. The umbrella review synthesized diverse findings, revealing variations in dental caries and periodontal disease prevalence among ASD individuals. This review underscores the need for tailored interventions and policies to address oral health disparities. It highlights the necessity of integrated care systems, methodological improvements, and longitudinal studies to comprehensively address the multifaceted oral health challenges within the ASD population.

Behavioral guidance for improving dental care in autistic spectrum disorders

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.

Development and evaluation of an individualised dental habituation programme for children with autism spectrum disorder living in Rogaland, Norway

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.

Insights on dental care management and prevention in children with autism spectrum disorder (ASD). What is new?

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.