Oral Health of Children with Autism: The Influence of Parental Attitudes and Willingness in Providing Care

Clustering of children's oral diseases in families and villages in a rural setting in Egypt

BACKGROUND

This study assessed the clustering of children' caries experience, plaque accumulation and gingival inflammation in families and villages in Northwestern Egypt and the factors related to the severity of these conditions.

METHODS

This was a secondary analysis of a 2019 household survey of children in villages around Alexandria, Egypt. Clinical examination assessed primary and permanent teeth caries experience (dmft/ DMFT using the World Health Organization criteria), plaque accumulation (Plaque Index (PlI)) and gingival inflammation (Gingival Index (GI)). A child questionnaire assessed child's age, sex, the frequency of toothbrushing (at least twice daily versus less) and frequency of consuming eight types of sugary products (daily sugar consumption score, sum of sugary products consumed daily). Mothers' questionnaire assessed the number of children in the family, mother's education (at least high school versus less), at least twice daily toothbrushing and daily sugar consumption similar to the child. Multilevel regression analyses assessed clustering, calculated by the intraclass correlation coefficient (ICC) of the three conditions in families and villages. Regression estimates (B) and 95% confidence intervals (CIs) of individual and family factors were calculated.

RESULTS

Complete data were available for 450 children (246 families, seven villages], mean = 9.9 years-old and 56% females. The mean caries experience score = 3.6, mean plaque index = 1.5 and mean gingival index = 1.2. Caries experience, plaque accumulation and gingival inflammation were not clustered in villages (ICC < 0.01) but clustered in families (ICC = 0.10, 0.44 and 0.29). Child factors significantly improved model fit for caries experience and gingivitis (p < 0.001) but not plaque accumulation (p = 0.90). Family factors did not improve any model fit (p > 0.05). Child's age was significantly associated with caries experience (B= -0.48, p < 0.001) and gingival inflammation (B = 0.032, p < 0.001). Children who brushed their teeth twice daily had significantly more caries experience (B = 1.04, p = 0.01).

CONCLUSION

The three oral conditions were not clustered in villages but clustered in families. Plaque accumulation showed the greatest within-family clustering. Family factors were not associated with the three conditions and individual factors indicated the need for interventions to promote preventive behaviors and identify families at risk of oral conditions.

Prenatal maternal stress and the severity of autism spectrum disorder: A cross-sectional study

Autism spectrum disorder (ASD) is a neurodevelopmental disorder linked to several genetic and environmental factors including antenatal stress. Hence, we aimed to examine whether a mother's stress during pregnancy is associated with the severity of autism spectrum disorder in children. The study was conducted with 459 mothers of children with autism (aged 2-14 years) who were attending rehabilitation and educational centers in the two major cities of Makkah and Jeddah in Saudi Arabia. Environmental factors, consanguinity, and ASD family history were assessed using a validated questionnaire. The Prenatal Life Events Scale questionnaire was used to assess whether the mothers were exposed to stress during pregnancy. Two models of ordinal regression analysis were conducted including gender, child age maternal age, parental age, maternal education, parental education, income nicotine exposure, mother taking medication during pregnancy, family history of ASD, gestation, consanguinity, exposure of prenatal life events (in model 1), and severity of prenatal life events (in model 2). Family history of ASD showed a statistically significant association with the severity of ASD in both regression models (p = .015, odds ratio [OR]: 4.261 in Model 1, and p = .014, OR: 4.901 in model 2). In model 2, the moderate severity prenatal life events showed higher statistically significant adjusted odds ratio for ASD severity compared to no stress (p = .031; OR: 3.82). Within the limitations of this study, prenatal stressors showed some potential contribution to ASD severity. Family history of ASD was the only factor that showed a persistent association with ASD severity. A study that assesses the effect of COVID-19 stress on ASD prevalence and severity is recommended.

PREVALENCE OF GINGIVITIS IN CHILDREN WITH AUTISM SPECTRUM DISORDERS (ASD)

OBJECTIVE

The aim: To evaluate and compare the prevalence of gingivitis according to the PMA index in children aged 5 to 6 years in preschool with ASD and without disorders (Kyiv, Ukraine).

PATIENTS AND METHODS

Materials and methods: Oral assessment was conduct on 69 children with ASD and 23 children without ASD aged 5 to 6 years. To determine the periodontal status it was used the papillary-marginal-alveolar index - PMA (according to Schour, Massler, in the modification of Parma).

RESULTS

Results: Children with ASD (18.84%) were 3.7 times less likely to have a clinically healthy periodontium than children without disorders (69.57%). The average PMA index among the main group was 6.8 times higher (15.31 ± 1.49%) than in the control group (2.25. ± 0.73%), but this difference was not statistically confirmed (p> 0.05). The most common pathology of periodontal tissues was chronic catarrhal gingivitis. 49.28% of children in main group with ASD had mild catarrhal gingivitis, while just 30.47% of children in control group without ASD had this pathology. Catarrhal moderate gingivitis was diagnosed in 31.88% of children from main group, symptoms of moderate gingivitis were not detected in the control group without disorders.

CONCLUSION

Conclusions: ASD children 5-6 years old may have major risk of developing such periodontal lesions as mild and moderate gingivitis. Further investigations need to be done to clarify prevalence of other oral pathologies in ASD individuals to understand the effect of the disorder on oral health.

Oral Health Status, Oral Health Behaviors, and Oral Health Care Utilization among Persons with Disabilities in Saudi Arabia

Various studies have indicated that persons with special needs may face several barriers to dental treatment, which increases the prevalence of oral diseases in this population. Moreover, these studies suggested that Saudis with special needs have a higher prevalence of oral diseases, such as dental caries and periodontal disease. The aim of this review is to synthesize evidence regarding the current status, trends in oral health behaviors, and oral health care utilization among these individuals, as well as to assess the quality of the literature. Furthermore, this review seeks to recommend directions for future research and oral health care policymaking. An electronic search was conducted using the following databases and registers: PubMed/Medline, Embase, ISI Web of Science, Scopus, ClinicalTrials.gov, and CENTRAL. Gray literature, which included conference proceedings and unpublished literature, was searched via the library services and Google/Google Scholar, and the quality of studies was assessed using the AXIS scale for cross-sectional studies. A total of 38 studies were included in this review, with the majority of the studies graded as 'low'. Within the limitations of this study, it can be concluded that individuals with special needs have limited access to oral health care, poor oral health status, and a general lack of awareness in regard to oral health. Therefore, nationwide surveys should be carried out to ascertain the actual extent of the oral inequities among individuals with special needs.

Family Influences on the Dental Caries Status of Children with Special Health Care Needs: A Systematic Review

Oral health is a likely source of health inequalities in children with special health care needs (CSHCN), according to multiple studies. This systematic review aimed to explore the evidence of family influence—as well as family features, such as societal variables and parents’ perspectives—on these children’s dental caries status. Embase, Ebsco, Scopus, PubMed, and Web of Science databases were all searched. All cross-sectional research published on the variables of family impact ranging from 2010 to 2021 were considered. The DMFT and dmft index was utilised for the report data of dental caries, whereas the National Heart, Lung, and Blood Institute (NHLBI) was used for the purposes of assessing quality. Of the 3861 records identified, 14 were eligible. Further, most of the studies had a caries prevalence of over 50%, (p-value < 0.005). Family influences imparted a significant relationship and association towards the dental caries status of the demographic being studied. The influences on the children included tooth brushing behaviour, parents’ education level, parents’ occupation level, diet pattern, dental visit, snacking frequency, parents’ psychological status, family size, and parents’ knowledge towards oral health. Future research should further explore the family functioning domains, specifically among the CSHCN population. This study was registered on PROSPERO, number CRD42021274923.

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.

Dental experiences related to oral care of children with autism spectrum disorders in Saudi Arabia: A literature review

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.