Article

The Caries Experience and Behavior of Dental Patients With Autism Spectrum Disorder

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Abstract

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. The authors conducted a study to evaluate the demographics, caries experience and behavior of patients with ASD and compare these characteristics with those of patients without ASD (unaffected patients). The authors reviewed patients' charts and identified a group of 395 patients with ASD and a group of 386 unaffected patients. They obtained the following patient data for analysis: primary diagnosis, age, sex, residence (home versus institution or group home), presence of seizure disorder, additional diagnosis (mental retardation, cerebral palsy, self-injurious behavior or pica), medications, caries prevalence, caries severity and behavior. The ASD group had a male:female ratio of 4:1, and patients had a diagnosis of autism, pervasive developmental disorder-not otherwise specified or Asperger syndrome. Sex distribution was equal in the unaffected group, which was younger and had a higher decayed, missing and filled teeth (DMFT) score than did the ASD group. When the authors controlled for age and sex, they noted a statistically significant association between ASD and dental caries prevalence. A significantly higher percentage of patients with ASD than unaffected patients were uncooperative and required dental treatment to take place under general anesthesia. Caries prevalence and severity in patients with ASD were not associated with institutionalization, presence of seizure disorder or additional diagnosis. People with ASD were more likely to be caries-free and had lower DMFT scores than did their unaffected peers. Significantly more patients with ASD than unaffected patients were uncooperative and required general anesthesia to undergo dental treatment.

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... For example, a few researchers reported no significant differences in the prevalence of caries degree, oral hygiene and gingivitis [Backman and Pilebro, 1999;Fahlvik and Herrstrom, 2001;Desai et al., 2001]. Some other researchers, on the other hand, reported lower incidences of dental caries [Loo et al., 2008;Kedzierawski and Auinger, 2008;Namal et al., 2008], but a higher rate of periodontal diseases for the autistic children [Vajawat and Deepika, 2012]. Therefore, it is seen that the literature provided inconclusive answers concerning whether autism is a risk factor for oral, gingival and dental health status of children. ...
... Some researchers found that dental caries experience of autistic children was higher than that of healthy children [Marshall et al., 2010, Jaber et al.,2011. Some researchers have reported that the incidence of caries was lower in autistic children compared to healthy children [Vajawat and Deepika, 2012;Loo et al., 2008;Kedzierawski and Auinger, 2008;Namal et al., 2008]. Shapira et al. [1989] also stated that the dental caries values were similar between autistic and healthy children. ...
... Prevalence of caries was significantly lower in the autistic children than the healthy children in this study. This result was consistent with the results from other authors [Namal et al., 2008;Jaber et al., 2011;Loo et al., 2008;Vajawat and Deepika, 2012]. Lower caries prevalence in autistics could be related to the assistance by the parents and caregivers and less snacking. ...
Article
Aim: The aim of the present study was to comparatively evaluate the oral health status and influential factors, brushing, developmental and orthodontic disorders, bruxism, drug intake, sweet eating habits, sociodemographic factors and lifestyles of autistic and healthy children. Participants in this study were greater in number compared to the previous studies investigating the same phenomenon. Furthermore, it was a more comprehensive study than other studies in the literature in terms of number of variables included. Methods: The study was carried out with a total of 407 participants, 285 autistic (test group) and 122 healthy children (control group). The ages ranged from 5 to 16. A total of 407 children were examined. DMFT, dmft, plaque index, dental trauma, oral symptoms, developmental and orthodontic disorders of these children were recorded. Participants were also asked to fill a two-part questionnaire. The first part included questions related to the child's and parents' demographics such as the child's age, gender, number of siblings, the mother's and father's age, education, occupation and income. The second part included questions related to systemic diseases, drug intake, the dental history of children and their parents, brushing and nutrition habits. Results: The results from the inferential statistics showed that both DMFT and dmft indices values of the autistic children were lower than those of the healthy children. Caries prevalence of the autistic children was lower compared to the control group. There was also no difference in the plaque index values between the two groups. Drooling of saliva of the autistic children was higher than that of the healthy children. The results showed statistically significant differences between the two groups regarding bruxism, deep-palate and tongue thrusting, though no statistically significant differences were found between the two groups regarding open bite. However, significant differences were observed in terms of dental crowding between the two groups in that the healthy children had more dental crowding than the autistic children. Conclusion: One of the main findings of the study was observed in relation to caries prevalence in that autistics had lower caries prevalence values than controls. Another main finding was that no statistically significant differences were found in terms of plaque index values when the groups were compared. When the findings related to deep palate, open bite and dental crowding were examined, it was seen that deep palate was higher but dental crowding was lower in the autistic children. However, in this study there were no statistically significant differences between the two groups in terms of open bite.
... When analysing the articles selected, the evidence turned out did not show a common DFMT for the groups of children affected by Autism Spectrum Disorder considered. When compared to group of unaffected children, groups of ASD children not always showed a higher incidence of caries, sometimes it was higher, (1,4,11,20) sometimes lower (7,9,13,22). ...
... In some of the articles it was just taken into consideration a first examination, but in four of them, where the treatment was performed and taken into consideration, there was a high incidence of necessity of General Anaesthesia due to the lack of collaboration of the children (7,10,13,21). ...
... As predictable, Subramaniam et al. (21) reported a negative or definitely negative behaviour in 65% of the cases with ASD, Loo et al. (13) reported 55.6% of cases with negative or definitely negative behaviour over the total ASD children examined and El Khatib et al. (8) a 48% of cases in the same class of behaviour. ...
Article
Purpose: To investigate the prevalence of dental caries and periodontal disease in children with ASD, and to analyse the necessity of treatment and the prevalence of using general anaesthesia in order to perform it. Materials and methods: A search was performed covering the last 10 years utilising the following databases: Pubmed, Scopus, Medline, BASE, Science Citation Index, Science Direct, Web of Science. Four reviewers evaluated each study. Review findings were summarised using the PRISMA Statement for reporting. Thirteen articles were included in this systematic review. Results: When analysing the articles selected, the evidence turned out did not show a common DFMT and dmft for the groups of children affected by Autism Spectrum Disorder considered. When compared to group of unaffected children, groups of ASD children not always showed a higher prevalence of caries but always higher Periodontal Indexes (PI and GI), resulting in higher prevalence of periodontal disease. Where the treatment was performed and taken into consideration, there was a high incidence of necessity of General Anaesthesia due to the lack of collaboration of the children. Conclusion: The high prevalence of treatment under general anaesthesia and the often-reported negative behaviour evidence how there is a lack of protocols specifically designed for these patients, in order to better improve their collaboration and subsequently their oral health and so additional strategies for a preventive care should be applied for these patients.
... Moreover, many parents refrain taking their ASD children to the dentist because of children's extremely uncooperative behavior, and the consequent augmentative expense of dental care, including the potential of dental treatment under general anesthesia (Jaber 2011;Kopycka-Kedzierawski and Auinger 2008;Loo et al. 2008). Thus, ASD children's oral health may be neglected due to their special needs, lack of cooperation or communication, and/or limited access to professional dental care (Ferrazzano et al. 2020). ...
... About 31% of ASD children who had been to a dentist (n = 94), had no dental treatment, while 14% had dental treatment with nitrous oxide, and 35% had dental treatment under general anesthesia. These findings are in compliance with previous reports among ASD children of having dental treatment with nitrous oxide (10%) (Murshid 2014), and 25-37% under general anesthesia (Loo et al. 2008;Murshid, 2011Murshid, , 2014. ...
... Dental treatment under general anesthesia is more indicated in ASD children and should be considered when other treatment alternatives fail. Parents of ASD children seem to have a confidence towards dental treatment under general anesthesia due to the impaired behavior and uncooperation of their children, despite costs and risks (Loo et al. 2008(Loo et al. , 2009Marshall et al. 2008). ...
Article
Full-text available
Aims were to: (1) investigate the parental difficulties toward their ASD children dental care and, (2) analyze factors influencing their access to such services. Questionnaires were completed by 142 mothers of ASD children. Children aged between 2.5 and 14 years old, with 3.9:1 male to female ratio. 68.3% perceived difficulties in finding dental care. Most barriers were: Cost (75.4%), finding a dentist to treat ASD child (74.6%), and behavior of their ASD child (45.1%). There was no difference among age and “difficulty finding dental care” (p = 0.429). Having medical insurance and previous bad experience showed significant effects on the difficulty in finding dental care (p < 0.05). Children with ASD and their parents encounter various barriers to dental services.
... Many studies have investigated the oral health status of children with ASD either as a single group or in comparison with the general population [5][6][7][8][9][10]. Studies on the prevalence of dental caries in ASD children are controversial. ...
... Studies on the prevalence of dental caries in ASD children are controversial. Some studies reported lower prevalence of caries in patients with ASD; [6,9] and others reported a higher rate of caries among children with ASD, [5,7] while in one study, no association between the risk of caries and ASD was found [10]. On the other hand, in several studies, poor oral hygiene and the resulting periodontal disease were reported to be prevalent among children with ASD [5,7,8,10]. ...
... In the current study, the prevalence of dental caries in primary and e Scientific World Journal 5 permanent dentitions was 76% and 68%, respectively, which could have been mainly due to poor oral hygiene observed among participants since 22.7% did not brush at all and 61.3% did not floss. However, neither sugar consumption nor oral hygiene practices were associated with dental caries among the participants, and previous studies have also failed to detect any significant associations between caries and oral health practices among ASD children [4][5][6][7][8][9][10]. Several studies conducted worldwide on ASD individuals have shown that children with ASD have either statistically higher, lower, or similar caries status when compared with nonautistic children [5-10, 12, 25]. ...
Article
Full-text available
Objectives. Parents play a crucial role in health-related practices of children with autism spectrum disorder (ASD). &is study assessed the association between oral health status and oral health practices of children with ASD in relation to their parental attitudes and comfort in providing oral care. Methods. &is cross-sectional study included 75 children with ASD attending the special needs schools in Eastern Saudi Arabia from 2015–2018. Parents responded to a self-administered questionnaire assessing their attitudes toward oral health and comfort in providing oral care for children. &e clinical examination assessed dental caries (decayed, extracted, and filled: (DMF and def)), gingival disease, and plaque accumulation. &e Pearson correlation coefficient was used to assess the relationship between the study variables, while ANOVA followed by post hoc was used to assess the differences. Results. Prevalence of dental caries in primary teeth was 76% and 68% in the permanent dentition with a mean of 0.85 ± 1.9 and 1.03 ± 2.9, respectively. &irty-one participants had gingival problems, mean gingival index was 1.03 ± 0.88, and mean plaque index was 0.95 ± 0.43. Half of the parents supervised their children’s brushing, which was significantly associated with plaque accumulation (p = 0.004), gingival disease (p < 0.0001), and def (p = 0.02). Parental attitudes and comfort in providing oral health care were not associated with oral health status of ASD children; however, positive parental attitudes were associated with lower sugar consumption (p = 0.043). An inverse correlation was observed between comfort in providing oral health care with gingival and plaque scores r = −0.18 and −0.23, respectively. Conclusions. &e data are indicative of poor oral health practices and status among ASD children. Parents’ oral health care practices seem to be reactive rather than proactive. Positive parental attitudes were associated with lower sugar consumption. Greater comfort in providing care was negatively correlated with plaque accumulation and gingival problems.
... Many studies have investigated the oral health status of children with ASD either as a single group or in comparison with the general population [5][6][7][8][9][10]. Studies on the prevalence of dental caries in ASD children are controversial. ...
... Studies on the prevalence of dental caries in ASD children are controversial. Some studies reported lower prevalence of caries in patients with ASD; [6,9] and others reported a higher rate of caries among children with ASD, [5,7] while in one study, no association between the risk of caries and ASD was found [10]. On the other hand, in several studies, poor oral hygiene and the resulting periodontal disease were reported to be prevalent among children with ASD [5,7,8,10]. ...
... In the current study, the prevalence of dental caries in primary and e Scientific World Journal 5 permanent dentitions was 76% and 68%, respectively, which could have been mainly due to poor oral hygiene observed among participants since 22.7% did not brush at all and 61.3% did not floss. However, neither sugar consumption nor oral hygiene practices were associated with dental caries among the participants, and previous studies have also failed to detect any significant associations between caries and oral health practices among ASD children [4][5][6][7][8][9][10]. Several studies conducted worldwide on ASD individuals have shown that children with ASD have either statistically higher, lower, or similar caries status when compared with nonautistic children [5-10, 12, 25]. ...
Article
Full-text available
Objectives. Parents play a crucial role in health-related practices of children with autism spectrum disorder (ASD). This study assessed the association between oral health status and oral health practices of children with ASD in relation to their parental attitudes and comfort in providing oral care. Methods. This cross-sectional study included 75 children with ASD attending the special needs schools in Eastern Saudi Arabia from 2015–2018. Parents responded to a self-administered questionnaire assessing their attitudes toward oral health and comfort in providing oral care for children. The clinical examination assessed dental caries (decayed, extracted, and filled: (DMF and def)), gingival disease, and plaque accumulation. The Pearson correlation coefficient was used to assess the relationship between the study variables, while ANOVA followed by post hoc was used to assess the differences. Results. Prevalence of dental caries in primary teeth was 76% and 68% in the permanent dentition with a mean of 0.85 ± 1.9 and 1.03 ± 2.9, respectively. Thirty-one participants had gingival problems, mean gingival index was 1.03 ± 0.88, and mean plaque index was 0.95 ± 0.43. Half of the parents supervised their children’s brushing, which was significantly associated with plaque accumulation ( = 0.004), gingival disease ( < 0.0001), and def ( = 0.02). Parental attitudes and comfort in providing oral health care were not associated with oral health status of ASD children; however, positive parental attitudes were associated with lower sugar consumption ( = 0.043). An inverse correlation was observed between comfort in providing oral health care with gingival and plaque scores r = −0.18 and −0.23, respectively. Conclusions. The data are indicative of poor oral health practices and status among ASD children. Parents’ oral health care practices seem to be reactive rather than proactive. Positive parental attitudes were associated with lower sugar consumption. Greater comfort in providing care was negatively correlated with plaque accumulation and gingival problems. 1. Introduction Autism spectrum disorder (ASD) refers to a variety of complex neurodevelopmental disorders that include impairments in three different areas: communication, social interaction, and affinity for repetitive behavioral patterns [1]. ASD typically presents during the first three years of life and usually affects males more than females [2]. Recent estimates by the World Health Organization (WHO) show that the global prevalence of ASD is 1 : 160 people [3], while the prevalence in Saudi Arabia is 1 : 167 [4]. Many studies have investigated the oral health status of children with ASD either as a single group or in comparison with the general population [5–10]. Studies on the prevalence of dental caries in ASD children are controversial. Some studies reported lower prevalence of caries in patients with ASD; [6, 9] and others reported a higher rate of caries among children with ASD, [5, 7] while in one study, no association between the risk of caries and ASD was found [10]. On the other hand, in several studies, poor oral hygiene and the resulting periodontal disease were reported to be prevalent among children with ASD [5, 7, 8, 10]. Most studies have reported less frequent brushing in children with ASD than in normally developing children, which in most cases was carried out by parents or is done under parental supervision [10]. Self-mutilation practices, ASD medications, and lack of oral hygiene practices may result in the deterioration of oral health with a negative impact on nutritional status, quality of life, and overall well-being of an ASD child [11, 12]. Proper oral care at home and in the dental office is necessary to improve the oral health of children with ASD. Their impaired behavioural activities and complicated medical condition make the dental management of patients with ASD challenging [12]. Furthermore, the invasive nature of dental care and hypersensitivity of children with ASD to sensory stimulation (sound, touch, and light) may trigger violent and undesired responses during dental treatment [13]. In a recent qualitative study in which parents and dentists report of successful strategies implemented during dental care for ASD children were examined, and most of the interviewed dentists valued the parental role in their children’s oral health and the success of dental visits [14]. On the other hand, many problems have been reported by parents regarding oral health care of their ASD children. The most reported challenges were finding specialized dentists and difficulty in accessing dental care [15]. Parents also reported difficulties in brushing the teeth of the ASD children due the sensory sensitivities of their children, and the unpredictable -sometimes aggressive-behaviour that may require physical restraints [16, 17]. Parents of children with ASD are as such subject to physical, financial, and psychological burdens. Time pressures, greater necessity for parenting, increased investment in healthcare, and scarcity of medical aid coverage collectively may result in more fatigue, stress, and anxiety among ASD parents [18]. On the other hand, children with ASD are dependent mainly on their parents for their daily needs, dietary choices, and general and oral hygiene [11]. Negative parental attitudes toward oral health were found to be associated with deterioration of their children’s oral health [19, 20]. As such, a parent’s positive attitude towards the oral health of a child with ASD can be a strong predictor of a child’s favourable oral health. However, there is limited research investigating parental factors and their impact on the oral health of children with ASD. Therefore, the present study aimed to assess the association between oral health status and oral health practices of children with ASD in relation to their parents’ attitudes and comfort in providing oral care. 2. Materials and Methods This cross-sectional study included children with ASD attending special needs schools in the Eastern province of Saudi Arabia from 2015 to 2018. Eligible participants fulfilled several criteria: (1) regular attendees of schools, (2) received a diagnosis of ASD by a paediatrician, medical specialist, and/or psychologist, and (3) age between 6 and 18 years. The study was approved by the Imam Abdulrahman University Ethics Committee (IRB-2014-02-030), and access to schools was arranged through the Ministry of Education, Eastern Province sector, in four main regions: Dammam, AlKhobar, Dhahran, and Al-Qatif. These areas had a total of 17 special needs schools. Of these, four schools had attendees under the age of five years (kindergarten) and therefore were excluded. A total of 13 schools were selected with seven schools in Dammam, three in Al-Qatif, one in Dhahran, and two in AlKhobar. A self-administered Arabic questionnaire was developed for the purpose of this study based on the previous studies [5, 7, 8]. The questionnaire was pilot-tested and sent to parents along with a consent form and an explanatory letter through school administrations. The questionnaire was divided into four sections: (1) demographic information (sex, age, and age at diagnosis), (2) their child’s oral health practices (brushing, flossing, and sugar consumption), (3) the parents’ attitudes towards their child’s oral health using 8 positive attitude items and 7 negative attitude items to which parents agreed on a 5-point Likert scale (ranging from 0 = strongly disagree to 4 = strongly agree), and (4) parental levels of comfort in providing oral care to their children on a 4-point Likert scale (ranging from 1 = not comfortable at all to 4 = totally comfortable). Children were assessed for plaque, gingival condition, and dental caries. The gingival condition was recorded using the modified gingival index (GI) by Loe [21]. Dental plaque was assessed using the plaque index (PII) [22]. Both indices were applied on six index teeth (16, 12, 24, 36, 32, and 44) on the proximal, buccal, and lingual surfaces, and the scores were averaged to give a score at the individual level. Dental caries (for both primary and permanent teeth) was assessed according to the World Health Organization criteria [23], which considered a tooth to be decayed when frank carious cavitation was present, missing if it was extracted due to caries, and filled if it had a restoration for a carious lesion. Exfoliated teeth, congenitally missing teeth, and those extracted for reasons other than caries were not recorded. The DMF/def score of a participant was the sum of the number of decayed, missing, and filled teeth. The mean number of DMF/def was the sum of participants’ DMF values divided by the total number of the children examined [23]. The clinical examination was conducted by a single examiner, an American board-certified paediatric dentist, who demonstrated intraexaminer consistency in duplicate caries examination of 15 children for each of the study years (Kappa = 0.91, 0.89, 0.93, and 0.90). The intraexaminer consistency for using plaque or gingival indices was not measured due to the reversible nature of these two conditions. It was reported that intra- and interexaminer reliability and reproducibility of the PII and GI (particularly the visual inspection) appeared to be problematic even after calibration and training sessions and could not be reproduced over long periods of examination [24]. The oral examination was conducted in schools with the help of schoolteachers, using disposable mirrors, probes, and a portable source of light. For those who needed treatment, a report was sent to parents informing them of their children’s oral health treatment needs with a referral form to Imam Abdulrahman Bin Faisal University Dental Hospital. Specialized paediatric dentists from the research team performed necessary treatments. Data were analysed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were calculated, including the mean and standard deviations (SD) for the quantitative variables, and frequencies and percentages for categorical variables. Differences between outcome variables were compared with respect to oral brushing practices, using analysis of variance (ANOVA) or Kruskal-Wallis test, for nonnormally distributed variables followed by post hoc Tukey’s correction test. Pearson’s correlation was used to assess the relationship between oral health status and parental attitudes toward oral health and comfort with providing care. The significance level was set at 5%. 3. Results Figure 1 shows the result of the recruitment process. Within the 13 invited schools, there was a total number of 322 registered autistic children. Regular attendees (those who were affiliated to their schools for at least the past three years and with no absence more than two days/week) accounted for 108 ASD children. At baseline, all the 108 children were examined (with parents’ consent); 22 left their schools with the beginning of the study resulting in 86 regular attendees, and 11 withdrew midway during the study. The final study group consisted of 75 children with ASD whose parents provided consent to participate, who were regular attendees of the schools and those who completed the whole study duration (response rate = 87.2%).
... Other Investigations did not find any significant difference in pervasiveness of gingivitis, caries, and level of oral hygiene compared to the non-autistic cases (Shapira J et al,1989;Fahlvik-Planefeldt C et al, 2001). Put differently, some reports demonstrated that the patients with ASD have been highly caries free with the less DMFT scores in comparison to the controls (Loo CY et al, 2008). Few research has been performed concerning severity of dental caries and oral health status amongst autism cases. ...
... Severity of dental caries (dmfs and ds) for primary teeth decreased amongst the study group in comparison with the controls. These findings agree with other investigations that showed low spread of caries in children with autism (Ali Hadi F et al, 2017;Fighan J et al, 2018;Shapira J et al., 1989;Loo CY et al., 2008;DeMattei R et al., 2007;Orellana, L et al., 2012;Al-Rawi N et al, 2011). This finding could be related to many reasons such as special rituals or routines and distressing in case of changes in a routine, even partly and fussy eating habits, like a constant menu; therefore, they have been shown to be more regular in their behaviors at meals in comparison to the healthy cases. ...
... This finding could be related to many reasons such as special rituals or routines and distressing in case of changes in a routine, even partly and fussy eating habits, like a constant menu; therefore, they have been shown to be more regular in their behaviors at meals in comparison to the healthy cases. Hence, lack of in-between snacking, less cariogenic diet can be attributed to the decreased occurrence of caries amongst autistics (Ali Hadi F et al., 2017, Loo CY et al., 2008Vajawat M et al., 2012). Moreover, flat occlusal surface because of bruxism as well as open proximal contact (Shapira J et al, 1989;Al-Rawi N et al, 2011). ...
Article
Background: The autism spectrum disorder (ASD) has been introduced as one of the complicated developmental disabilities impairing communication and behavioral, intellectual as well as social functioning describes diverse symptoms, such as difficulties in communication skills and social interactions. The present research has been performed to assess seriousness of the dental caries in conjunction with the oral cleanliness amongst children suffering from autism in comparison with a control group according to age groups and gender. Materials and Methods: This research involved 30 children aged 3-14 years (male, female) who suffered from autism and attended autism centers in Welfare Children Teaching Hospital in Baghdad province, Iraq, were selected for the study compared to 30 healthy children with the same age group. Plaque (PlI), Decayed, missing, and filled surfaces (dmfs, DMFS), calculus (CI) as well as Gingival (GI) indices have been applied for measuring the status of oral health for these two groups. The data of our research has been analyzed by SPSS 26. Results: The entire autism group was caries active. For primary dentition, a lower dmfs values were recorded for study in comparison with the controls, differences have been not significant in dmfs, while for permanent dentition, a higher DMFS values were recorded for study in comparison with the control group with statistically significant concerning DMFS (P < 0.05). Moreover, caries experience (DS and DMFS) among both genders were higher in the study group in comparison with the controls with a significant difference in female only. Total mean value of PlI in the study group has been greater than the controls with no statistically significant difference. In addition, total mean value of GI in the study group has been lower than the controls with no statistically significant difference. Furthermore, correlation coefficient between the caries experience of primary and permanent teeth with PlI and GI among study and control group showed no significant correlations seen in the study and control groups, all of them were positively correlated except (ds) with (GI) in control group which was negatively correlated with no significant correlation. Conclusion: children with ASD had higher dental caries severity regarding permanent teeth compared to normal subjects, plaque higher in autistic group than control group. Dental care planners must design preventing strategies for avoiding caries; procedures for oral care as well as educational programs for oral care and promotion for addressing diverse challenges facing the oral care in ASD.
... Cariogenic foods are often used as a reward for reinforcement of good behavior. All these factors increase the risk for dental caries in the ASD population (Loo et al. 2008). The rates of caries prevalence in ASD patients vary in the literature (Da Silva et al. 2017). ...
... Only a few studies are available about the caries prevalence in ASD children and they generally have small samples. Some authors mention that the prevalence of caries in ASD children is lower than in healthy developing peers (Loo et al. 2008;Fakroon et al. 2015), others report a similar or higher caries prevalence in children with ASD (El Khatib et al. 2014;Delli et al. 2013). Nevertheless, consensus does exist on the extent of treatment, stating that ASD children have untreated dental decay more often (Tchaconas and Adesman 2013;Kopycka-Kedzierawski and Auinger 2008). ...
... It can be assumed that due to the factors mentioned above, challenges in the dental setting are aggregate for both the dental care professional and the ASD patient. This assumption is supported by experience, whereas various studies also report upon the uncooperative behaviour, anxieties and negative experiences the children with ASD exhibit in the dental setting (Loo et al. 2008;Barry et al. 2014;Duker et al. 2017). Due to the mutual difficulties faced by both the dental caregivers and the ASD patients, dental health care is often lagging in children with ASD. ...
Article
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Purpose To assess if Dutch children with Autism Spectrum Disorder (ASD) regularly visit a dentist and to evaluate parent’s satisfaction on the care provided. Methods Parents of ASD children (2–18 years) were invited to fill out a survey. The survey consisted of questions regarding ASD severity, frequency of dental visits, history of dental pain, type of dental practice and parents’ satisfaction. Results were analysed using Chi square and Mann–Whitney U tests ( α = 5%). Results Of the 246 returned questionnaires, 19 were excluded (incomplete or unconfirmed ASD diagnosis). All children visited a dentist at least once and 5% of them had their last visit more than 12 months ago. According to parents, 15% of the children did not receive the needed care when they had toothache and 21% of the parents were unsatisfied with the current dental care provided. No difference was found between satisfied and unsatisfied parents in type of dental practice visited ( p > 0.05). The children of unsatisfied parents reported more often pain during the last year ( p = 0.013) and had a more severe type of ASD ( p = 0.016). Conclusions The majority of Dutch ASD children investigated regularly visit a dentist and 21% of the parents is unsatisfied with the dental care provided.
... Moreover, children and adolescents with ASD are regarded as a high-risk group for dental caries (6,7,(11)(12)(13), and are prone to self-injury and dental trauma-even self-extraction of teeth (9,14). Studies performed in American, European, and Middle Eastern countries have reported conflicting findings regarding these issues (7,(9)(10)(11)(15)(16)(17)(18)(19)(20). However, the risk for oral problems among Chinese children with ASD remains unexplored. ...
... Although many studies have indicated higher amounts of dental caries in children with ASD (7,12,15,19), we found a similar prevalence of caries (according to parental report) in the ASD and TD groups. No or little difference of caries risk has also been reported in studies using dental examinations conducted in Western countries and Hong Kong, which might have been due to the similar plaque pH and saliva buffering capacity in children with and without ASD (18,20,22,37). ...
... Of those children with ASD who had received dental care, more than half had encountered an unpleasant or very unpleasant experience ( Table 3). Several prior studies also found children with ASD usually exhibited uncooperative behavior during dental procedures (9,18,19,36).Children with ASD are prone to anxiety and temper tantrums when exposed to an unfamiliar dental setting and become noncompliant and uncooperative for the dental procedure (14). Other factors that may make oral health treatment unpleasant for children with ASD include: limited verbal communication, heightened sensory perception, resistance to receiving dental care, possible avoidance of social contact, and urgent need for dental treatment, along with the inexperience with ASD on part of the dental clinician (12,19,36,52). ...
Article
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Objectives To assess and compare the oral health status of children with and without autism spectrum disorders (ASD) in China.Methods This study recruited 144 children with ASD and 228 unrelated children with typical development (TD) aged 3–16 years from China. Data were collected using parent-reported questionnaires. Oral problems (oral symptoms and habits), oral health measures (oral hygiene practice and dental care experience), and the impact on the child's quality of life (based on a modified version of the Parental-Caregiver Perception Questionnaire) were assessed and compared between the two groups.ResultsChildren with ASD had worse oral health status than children with TD. Oral symptoms were more prevalent in the ASD group, especially halitosis (p < 0.001), food impaction (p < 0.001), and oral lesions (p < 0.001), than the TD group. The rate of damaging oral habits, including mouth breathing (p < 0.001) and object biting (p < 0.05), was also high in the ASD group. Compared with the TD group, more children with ASD did not brush their teeth independently and frequently (p < 0.001), had difficulty accessing dental care (p < 0.01), and reported unpleasant dental experiences (p < 0.001). The presence of ASD was associated with decreased oral health-related quality of life (p < 0.001) in these children and their families.Conclusion Oral problems such as halitosis and bad oral habits are more prevalent among children with ASD. These children also lack oral hygiene practice and dental visits. This situation negatively impacts their quality of life, and must be brought to the attention of their treating dentists.
... The diagnosis is made by an analysis process which includes the clinical and developmental history, receptive and expressive language skills evaluation, and cognitive function tests. 8,29,30 There are numerous diagnostic instruments. In autism research, there are two frequently used instruments, one is a semi structured parent interview, which is the "Autism Diagnostic Interview-Revised (ADI-R)", and the other, the "Autism Diagnostic Observation Schedule (ADOS)", diagnoses autism through observation and interaction with the child. ...
... Several factors have been implicated such as: "genetics, environmental poisons, neurologic psychopathy, dietary deficiencies, and allergies". 29 Immunizations with the measles-mumps-rubella vaccines have been studied for their possible link to the increase in autism but have failed to confirm this link. 32 There is evidence of multiple genetic factors interacting as the autism's primary causative determinants. ...
... Of the healthcare providers, dentists may often be the first to realize an extraordinary pervasive behavioral disorder in a 1-2-year-old child. 29 In a survey to investigate the professional conduct and demeanor of pediatric and general dentists towards ASD patients in the United States, it was found that 32 % of general dentists and 89 % of pediatric dentists treat ASD youngsters. 36 Children with autism may display few unusual oral health conditions. ...
... All these characteristics make it challenging to provide conventional dental treatment to children with ASD, resulting in a significant portion of children with ASD having unmet dental needs. 5 Although the data on caries prevalence in children with ASD are conflicting, 6,7 37.2% of children with ASD required treatment under general anaesthesia which is significantly more than their neurotypical counterparts. 6 Recently, general anaesthesia in young children has come under scrutiny for possible deleterious effects. ...
... 5 Although the data on caries prevalence in children with ASD are conflicting, 6,7 37.2% of children with ASD required treatment under general anaesthesia which is significantly more than their neurotypical counterparts. 6 Recently, general anaesthesia in young children has come under scrutiny for possible deleterious effects. 8 As such, parents and clinicians are exploring alternative treatment approaches. ...
... 26 Although unsurprising, it is a novel finding that parents of children with ASD perceived a significantly higher level of dental fear (56%) when compared to parents of neurotypical children. Additionally, we also found that a significantly higher proportion of children with ASD had never seen the dentist before when compared to neurotypical children, highlighting the barriers to accessing dental treatment in this vulnerable population 5,6 which may include the high level of perceived dental fear and resulting lack of cooperativity. In this population, conventional treatment can often propagate that fear due to the uncomfortable nature of some dental procedures and the ineffectiveness of certain behavioural management techniques. ...
Article
Background: Parents of children with autism spectrum disorder (ASD) may have concerns with fluoride/silver content in silver diamine fluoride (SDF). Aim: To compare parental acceptance of SDF and dental fear between children with and without ASD. Design: Three hundred parents were enrolled. Demographics, dental history, and dental fear were recorded. Subjects viewed an educational video and completed survey about SDF acceptance including: a) overall acceptance, b) aesthetic concerns by tooth location, c) fluoride/silver concerns, and d) its use as a general anaesthesia (GA) alternative. Descriptive, bivariate, and multivariate analyses were used. Results: Significantly more children with ASD had dental fear (ASD: 56% versus Neurotypical: 26%). No differences in acceptance existed between the two groups overall or with respect to aesthetics, fluoride/silver content, or as an alternative to GA. Overall acceptance is >60%. Regardless of group, parents of older children were less likely to accept SDF as an alternative to GA (OR=0.67 [95%CI: 0.50 to 0.90]). Conclusion: Parents of children with ASD had similar acceptance of SDF use compared to parents of neurotypical children. Children with ASD had higher levels of dental fear. Parents of younger children are more likely to accept SDF as an alternative to GA in both groups.
... It remains contentious whether there is a difference in the oral health status between individuals with and without ASD. One study found that dental caries were more frequent in children with ASD compared to their healthy siblings (50% vs. 22.2%) (Suhaib et al. 2019), while another study argued that ASD individuals were less likely to have dental caries and had lower decayed, missing, and filled permanent teeth (DMFT) scores compared to non-ASD individuals (Loo et al. 2008). A significantly lower DMFT index/ Yujian Zhang, Ling Lin and Jianbo Liu contributed equally to this work. ...
... After removing duplicates, title and abstract screening was conducted and 106 articles were selected for full-text review. After excluding 83 articles lacking relevant outcomes, 11 articles lacking healthy controls (Altun et al. 2010;Awasthi et al. 2015;Dias et al. 2010;Gace et al. 2014;Jaber et al. 2011;Kalyoncu and Tanboga 2017;Marshall et al. 2010;Morales-Chavez 2017;Shapira et al. 1989;Slayton 2010;Subramaniam and Gupta 2011), and 3 articles providing data lacking standard deviation (Loo et al. 2008;Namal et al. 2007;Vajawat and Deepika 2012), a total of 9 studies comprising 532 patients with ASD and 622 controls were included in the meta-analysis (Al-Maweri et al. 2014;Bassoukou et al. 2009;Bhandary and Hari 2017;El Khatib et al. 2014;Fakroon et al. 2015;Jaber 2011;Onol and Kirzioglu 2018;Qiao et al. 2018;Yashoda and Puranik 2014). Table 1 shows the details of the nine studies included in this meta-analysis. ...
... In a cross-sectional survey conducted in Pakistani children, children with ASD were reported to have a higher incidence of caries compared with their healthy siblings (Suhaib et al. 2019). In a retrospective study conducted in a university hospital in Boston, the medical charts of children with ASD were reviewed along with patients without ASD; the results showed that children with ASD had lower DMFT scores than the controls (Loo et al. 2008).Since only patients with a dental visit were included in the analysis, the possibility that those without a dental visit had a different pattern may not be excluded. In fact, it has been reported that individuals with ASD have an increased difficulty making dental appointments than those without ASD (Delli et al. 2013). ...
Article
Full-text available
The objective of this meta-analysis was to assess the dental health status of children with ASD in terms of decayed, missing, and filled permanent teeth (DMFT) and decayed, missing, and filled deciduous teeth (dmft). PubMed, Embase, psycINFO, and Cochrane library were searched for studies published until September 2018. A random-effects model was applied to estimate the pooled results.Nine studies comprising 532 children with ASD and 622 controls were included. No significant differences between children with ASD and controls were observed for DMFT and dmft in the world. Subgroup analyses revealed that children with ASD had a significantly higher dmft index than that of controls in Asia.Children with ASD have a worse dental health status than healthy children in Asia, but caution is necessary given the limited studies available for analysis.
... The results of the studies regarding dental caries in patients with ASD are contradictory; however, they indicate the difference in the oral health status of the patients in developed and developing countries. Some studies, mostly those conducted in developed countries that have special care and training centers for children with autism such as the United States, Sweden and Japan, have reported a low prevalence of dental caries in these individuals [12][13][14]. On the contrary, in developing countries such as Pakistan, Egypt and the United Arab Emirates, most of the studies found a higher prevalence of dental caries in patients with autism compared to healthy children [15][16][17]. ...
... Most Studies in developed and newly industrialized countries [29], where there are special care and training centers for individuals with ASD, have reported low caries experience in the ASD population. These studies contained the United States [13], China [30], India [31], Turkey [32] Sweden [14] and Japan which found that the experience and severity of dental caries showed a marked decrease from previous observations in children with ASD. The results showed that the social context of dental treatment for physically challenged children improved during the past 15 years. ...
Article
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Background Autism spectrum disorders (ASD) are a set of developmental, psychological, and neurological disorders that occur in early childhood. The most important characteristic of individuals with autism is difficulty in social interactions and communication. Researchers in the field of oral health have not paid enough attention to these individuals due to their specific behavioral characteristics. Therefore, due to the limitations of the studies in this field in Iran, increasing prevalence of autism, and importance of oral health in people with ASD, this study was conducted to evaluate the oral health status of primary school students with autism (7–15 years old) in autism schools in Tehran. Methods Students from seven governmental special primary schools in Tehran were selected for this study. Data about oral health behavior and the presence of each of the seven barriers of tooth brushing task was collected via questionnaires completed by parents. During the dental examination, the cooperation level according to the Frankle Index, oral hygiene status according to the Simplified Oral Hygiene Index, and caries experience (DMFT) of the students were recorded by a calibrated dentist. A psychologist assessed the level of ASD using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM5). Data analysis including descriptive and regression analysis was done using the SPSS software version 24. Results Two hundred and seventeen students aged 7–15 years participated in this study, of whom 65.4% brushed their teeth once or more every day, 85.7% had sugary snacks twice or less per day, 73.7% used fluoridated tooth paste, and 80% brushed their teeth with parents’ help. The most common barrier to tooth brushing was difficulty in brushing (51.6%). The cooperation level was definitely positive in 46.1%. The mean Simplified Oral Hygiene Index (OHI-S) and caries experience (DMFT) scores were 1.92 ± 0.55 and 2.36 ± 2.38, respectively. Conclusion The clinical indices of OHI-S and caries experience (DMFT) were used to evaluate the oral health status in the students with ASD in Tehran, Iran. A better oral hygiene status was related to higher brushing frequency and lower sweet snack consumption. The findings of the present study indicate that educational interventions regarding oral hygiene and healthy diet may improve oral self-care in individuals with ASD.
... Este trastorno se caracteriza por el deterioro de la capacidad de comunicación e interacción social, dificultades motrices, comportamientos repetitivos y déficit cognitivo. Generalmente son niños pasivos, alejados de las personas y poco sensibles a su entorno, evitan cualquier contacto visual, muestran resistencia a los cambios de ambiente y a actividades inusuales (3)(4)(5)(6). ...
... Varios autores recomiendan implementar la técnica del pictograma con música, especialmente la clásica y el jazz, esto es considerado como un medio de terapia eficaz, pues es creativa y espontánea, atrayendo la atención y promoviendo la relajación de los pacientes con autismo. Por el contrario, los olores y los sonidos generados en el consultorio, como el de la pieza de mano, el eyector, el olor del acrílico y del flúor pueden desencadenar reacciones de comportamiento adverso en el paciente, como hiperactividad, agresión y una respuesta negativa frente a la cita odontológica, por lo que se deben introducir cuidadosamente a la cita por medio de técnicas como "decir -mostrar -hacer" (3,4,(14)(15)(16). ...
Article
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El autismo es una condición que hace parte de los Trastornos Generalizados del Desarrollo (TGD). Se caracteriza por el deterioro de la capacidad de comunicación e interacción social, dificultades motrices, comportamientos repetitivos y déficit cognitivo. El objetivo de este trabajo fue generar métodos de sensibilización en un paciente con autismo utilizando pictogramas para lograr la adaptación a la atención odontológica. Paciente de sexo femenino de 15 años de edad, diagnosticada con Trastorno del Espectro Autista, acudió a la clínica odontológica de la Universidad Autónoma de Asunción en la cátedra de Odontopediatría II. En la primera consulta, se realizó la historia clínica médica-odontológica, la observación de la conducta y evaluación oral para realizar un plan de tratamiento, de acuerdo al cual se elaboró un esquema de lo que sería la primera cita odontológica. Se confeccionó un pictograma para realizar una sensibilización progresiva y anticipada de su atención odontológica. En la segunda sesión, el odontólogo mostró a la paciente el pictograma y explicó cada procedimiento que se realizará. La paciente miró atentamente las imágenes y el odontólogo realizó la explicación breve de la secuencia del pictograma. En la tercera sesión, se repitió nuevamente la demostración del pictograma, pero de la técnica de cepillado, de esta manera se motivó a la paciente a realizar el cepillado y así obtener una disminución del nivel de placa. La utilización del pictograma fue satisfactoria para el abordaje odontológico de la paciente, ya que estaba motivada y alegre a la hora de observar las imágenes
... According to the DSM-IV, PDD is an umbrella term that defines specific diagnoses, including AD, Asperger's syndrome, and rare disorders such as Rett syndrome, childhood disintegrative disorder and PDD-NOS (Not Otherwise Specified) or "atypical autism" [5]. During a dental examination, a number of issues may arise with ASD children, and research has shown that 50 -72% of ASD children exhibit uncooperative behavior [6][7][8]. These are the main factors for barriers and issues during a dental examination of ASD children. ...
... Unfortunately, with ASD children this is rarely the case due to the child's basic condition and the fact that initial dental appointments usually never take place. Parents often avoid scheduling a dental appointment for their child be-cause of fear of uncooperative behavior [6][7][8]. Many studies on tooth decay in mentally challenged persons have shown that there is a higher prevalence of untreated or inadequately treated tooth decay compared to the general population, as well as a higher prevalence of oral diseases [12]. ...
Article
Full-text available
Introduction. Autism is a severe and lifelong developmental disorder characterized by impaired social interaction and interpersonal communication, as well as characteristic repetitive patterns of interest and behavior. The purpose of this study is to point to the possibility of applying various techniques of adaptation of children with autism to dental interventions in order to maintain oral health. Material and Methods. A multidisciplinary project was carried out by the Dental Clinic of Vojvodina, Special Education School ?Dr. Milan Petrovic? and the Autism Society of Novi Sad. The following education models were used in the project: behaviororiented models, developmental strategies, therapy based interventions, and combined interventions. The success rate of applied education models and adaptation of children with autism spectrum disorders to dental interventions was examined. The success criteria included the ability to make contact, communicate, cooperate, and perform dental treatment. Results. The multidisciplinary project included 20 active members the Autism Society of Novi Sad and 20 members of the Special Education School ?Dr. Milan Petrovic? day care program. The results of the study showed a 95% success rate of the most commonly used applied behavior analysis. The success rate of the communication oriented interventions was 90%, while therapy based interventions showed an 85% success rate. The combined interventions showed a 100% success rate. Conclusion. Only integration of several methods, multidisciplinary cooperation and an individual approach to work with children with autism can lead to success in work and adaptation to dental interventions of persons with autism spectrum disorder.
... To enable periodontal status, caries prevalence and severity to be compared, subgroup analyses of primary, mixed, and early permanent dentition have been performed. Although comparisons between adults diagnosed with ASD and their healthy controls are beyond the scope of this review, we encountered four studies that reported such findings during the screening process (Altun et al., 2010;Blomqvist et al., 2015;Loo et al., 2008;Orellana et al., 2012). The results reported in adult dentition are somewhat similar to the findings of this review, which significantly poorer oral hygiene among individuals diagnosed with ASD (Blomqvist et al., 2015;Orellana et al., 2012) and no significant differences in trauma prevalence (Altun et al., 2010) were identified. ...
... The results reported in adult dentition are somewhat similar to the findings of this review, which significantly poorer oral hygiene among individuals diagnosed with ASD (Blomqvist et al., 2015;Orellana et al., 2012) and no significant differences in trauma prevalence (Altun et al., 2010) were identified. The findings of caries prevalence and severity are also similar, which individuals diagnosed with ASD were having either no difference or significantly lower caries prevalence and severity when age and socioeconomic status were not matched (Blomqvist et al., 2015;Loo et al., 2008;Orellana et al., 2012). The main differences from our current findings are more gingival recession and higher prevalence of anterior open bite was identified among adult individuals diagnosed with ASD (Blomqvist et al., 2015;Orellana et al., 2012). ...
Article
Full-text available
Lay abstract: Children and adolescents diagnosed with Autism Spectrum Disorder (ASD) are thought to be more vulnerable to oral diseases than typically-developing individuals. This is due to their increased barriers to dental care services, self-harm behaviors and dietary habits that may favor tooth decay. In this review, we summarized the current evidence comparing the oral health status of children and adolescents diagnosed with and without ASD. After a systematic search in the literature, we found that the salivary pH of individuals diagnosed with ASD was significantly lower, but the results were not clinically significant that can increase their risks to tooth decay. We also found weak evidence suggesting a higher percentage of children and adolescents diagnosed with ASD having the habit of tooth grinding compared with their neurotypical counterparts. When comparing salivary flow rate, tooth decay, gum diseases, tooth malalignment and tooth trauma; no significant differences were found between the two groups. The findings did not suggest ASD as a predisposing factor to oral diseases: other factors including sugary diet and inadequate oral hygiene may play a more important role. We also call for further research to establish more concrete association between ASD and oral diseases.
... In a study conducted in R i y a d h S a u d i A r a b i a t h e m e a n DMFT/dmf was highest in the children with intellectual disabilities as compared 22 to blind and deaf children, which is in accordance with our study The mean dmf, and DMF for the autistic children was 2.4 in a study conducted in Ajman, 30 UAE. Lower caries prevalence in autistic children is reported in other 31,32 regional and international studies this is in line with the results of our study. The low DMFT/dft in deaf or hard of hearing group in our study as compared to other groups was because they have better dexterity and coordination and these children are not totally dependent on their parents to maintain their oral 3 hygiene as compared to other groups. ...
Article
Full-text available
OBJECTIVE: To determine the frequency and determinants of dental caries among children with special health care needs in the special needs schools of Karachi, Pakistan METHODS: This cross-sectional study was conducted among 196 children (aged 6-18 years) attending the public and private sector special-needs schools of Karachi, Pakistan. Children with mental and/or physical disability were included in the study. Prevalence of dental caries determined oral examination using the Decayed Missing Filled Teeth and Decayed Filled Teeth (DMFT/dft) index. Parental education level, oral health knowledge and house-hold level socioeconomic status were measured through a structured questionnaire. Data were analyzed in SPSS version 20. RESULTS: The overall frequency of dental caries was 58.2% with 70.3% and 55.3% prevalence in the public and private special needs schools. The mean DMFT/dft value was 1.85±2.28. The Down syndrome group had the highest mean (DMFT/dft=2.45±2.65), followed by the group including (vision impairment, autistic and cerebral palsy children) (DMFT/dft=2.05±2.51), Intellectual disability (DMFT/dft=1.70±2.01) and the deaf or hard of hearing group (DMFT/dft =1.49±2.27). Caries status was not significantly associated with gender (p=.518), socioeconomic status (p=.067), father education (p=.158) and mother education (p=.758). CONCLUSION: The frequency of dental caries was high among children with disabilities in the Karachi district of Pakistan. The most important factor in improving the oral health status of these children is the awareness of their families by continuous community oriented medical and dental education programs.
... Research has demonstrated that children with ASC have higher anxiety levels compared to typically developing children (van Steensel and Heeman, 2017). Attending dental appointments to assess oral needs can be extremely stressful and demanding for a child with ASC and their family with approximately 50-72% of children being reported as anxious and uncooperative at the clinic (Marshall et al., 2007;Loo et al., 2008;Brickhouse et al., 2009). Unlike a medical practice where attendance is usually motivated by need, regular attendance at a primary care dentist is recommended. ...
... [12][13][14][15][16] Moreover, the prevalence of dental caries in these children was lower than or similar to that of the typical population; however, it can be considered as high. [12,[17][18][19] Therefore, preventive dental care is essential to prevent oral diseases in patients with ASD. ...
Article
Objectives: The aim of this study was to evaluate toothbrushing effectiveness in children with mild and moderate levels of severity of autism spectrum disorder (ASD) after using visual pedagogy. Materials and methods: This quasi-experimental study was carried out with 30 children with ASD aged 5-17 years; 21 had mild ASD and 9 had moderate ASD. Informed consent and the subject's demographic information were obtained from caregivers. All subjects were then asked to show their toothbrushing practices, which were recorded by video. The toothbrushing ability, toothbrushing cooperation, and plaque index were evaluated before the study and at 2 weeks, 4 weeks, 3 months, and 6 months after visual pedagogy had been used. Results were analyzed by the Friedman test, Pearson's chi-square test, Fisher's exact test, and Mann‒Whitney U test. Results: Toothbrushing ability was significantly improved at all periods of follow-up. Toothbrushing cooperation and the dental plaque index were significantly better than before the study at 4 weeks, 3 months, and 6 months of follow-up. The toothbrushing ability of subjects with mild ASD was significantly better than that of subjects with moderate ASD at 4 weeks and 6 months of follow-up. The toothbrushing cooperation of the mild group was significantly better than that of the moderate group at 2 weeks, 4 weeks, and 3 months. There was no statistically significant reduction in the plaque index between the two groups. Conclusion: Visual pedagogy is useful for improving toothbrushing effectiveness in children with mild or moderate severity ASD. However, children with moderate severity ASD take longer to improve.
... 9,10 Some other studies reported that the frequency and severity of dental caries were low in a group of patients with ASD. 7,11 The prevalence of malocclusion and oral habits in children with ASDs has been evaluated in some studies, though the results were contradictory. In comparison with non-ASD patients, it has been shown that the prevalence of oral habits (bruxism, tongue thrust, and thumb sucking) was significantly higher in patients with ASD. ...
Article
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Background: The purpose of this cross-sectional study was to evaluate the prevalence of malocclusion in children with autism spectrum disorders (ASDs) and to determine the most common occlusal traits. Materials and methods: The present cross-sectional study was conducted among 7-15 years old children with ASDs and randomly selected healthy children with the same demographic characteristics. Molar relationship, lip incompetence, overbite, overjet, midline deviation, crossbite, and crowding/spacing were recorded. A descriptive analysis was performed for all variables. A comparison of the presence or absence of malocclusion traits between children with and without ASDs was assessed using the chi-square test. Univariate and multivariate logistic regressions were used to calculate odds ratio (OR) and 95% confidence intervals (95% CI) to assay various parameters between autism and non-autism group. Results: A total of 96 patients were assessed, 47 patients in the ASD group, and 49 in the control (non-ASD) group. The results showed no significant difference between the ASD and control groups in terms of the overall prevalence of malocclusion (P>0.05). However, the prevalence of increased overjet and Class II molar relationship was significantly higher in the ASD group compared to the control group (P=0.03). Patients in the control group showed a higher prevalence of midline deviation (P=0.001). Conclusion: Despite a higher prevalence of overjet and Class II molar relationship in children with ASDs, the prevalence of malocclusion was not higher in this group of patients.
... Child symptoms, such as parent-reported challenging behaviors, communication difficulties, and sensory sensitivities, as well as the presence of comorbid intellectual disability (ID), have been linked to difficulties obtaining dental care in this population (Brickhouse et al. 2009;Lai et al. 2012;McKinney et al. 2014). Relative to children without ASD, children with ASD may also exhibit greater distress during dental care (Stein et al. 2014) and may be more likely to experience use of physical restraint and pharmacological intervention during routine dental visits (Loo et al. 2008). Challenges during dental visits may compromise the quality of services rendered (Eidelman et al. 2000;Wilson 2013) and may influence parental perspectives on returning for ongoing care (Stein et al. 2014). ...
Article
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Dental care received by children in the Autism Speaks Autism Treatment Network (ATN) was compared to National Survey of Children’s Health (NSCH) data for children without special healthcare needs and children with parent-reported ASD. Correlates of obtained preventive dental services were examined within the ATN sample. Participants included 375 families of children ages 4 to 17 enrolled in the ATN. ATN families reported levels of preventive dental care that were similar to, or exceeded, NSCH-reported care. However, disparities in obtained preventive dental services emerged within the ATN sample. Lower intellectual functioning was the most consistent correlate of reduced access to and completion of preventive dental care. Implications for developing system-wide supports and targeted interventions are discussed.
... Most research indicates that children with ASD exhibit a high prevalence of poor oral health, as assessed by prevalence and severity of caries (De Mattei et al. 2007;Jaber 2011;Kopycka-Kedzierawski and Auinger 2008;Marshall et al. 2010), despite a small group of contrary studies (Fahlvik-Planefeldt and Herrstrom 2001;Loo et al. 2008;Morinushi et al. 2001). Although not a direct cause of dental deficit, life factors and behaviors prevalent in ASD patients are associated with increased caries (Marshall et al. 2010). ...
Article
Full-text available
Oral health care can be a difficult experience for a child with Autism Spectrum Disorder (ASD), for their family and for the dentist. The purpose of this study is to provide an understanding of the challenges experienced by the three aforementioned figures during oral care treatment. A cohort of 275 parents of typical development children (TD), 57 parents of children with ASD (3–15 years old) and by 61 dentists, completed two different multiple choices questionnaires. The data obtained show a great difficulty in the treatment of children with ASD as seen by the dentists and by the parents. This is due to: caregivers’ demographic issues; difficulties encountered before and during the dental examination; scarce presence of experts in ASD treatment.
... [16] These difficulties of communication mean that these patients have less access to the dentist, which can result in worse dental conditions with subsequent loss of teeth. [17][18][19] However, behavioral approaches to promote and develop an alternative communication, as with the Treatment and Education of Autistic and related Communication-handicapped children (TEACCH ® ), [20] Son-Rise ® Program, [21] and Picture Exchange Communication System (PECS ® ), [22] are promising methods of intervention in patients with ASD. During dental care, these strategies can facilitate patient-professional contact [23] and allow dental care ambulatory. ...
Article
Full-text available
The purpose of this article is to discuss the clinical management and behavior during periodontal treatment in two patients with fragile X syndrome (FXS) using alternative communication with pictures (ACP). Both patients had a history of previous dental care only possible under general anesthesia. The ACP was used to anticipate the activities to be carried out, promoting ambiance, improving the professional-patient communication, and decreasing the stress of the patient. It was possible to carry out outpatient care without oral sedation and containment/physical restraint in both patients, being surpassed the communicative and behavioral difficulties. These case reports allow us to rethink dental care under general anesthesia or other invasive methods for patients with FXS. Therefore, the ACP is an important mediator tool that can facilitate the insertion and the management of patients with FXS, allowing the dental care outpatient clinic to promote oral health and quality of life for these patients, improving adherence to periodontal treatment and the periodontal maintenance for oral hygiene.
... An association between dental trauma and ASD could not be established [43]. While some studies have shown an increased prevalence of caries or gingivitis in children with ASD [44][45][46], other studies have shown that cohorts of patients with ASD have less (or no) caries experience and less periodontal disease than cohorts of patients without ASD [18,[47][48][49]. Therefore, it is likely that not every type of impairment must lead to an increased prevalence of caries, periodontitis, or trauma [43]. ...
Article
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Background: Patients with autism spectrum disorder (ASD) or other mental or physical limitations experience an imbalance in the frequency of dental treatment as compared with the general patient population, in part, due to inadequate pre-graduate training of future dentists. Case presentation: This case report describes a successful anterior tooth restoration, in awake state, in a 15-year-old boy with early childhood autism. The procedure was carried out independently by students of dentistry within the scope of their integrated clinical training semesters. Desensitization sessions were used as a preparatory measure and elements of behavioral facilitation (tell-show-feel-feel-do) were applied during the treatment. Conclusions: To avoid discrimination of this group of patients in the provision and quality of dental care, a structured approach to the transfer of theoretical and practical knowledge in the field of special care dentistry is indispensable. To this end, treatment strategies for special care patients should be taught to pre-graduate dental students as a fundamental part of their university curriculum.
... 16 One study found that approximately 37% of patients with ASD required general anesthesia for dental treatment due to challenges regarding cooperation. 17 Oral health is affected by social and behavioral factors, with dental caries disproportionately prevalent among socioeconomically disadvantaged groups. 18 Fisher-Owens et al posit that health behaviors, practices, and coping skills at many levels influence oral health outcomes, 19 underscoring the role that fatalistic beliefs about oral health may play within a family. ...
Article
Full-text available
Aims To study correlates of oral health fatalism (OHF) in caregivers of children with autism spectrum disorder (ASD). Methods and results This exploratory analysis used baseline data from 118 Medicaid‐eligible families of children with ASD in a multi‐site randomized clinical trial of a parent training intervention supporting home oral hygiene and dental visits. About half (46%) of caregivers agreed with the statement “most children eventually develop dental cavities,” endorsing OHF. Hispanic caregivers more strongly endorsed OHF than non‐Hispanics (cumulative odds ratio = 2.4, 95% confidence interval [CI]: 1.2‐4.7, P = .014). Caregivers living alone with children less strongly endorsed OHF than caregivers cohabitating with other adults (cumulative odds ratio = 0.39, 95% CI 0.17‐0.86, P = .019). Multivariable analysis maintained significance of ethnicity (P = .030) but not living situation (P = .052). Additional analyses included demographics, parenting beliefs, and children's oral hygiene and oral health status. Conclusion About half the caregivers endorsed OHF, with Hispanic caregivers more strongly endorsing OHF. OHF was not significantly associated with oral health behaviors or status, consistent with emerging literature suggesting fatalism is not necessarily linked to health behavior. Further exploration of OHF correlates in families of children with ASD is needed; ethnicity, living situation, child age, and caries status are of interest.
... On the other hand, other studies reported similar caries prevalence [8,9] or lower caries prevalence and severity in children with ASD compared to controls [10,11]. The less frequent snacking in individuals with autism might contribute to low caries susceptibility compared to controls [1]. ...
Article
Full-text available
Background Oral care is acknowledged as an integral component of general health and plays an essential role in establishing the desired level of quality of life for individuals with autism spectrum disorder (ASD). Purpose To investigate oral health knowledge and dental behaviors in individuals with ASD in comparison with individuals without ASD in Jordan. Methods A case–control study was carried out among 296 caregivers of individuals with ASD (n = 147) and control (n = 149) groups. A closed ended, validated self-designed questionnaire was distributed. The questionnaire included questions addressing participant’s oral health knowledge and behaviour. Data were analyzed using SPSS® software Version 22 with a 0.05 level of significance. A Chi-square test and contingency-table analysis were performed. Results Individuals with ASD in Jordan were significantly less knowledgeable about different oral health aspects than individuals without ASD ( p < 0.05). Fewer individuals in the ASD group brushed their teeth once or twice daily (89%), compared to the control group (93%). Only 15% of the ASD participants could brush their teeth without help. The use of fluoridated toothpaste and the frequency of using mouth rinse demonstrated a significant difference between groups ( p < 0.05). Conclusion ASD individuals in Jordan suffer from a significant lack of oral knowledge comparing to their controls, leading to a misunderstanding of the basic and highly important dental health aspects. Indicating that the knowledge was not enough to influence their dental behaviors. Children with ASD and their families should receive appropriate education in special need oral health care given by oral health professionals to reduce the risk of having dental problems and oral disease and enhance their quality of life.
... Autistic individuals are at a greater risk for experiencing psychiatric conditions (Croen et al., 2015) so quality of care in mental healthcare services is important. Similarly, autistic individuals may be more likely to experience poor dental or oral health (e.g., caries and receding gums; Blomqvist et al., 2015;Loo et al., 2008). However, as the barriers to physical healthcare access have been delineated (Mason et al., 2019;Walsh et al., 2020a), and may differ from the barriers experiences within other types of services, it was considered most appropriate to focus on interventions that were implemented and evaluated in such settings. ...
Article
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Autistic individuals report barriers to accessing and receiving healthcare, and experience increased morbidity and mortality. This systematic review synthesizes 31 research studies evaluating interventions implemented to improve the healthcare experiences and/or access of autistic persons. Interventions were most commonly patient-focused (58.1%), focused on supporting the autistic individual to engage with, tolerate, or anticipate medical procedures, care, or settings. Fewer studies were provider-focused (48.4%) or organization-focused (6.5%). Interventions were typically evaluated using measures of reactions (45.2%) or behavior (48.4%), and outcomes were predominantly positive (80.6%). Further research is imperative and should look to how providers and organizations must change. Future research must be inclusive of the autistic community, must measure what matters, and must offer complete detail on interventions implemented.
... However, due to the difficulties in communication, examination and treatment, only a few dentists will commit to provision of dental care to such patients 4 . Dental appointments are poorly tolerated and perceived as stressful, although some researchers have found that children with autism have less caries than their peers [5][6][7] . Anxiety in an unfamiliar environment, common for individuals with ASD, can aggravate agitation and provoke violent behavior in the dental office. ...
Article
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Background/Aim: Autism spectrum disorder (ASD) is pervasive neurodevelopmental condition with raising prevalence over the last decades. Oral health related problems arise mostly due to challenging behavior, communication limitation, and resistance to receiving dental treatment. The aim of this retrospective study was to investigate the frequency, quality and type of dental care during routine appointments and under general anesthesia (GA) in persons with ASD. Matreial and Methods: The data were obtained in retrospective cross-sectional study by analyzing patients' records from the central electronic database of the Clinic for Dentistry of Vojvodina. Demographic, medical and dental data were analyzed employing Mann Whitney U test, Kruskal Wallis test and CATREG regression analysis. Results: A total of 51 patients from 4.2-47.6 years of age had an average of 13.2 ±13.5 dental appointments, with 2.27±4.23 treatments done under GA in a period of 7 years. The average number of restored teeth was 3.64±4.42 and 4.64±5.95 teeth were extracted. Only 21.5% of participants regularly attended scheduled appointments. Patients who started oral health care earlier had more teeth restored and extracted during RDT, and were less subjected to treatment under GA. Conclusions: Dental services to patients with ASD are commonly limited to more radical approach comprising multiple teeth extractions and repeated treatment under GA. It is of utmost importance to tailor comprehensive plan for dental care provision in individuals with ASD at earliest possible age.
... The gender distribution in our study was 32.8% females and 67.2% males with a male to female ratio of 2:1. This is due to the higher prevalence of ASD in males, which coincides with previous studies reported in the literature [30][31][32]. ...
Article
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Autism spectrum disorder (ASD) prevalence has escalated in the last few decades; it is common to have children with ASD seek dental treatment. Their unique behavior patterns prevent them from attending a regular dental setting and receiving proper oral hygiene instructions (OHI); therefore, culturally adapted dental visual aids are necessary to teach them proper OHI. The aim of this study was to assess the effectiveness of culturally adapted dental visual aids in improving oral hygiene (OH) status in children with ASD. A blinded, randomized, controlled clinical trial with sixty-four children with ASD were randomly divided into two groups according to the type of dental visual aids given to them. The experimental group received culturally adapted dental visual aids developed specifically for the study, and the control group received regular dental visual aids. OH status was assessed before and after using the dental visual aids, and data were processed using SPSS version 25.0. OH status improved significantly in both groups after using the dental visual aids (p < 0.001, p < 0.001), respectively. The experimental group showed significant improvement in comparison to the control group in OH status (p = 0.030). Both dental visual aids showed effectiveness in improving OH status in children with ASD.
... In addition, problems such as tongue thrusting, erosion, hyperactive gag reflex, and some malocclusions such as anterior open bite and maxillary retrognathia were also reported in these individuals [42,43]. ...
Chapter
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Individuals with special needs are the most underserved regarding healthcare needs in almost all populations. Special needs patients with intellectual disability have muscle coordination disorder, impaired oral motor function, drooling, weak muscles that cause chewing and swallowing problems. Also, soft diet consumption makes this population more prone to dental disease. They have more caries, missing teeth, orthodontic and periodontal problems. Besides more difficulties obtaining professional dental care than other segments of the population. Though many countries developed community-based systems to improve oral health for people with special needs, providing good oral health mainly depends on the effort of the families. Therefore the education of the caregiver about oral hygiene provision is also critical for the special needs patient to enjoy a lifetime of oral health the same as other members of the society.
... [6] The oral health of these children needs special attention due to lack of social communications, deficient learning, and speech disorder. [7,8] Dental interventions are difficult to perform in autistic children. [9] Many of these children do not like to be touched or cannot sit quietly in a dental chair for a long time. ...
Article
Background: It is difficult to perform dental procedures in autistic children, and parental involvement is necessary for successful hospital dental services. Therefore, in order to promote oral health in autistic children, this study was aimed to explore the knowledge, attitude, and performance of autistic children's parents with respect to hospital dentistry. Materials and Methods: This cross-sectional study was conducted with the parents of 100 autistic children aged 2–6 years selected from among the children of Isfahan autism treatment centers. A self-administered questionnaire, including parental demographic information and 22 items on the assessment of knowledge, attitude, and performance of autistic children's parents regarding hospital dental procedures under general anesthesia, was completed by 100 parents. P
... An interesting finding was that most papers published in the Journal of Periodontology were before the 2000s and focused on Down syndrome patients, [16][17][18][19][20] while the majority of papers published in the JADA were after 2004 and had a wide variety of subjects. [21][22][23][24][25][26] Moreover, most papers presented data about epidemiology, mainly related to oral health status and prevalence of dental trauma. As for the disability studied, Down syndrome and autism spectrum disorder were the most frequent. ...
Article
Aim To conduct a bibliometric analysis of the top 100 most-cited papers in dentistry for individuals with neurodevelopmental disorders. Methods and Results A search strategy was constructed and conducted at the Web of Science in the category of “Dentistry, Oral Surgery, and Medicine”. The following information was extracted from each paper: title, authorship, year of publication, title of the journal, study subject, study design, age range of sample participants, type of disability, institution, country and continent, number of citations and citation density. Google Scholar and Scopus were used to crosscheck the number of citations of the most-cited papers. The VOSviewer software was used to generate bibliometric network maps. The papers received 4453 citations in Web of Science, ranging from 30 to 106 citations. Most papers were published by the USA (35%), had an observational design (78%) and the main subject was epidemiology (31%). Most studies focused on individuals with Down syndrome (34%) and Autism Spectrum Disorder (18%) and were published in the Journal of Periodontology (10%) and the Pediatric Dentistry Journal (7%). Conclusion Most of the studies included in this review were characterized as epidemiological studies. Future research should focus on behavior guidance, dental education, and access to dental services.
... Although the results of the individual studies on levels of dental caries are mixed, they consistently show high levels of unmet treatment needs and high levels of gingivitis [16,17]. Autistic children are also more likely than neurotypical children to receive treatment under general anaesthesia and to experience other dental problems such as bruxism, erosion, and tongue thrusting [18,19]. ...
Article
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Autistic children and adolescents are at high risk of dental disease and experience oral health inequalities. They consistently show high levels of unmet needs in relation to their oral health and access to dental care. There are no systematic reviews that bring together the evidence on the factors that influence oral hygiene behaviours, and access to and provision of dental care for autistic children and adolescents. A systematic search will be carried out in eight international databases and in grey literature of qualitative, quantitative and mixed method research studies from countries with a High Development Index which relate to oral health behaviours, and access to and provision of dental care. Only studies where participants are autistic children and adolescents aged 19 years or under, parents/guardians/caregivers, support staff, or oral health care providers will be included. Quantitative and qualitative data will be synthesized together through data transformation using a convergent integrated approach. Thematic synthesis will be used to carry out an inductive analysis of the data. The findings from the systematic review which this protocol generates will be used in the development of an appropriate local clinic care pathway for autistic children/adolescents and to inform national policies and practices. Prospero registration: CRD 42021248764.
... The following exclusion criteria were applied: medical condition associated with oral diseases; unable to cope with an oral examination; dental prophylaxis in the previous 6 months; history of orthodontic treatment. The assumptions made for sample size calculation were: caries prevalence in healthy children = 45% [Loo et al. 2008]; caries prevalence in children with ASD = 70% [Campus et al. 2007]; alpha-error = 5%, beta-error = 20%. ...
Article
Aim: Autism Spectrum Disorder (ASD) is characterised by communication deficits and repetitive unusual behaviours. The behaviour guidance of these children represents a challenge for the dental team. The aim of the study was to evaluate the oral health status in a group of Italian children with ASD. Materials and methods: Study Design: Sixty-four Italian children with ASD and 64 controls were included. Data were collected by means of questionnaires and clinical examinations. Results: Dental trauma (p=0.007), bruxism (p=0.001) and biting objects habit (p=0.021) were more frequent in the study group; fluoride exposure was lower (p=0.001) (chi-square test). The mean plaque index was 1.48 ±0.75 in the study group and 0.81±0.56 in the control group (p=0.001; Mann-Whitney U test); the mean dmft/DMFT was 3.00 ±1.2 and 2.3 ±1.8 in the study group and 1.8 ±1.1 and 1.0 ±1.1 in the control group (p<0.001; Mann-Whitney U test). Anterior open bite was more frequent in the study group (p=0.013; Chi-square test). No significant differences were found for enamel defects, molar relationship, posterior crossbite and deep bite. Significantly more children with ASD showed a negative behaviour (80% vs 35%: p =0.001; Chi-square test). CONCLUSION Children with ASD have a poorer oral health status than healthy children. The early establishment of a home dental hygiene should be encouraged.
... Children with ASD have higher rates of anxiety than children without ASD, with prevalence estimates of 40% in community samples [29]. In addition, children with ASD exhibit uncooperative behaviors during dental visits more frequently, compared to children without ASD [30] but commonly used anxiety measures may not be appropriate with this population. For example, the Spence Children's Anxiety Scale-Parent version, was found to have a different factor structure among children with ASD than in typically developing children [31]. ...
Article
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Youth with dental anxiety are at an increased risk of poor oral health but current tools used to identify dental anxiety in children in clinical settings are hampered by several limitations. This study assessed the psychometric properties of a measure of implicit associations with dental stimuli, the Affective Misattribution Procedure for dental stimuli (AMP-D) in 68 youth between the ages of 9 and 17 years. Measures of self-reported dental anxiety and parental perceptions of child dental anxiety were also administered. The internal consistency of the AMP-D was high (KR-20 = 0.96) and 1-week test-retest reliability was in the acceptable range (r = 0.75). The AMP-D was correlated with self-reported dental anxiety, providing evidence of construct validity. The psychometric properties of the AMP-D suggest it could be a useful tool in identifying youth with dental anxiety, particularly when concerns regarding self-representation may compromise the validity of self-reported anxiety.
... Студиите за оралното здравје на пациентите со аутизам даваат конфликтни резултати. Родителите на децата со аутизам наведуваат дека нивните деца добиваат послаба грижа за денталното здравје од нивните врсници(175).Од друга страна, студиите наведуваат дека преваленцијата на кариес на забите е подеднаква кај децата со аутизам и невротипичната популација(176,177).Orellana и соработниците во рамките на своето истражување спровеле третман заснован на TEACCH методологијата за полесно прифаќање на стоматолошкиот преглед кај децата со аутизам, кој опфаќал 10 чекори од влез во стоматолошката ординација до комплетен преглед на забите. Само по пет обуки спроведени во три последователни недели голем дел од испитаниците (77,77%) стигнале до претпоследниот чекор преглед на забите со сонда и огледало(178).Неколку студии кои се фокусирани на бариерите во денталното здравје кај децата со аутизам (179) зборуваат за тешкотии на родителите да пронајдат стоматолог кои има вештини и желба да работи со деца со аутизам, што е најчесто цитирана причина за проблем во врска со денталното здравје(180).Втора по значајност е карактеристиката "Допира луѓе и објекти" за која шансите некој кој има една оцена пониска да ја добие оваа карактеристика се 2.03 пати поголеми од шансите на некој кој има една оцена повисока, ако сите останати вредности останат исти. ...
Thesis
Children with autism perceive the world differently around them due to problems in processing and integrating sensory stimuli. These problems have been observed from when autism had been first discovered, but have been examined more in the past 15 years. Here in R. Macedonia, until now, there has been no research conducted in this area, although there are attempts to monitor global trends in the treatment of children with autism. In the last 5 years, they have opened sensory rooms within the NGO sector and special schools; however, awareness of programmed and systematic action is still low. Objective: The objective of this study was to assess the level of sensory function and identify problems in processing and integrating sensory received stimuli through the senses of smell, taste, touch, hearing, sight and balance (vestibular system and proprioception) in children with autism aged 7 to 10 years, compared with children from the neurotypical population and children with mild intellectual disability of the same age. Also, the survey was designed to assess the sensory issues of each child individually, which will continue to be used in work with children in the institutions visited. Methodology: Sensory Profile questionnaire for caregivers (Sensory Profile - Caregiver Questionnaire) by author Winnie Dunn and DSM IV diagnostic and statistical manual of mental disorders (Diagnostic and Statistical Manual of Mental Disorders) according to the American Psychiatric Association were translated and filled out. Questionnaires were applied to a convenience sample of respondents which consisted of a group of people (parents, teachers or educators) who care for children with autistic spectrum disorder (N = 35), another group of people (parents, teachers or educators) who care for children with mild intellectual disability (N = 35) and a third group of people (parents or teachers) who care for children with neurotypical development (N = 35). Data was processed in SPSS; and for the analysis of collected data the ANOVA test was used. The t-test and binary logistic regression were used for comparison of independent samples. For statistically significant difference was taken p <0,05. Results: In conducting the research and data processing, the results confirmed all our superior’s hypotheses. Autistic children differ significantly from children with mild intellectual disabilities and children from the neurotypical population in terms of sensory function in all tested areas of sensory processing, modulation, and behavioural and emotional reactions. According to all the factors of the sensory profile, subjects with autism have the lowest results in terms of total points compared to respondents with mild intellectual disability and respondents from the neurotypical population.In terms of classification and frequency discrepancies among respondents, the most definite differences in sensory processing appeared in "Multisensory processing" in 22 respondents. In the field of modulation, the most definite differences were found in "modulation of sensory input that affects the emotional reaction" in 25 respondents. While in the field of behavior and emotions definite difference have the highest number of participants with autism in each area, with 30 respondents in "behavioral manifestations of sensory processing"; in 22 respondents in "emotional / social responses" and in 26 respondents' statements indicating the level of the threshold of response". When applying the ANOVA test for independent samples for sensory processing, modulation and behavior and emotional responses, there are significant statistical difference in all groups together, in each area p = 0.000. To identify whether there is a difference between mean values in different groups, we made t-tests for each pair - which confirm that there is a significant statistical difference between each pair of groups in every area except with sensory processing in "vestibular processing". Here we verify that there is no significant statistical difference between the group of children with mild intellectual disability and neurotypical population (p = 0.131) and in the modulation where there is no significant statistical difference between the group of participants with mild intellectual disability and autism in "sensory processing related to endurance / tone "where (p = 0.050), the" modulation associated with maintenance of posture and movement "(p = 0.051) and " modulation of movement that affects the level of activity "(p = 0,066). The binary logistic regression, in the first step has singled out the features that are factors which having the greatest impact on the clinical picture in sensory processing: eg. "Appears to not hear what you say (for example, does not tune-in to what you say, appears to ignore you)"; "Prefers to be in dark"; "Seeks all kinds of movement activities (for example, being whirled by adult, merry go rounds, playground equipment, moving toys)"; "Expresses discomfort at dental work or tooth brushing (for example cries or fights"; "Has difficulty paying attention" and "Routinely smells nonfood objects". In modulation in the first step has singled out: "Props to support self (even during activity)"; "Hesitates going up or down curbs or steps (for example, is cautious, stops before moving)"; "Prefers quiet, sedentary play (for example watching TV, books, computers)"; Doesn’t perceive body language or facial expression (for example unable to interpret) and "Avoids eye contact" While, in the behavior and emotional responses as factors that influence the clinical picture of respondents with ASD that get highlighted are: "Has trouble staying between the lines when coloring or when writing" and "Does not seem to smell strong odors". Regarding the analysis of the factors, most differences include Factor 9 (concerning the fine motor/perceptual) and Factor 2 (relating to the emotionally reactive). Conclusions: The study found out that two or more disorders of sensory function appeared in all children with autism. The largest number of children with autism (22 children) have a multisensory disorder; which significantly differs from the other groups of respondents. They have a special emphasis on the characteristic of "difficulties in directing attention". A characteristic that stands out and significantly affects the clinical picture are "Prefers sedentary activities" for which researches showed that it is result of long hours spent in front of a screen. The impact of sensory impairment on behavior shows the greatest difference in autistic children. 30 children have definite differences, "There is a problem to write between the lines or coloring in the shape not out of line" and "There is a problem in tolerating change of routines ", showed the impact of primary sensory impairment in social interactions in autistic children, which differs considerably compared to other groups of children. In the future, further research is needed to confirm the results of a larger and more diverse sample of children with autism from the Macedonian population.
... (35,36) Although children with developmental disabilities are at a higher risk of developing caries than are children in the general population, children who have autism tend to have a lower caries rate. (37,38) GLUTEN, CASEIN & CPP-ACP Autism frequently is treated with applied behavioral and occupational therapy. However, when the GI problems are treated, many parents have stated that their children's behavior also improves. ...
... [12][13][14][15][16] Moreover, the prevalence of dental caries in these children was lower than or similar to that of the typical population; however, it can be considered as high. [12,[17][18][19] Therefore, preventive dental care is essential to prevent oral diseases in patients with ASD. ...
Article
Aims To evaluate the effect of visual pedagogy‐guided toothbrushing training on oral hygiene, toothbrushing ability, and fine motor skills in individuals with intellectual disability (ID) and impaired fine motor skills. Methods This quasi‐experimental study comprised 37 subjects aged 6–24 years. The plaque index (PI), gingival index (GI), toothbrushing ability, and fine motor skills were evaluated before and after 3 and 6 months of individual visual pedagogy‐guided toothbrushing training. Friedman's post hoc test and Spearman's correlation coefficient were used for statistical analyses. Results The PI, GI, toothbrushing ability, and fine motor skills of the 23 subjects who remained in the study at the 6‐month follow‐up period significantly improved from those measured at baseline (p < 0.05). A significant association was observed between the improvements in both toothbrushing ability and fine motor skills (p < 0.05). Conclusions Visual pedagogy‐guided toothbrushing training could improve the oral hygiene and toothbrushing ability of individuals with ID and impaired fine motor skills. Moreover, improvements in the toothbrushing ability could enhance the fine motor skills of these individuals.
... A thorough search of the relevant literature shows limited studies describing the gingival condition in individuals with ASD. Some studies have reported differences in the prevalence of gingivitis compared to that in non-autistic individuals (DeMattei et al., 2007;Kopycka-Kedzierawski and Auinger, 2008;Stein et al., 2012), while other studies have reported no significant differences (Marshall et al., 2010;Loo et al., 2008;Kuter and Guler, 2019). The controversy in these findings demonstrates the need to conduct a comprehensive literature search to evaluate the gingival health status among a population diagnosed with ASDs. ...
Article
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The prevalence of autism spectrum disorder (ASD) is close to 1% in the United States of America and other countries. Special attention should be given to oral health in individuals with ASD as they are often affected by oral diseases. However, gingival health in children with ASD and adolescents is controversial in terms of the severity of disease and number of people affected. Aim To conduct a systematic review and meta-analysis to assess the gingival health status of children and adolescents with ASD. Methods The search was conducted using eight databases for articles that met the inclusion and exclusion criteria. This search produced 742 relevant papers, but only five with sufficient data on gingival and plaque indices were eligible for inclusion in this systematic review and meta-analysis. Results The homogeneity of the sample was tested using the Cohen Q test, which identified significant heterogeneity (P<0.0001), indicating the use of the random effect’s standard mean difference. Significantly higher gingival index and plaque index values were found in children and adolescents with ASD than in children without ASD. Conclusion Individuals with ASD need help and better access to oral healthcare. Further investigation is needed with regard to gingival health in individuals with ASD and caries risk assessment to understand how this disorder affects oral health. A standardized index for gingival health will help in the inclusion of more studies to assess gingival health in children and adolescents with ASD.
... [6][7][8] The existing data on oral health of autistic people is mixed: while an international review (India, Japan, the United States, United Arab Emirates) showed a high occurrence of dental caries and periodontal disease in autistic children, 9 a review from the United States of autistic (average age 12) and non-autistic (average age 8) children's records found non-autistic children were more likely to have dental caries, though autistic children were considered less cooperative at the dentist. 10 In India, an observational study showed pediatric autistic patients had lower dental caries rates but higher periodontal disease rates than non-autistic patients. 11 However, while it cannot be claimed that all autistic individuals have poorer oral health than non-autistic individuals, the challenges associated with autism may impede dental care for a number of reasons. ...
Article
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Aims Previous international research has shown that autistic people have difficulty accessing dental care due to sensory processing, anxiety and communication issues. However, it is not known whether autistic adults in the United Kingdom are experiencing similar dental care barriers. The current study investigated autistic adults’ dental experiences in the United Kingdom. Methods and results A mixed methods survey was given to self‐selecting autistic (n = 37) and non‐autistic adults (n = 43) to compare whether autistic individuals had more negative experiences than non‐autistic individuals. Closed questions asked about anxiety, patient‐practitioner communication, satisfaction and the dental environment. Open questions asked about autism‐specific dental challenges, what works well at the dentist, and improving autistic individuals’ experiences. Responses were analyzed using thematic analysis. Overall, results demonstrated that autistic adults in the United Kingdom have more negative dental experiences than non‐autistic adults. These predominantly related to interactions with dental practitioners, a challenging sensory environment, anxiety, pain, and disclosure. Participants recommended sensory environment adaptations, ways to increase preparedness, longer appointments, and individual accommodations. Conclusion This study offers best‐practice strategies for working with autistic patients and highlights the importance of dentists working with autistic individuals to maximize the quality of care and outcomes for this underserved population.
... Concerning the dmft index at different dental visits of children using coconut oil and toothpaste, during the 1 st visit, no significant difference between the groups was reported which is in agreement with the study done by Lowe et al. [10] who reported that children with autism are considered to have high risk of caries. In contrast, Loo et al. [11] study stated that through logistic regression analysis it was determined that patients with autism were 70.5% less likely to have a positive caries history than the control group. ...
Article
Patient disruption during dental visits can impede treatment and may result in invasive approaches to care. The current study evaluated the efficacy of graduated exposure with and without extinction to decrease disruption during dental treatment for 4 young men with autism spectrum disorder (ASD). Modified functional analyses confirmed that disruption was maintained by escape from dental demands for all four young men. Initial treatment consisted of graduated exposure, whereby exam steps were initially removed and then gradually reintroduced as disruption remained low; throughout this phase, disruption resulted in a break from the exam. During the subsequent treatment phase, graduated exposure procedures continued and extinction for disruption was added. Graduated exposure alone did not result in sufficient treatment effects; however, the addition of extinction resulted in greater reductions in disruption and increases in exam completion for all 4 young men, and treatment effects generalized to a dental clinic setting.
Article
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Introduction: Diabetes mellitus is a chronic disease that affects all aspects of pediatric patient’s life, especially psychologically aspect and therefore health related quality of life. The aim of the study was to describe the health related quality of life in pediatric patients with type 1 diabetes mellitus and analyze its associated sociodemographic and clinical factors. Materials and methods: The research was conducted as a cross-sectional study. The sample (N= 37) included pediatric patients aged 8 to 18 years, with the type 1 diabetes mellitus diagnosis made six months ago or longer prior the study. For the purposes of the research, the Serbian version of child-friendly EuroQol-5D-Y instruments and patient documentation sheet to collect patients’ data (gender, age, and time since diagnoses- in years, glycosylated hemoglobin values, type of insulin therapy) were used. Results: The total score of general health status on visual analogue scale was in average 80.54 (SD= 20.87). A negative correlation has been noted between scores at the visual analogue scale and the duration of diabetes (ρ= -0.329, p< 0.05). The statistical significance of the difference in the distribution of respondents' responses to health domains in relation to the type of insulin therapy was confirmed in the domain "Feeling of concern" (χ2 (2) = 7.19, p< 0.05). Conclusion: The key determinants that influenced the assessment of the health related quality of life in pediatric patients with type 1 diabetes mellitus are: the duration of the disease and the use of insulin analogue therapy. Keywords: Adolescents; Children; Patient reported outcomes; Pediatric; Type 1 diabetes mellitus.
Article
‘Neurodiversity’ is a term used to describe people with neurological variation; this includes people with autism, dyspraxia, dyslexia and attention deficit hyperactivity disorder. Studies have shown an increased prevalence of malocclusion and dental trauma in people with these conditions. Unfortunately, a lack of understanding around such neurological differences can create barriers when accessing orthodontic care. The aim of this article is to raise awareness around the subject and to suggest reasonable adjustments to practice which may subsequently be used by the orthodontic team to improve the patient experience. CPD/Clinical Relevance: Recognition of neurodiversity and the need to make reasonable adjustments to orthodontic care may aid compliance and improve outcomes in this group of patients.
Thesis
Purpose: For patients with special health care needs who require intravenous sedation or general anesthesia for preventative dental care, there are few guidelines regarding ideal recall intervals. The purpose of this retrospective chart review was to investigate an association between caries incidence and length of recall interval to help determine guidelines for frequency of sedation for preventative care. This study particularly focused on adolescent and adult patients with special health care needs who require IV sedation or general anesthesia for dental prophylaxis and examination. Methods: A total of 375 recall visits were reviewed from 99 electronic medical records belonging to the University of Pittsburgh Center for Patients with Special Health Care Needs. The number of months between each recall visit was recorded as well as the number of carious lesions requiring treatment at each appointment. In addition, place of residence, history of caries within the past three years, and total number of carious lesions requiring treatment, were recorded from 87 patient charts. Linear regression was used to evaluate the primary outcome. Results: The length of time between recall visits was found to be a predictor of carious teeth requiring treatment (P=0.027). Patients with a history of caries within the past three years were more likely to experience new carious lesions (P=0.048). Conclusions: There appears to be an association between length of recall interval and number of carious teeth requiring treatment in this specific patient population.
Article
Pica is a condition associated with a number of physical and mental health diagnoses. The potentially fatal consequences of pica and the links with significant physical health problems are not always recognised. Pica is like other forms of behaviour that can challenge: clinicians must seek the underlying cause and treat this first, before primarily pursuing a behavioural form of treatment. In this article, we discuss the associations, consequences, assessment and management options available for pica to guide professionals. Pica often presents in a way individual to the particular patient, so tailoring of assessment and treatment is important.
Article
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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.
Article
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Autism is a developmental disorder characterized by difficulties in social and communication interactions. Parentally induced autism, brain injury/anomalies, constitutional vulnerability, and developmental aphasia have been incriminated in the epidemiology of the disease. Other suspected etiologies are structural cerebellar changes, genetics, viral infections, and immunological abnormalities, with various teratogens and vaccines. Autism Spectrum Disorders (ASD) displayed prevalence rates of about 1%, and a fourfold higher predominance of men over women. The life expectancy of autistic patients is reduced, and the death rates seem to be higher than in the general population. Dental and oral pathologies are mainly carious lesions and periodontitis. Many autistic patients are uncooperative and required general anesthesia during dental treatments. Diagnosis of autistic dental diseases includes self‐extraction of primary teeth, autistic syndrome and self-injurious behaviors. Most ASD are unmarried, poorly educated, and economically deprived. The number of adults with ASD grows. Some have a level of independence that allows full participation in their healthcare decisions; others have impairments that require dependence on caregivers to mediate the healthcare they receive.
Article
Reports suggest that individuals with developmental disabilities often engage in behavior during dental visits that precludes regular dental care. Graduated exposure therapies are an effective treatment for avoidant behavior in people with developmental delays, and some studies show that the duration of the intersession interval (ISI) can impact the effectiveness of graduated exposure treatments for typically developing individuals. The current study examined the effects of decreasing ISI on outcomes of a graduated exposure treatment during simulated routine dental care for 3 individuals diagnosed with autism. Treatment consisted of graduated exposure and extinction for disruptive behavior. Initially, sessions were conducted once per week. In subsequent conditions, treatment sessions were conducted 3‐5 times per week. A nonconcurrent multiple baseline across subjects design was used to demonstrate experimental control. Results suggest that decreasing ISI durations can produce improved treatment outcomes.
Article
Autism is a complex neurobehavioral disorder that causes problems in thinking, feeling, language, and the ability to communicate with other people. Over the past two decades, there has been a great deal of interest in autism disorder. This problem is recognized worldwide, and various measures are taken both nationally and internationally to improve the lives of affected individuals and families. The oral health care of such patients can be complicated since they cannot express their problems and can show unpredictable behaviors during treatment. The aim of the literature review was to collect information about the general oral health status of patients with autism, the difficulties that may be encountered during treatment, and the precautions that can be taken and the treatment approaches. This article reviews the dental literature from 1943 to the present.
Article
Background: We investigated the number of teeth in middle-aged and older individuals with intellectual disability and evaluated the related factors. Methods: A questionnaire survey on oral health was administered to 604 persons over 40 years old with intellectual disabilities in Aichi Prefecture, Japan. The questionnaire designed for this study included items on diagnosis of disability, severity of intellectual disability and type of residence. As oral-health-related factors, the proxy-reported number of teeth, family dentist, regular dental check-ups, problems during dental treatment and tooth-brushing frequency were evaluated. A multinomial logistic regression analysis was performed using the proxy-reported number of teeth (≥20, 10-19 or 0-9) as the dependent variable, and the odds ratios (ORs) and 95% confidence intervals (CIs) of independent variables were calculated. In addition, linear regression analysis was performed using the proxy-reported number of teeth as the dependent variable. Results: In the multivariate multinomial logistic regression analysis, age, diagnosis of disability and type of residence were significantly associated with having 10-19 versus ≥20 teeth. Participants with autism spectrum disorder had a significantly lower OR for 10-19 teeth compared with those with intellectual disability [OR (95% CI): 0.49 (0.22-1.08)]. Age, diagnosis of disability, regular dental check-ups and tooth-brushing frequency were significantly associated with having 0-9 versus ≥20teeth. Participants with Down syndrome had a significantly higher OR for 0-9 teeth compared with those with intellectual disability [OR (95% CI): 3.17 (1.09-9.23)]. The ORs for 0-9 teeth of participants who attend regular dental check-ups and who brushed their teeth ≥3 times/day compared with 1 time/day were significantly high, and the OR (95% CI) was 2.37 (1.06-5.30) and 4.76 (1.09-20.77), respectively. In the multivariate linear regression analysis, age, diagnosis of disability and regular dental check-ups were significantly associated with the proxy-reported number of teeth. The proxy-reported number of teeth was -0.42 less with each 1-year increase in age. With autism spectrum disorder, the proxy-reported number of teeth was 0.74 more compared with intellectual disability. In Down syndrome, the proxy-reported number of teeth was -0.93 less compared with intellectual disability. The proxy-reported number of teeth was -2.12 less for those who did not have regular dental check-ups. Conclusions: The number of teeth in middle-aged and older individuals with intellectual disability was related to age and the type of disability. Regular dental visits may be effective at preventing tooth loss in middle-aged and older persons with intellectual disability.
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Behavior of patients with autistic syndrome makes delivery of oral hygiene and dental treatment a problem. In this study, the oral health and needs of two groups of patients with autism were evaluated: noninstitutionalized children with a mean age of 11 and institutionalized adults with a mean age of 22. The latter group had severe periodontal problems; almost half required periodontal surgery. Many of the children also needed periodontal treatment. Adults were found to have lower decayed, missing, and filled teeth (DMFT) scores than functionally independent Israeli persons of the same age. This finding was surprising because institutionalized adults are predisposed to development of dental caries; they frequently consume sweets, have poor oral hygiene, and do not use fluoride. Noninstitutionalized children with autism had caries rates that were similar to rates of functionally independent peers.
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Dental publications on autism have been sparse since the first comprehensive article geared for the dental profession. New findings on the etiology of autistic disorder (AD) have been discovered, suggesting that it is an organic disorder characterized by abnormalities in the brain, especially the cerebellum and limbic system. This article summarizes the latest medical findings on the etiology, diagnosis, and treatment approaches of AD, and reviews the dental literature since 1969. The main dental topics reviewed are: oral health status and dental needs of patients with AD, characteristics of patients with AD, and self-injurious behavior (SIB) in the context of AD. Clinical behavior-management issues such as pharmacological and communicative techniques and physical restraint and desensitization are described. The affect of the dental office's environment and appointment structure on a patient with AD are presented.
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Children with an autistic disorder may need more dental care and may also be more difficult to treat than healthy children. This study compared oral health in autistic and healthy children. Also explored was the dental management of autistic children within the non-specialized Public Dental Service. The study was designed as a case-control study with all cases of autistic disorders aged 3-19 years identified within a primary care area in southwest Sweden. One dentist did a clinical investigation of cases and one control per case. The patients, or their parents, answered a questionnaire. 28 patients were identified and 20 (71%) agreed to participate in the study. Cases and controls had a similar prevalence of fillings, caries, gingivitis and degree of oral hygiene. However, the need of orthodontic treatment seemed to be greater among the autistic children. According to a standardised assessment, autistic children were less able to cooperate in the dental treatment. Approximately 30% of the cases had occasionally been subjected to specialized dental care. The results of this study indicate that the care provided to autistic children within the non-specialized Public Dental Service is satisfactory, provided that there is access to a paediatric dentist when necessary.
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Concern has been raised about possible increases in the prevalence of autism. However, few population-based studies have been conducted in the United States. To determine the prevalence of autism among children in a major US metropolitan area and to describe characteristics of the study population. Study of the prevalence of autism among children aged 3 to 10 years in the 5 counties of metropolitan Atlanta, Ga, in 1996. Cases were identified through screening and abstracting records at multiple medical and educational sources, with case status determined by expert review. Autism prevalence by demographic factors, levels of cognitive functioning, previous autism diagnoses, special education eligibility categories, and sources of identification. A total of 987 children displayed behaviors consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for autistic disorder, pervasive developmental disorder-not otherwise specified, or Asperger disorder. The prevalence for autism was 3.4 per 1000 (95% confidence interval [CI], 3.2-3.6) (male-female ratio, 4:1). Overall, the prevalence was comparable for black and white children (black, 3.4 per 1000 [95% CI, 3.0-3.7] and white, 3.4 per 1000 [95% CI, 3.2-3.7]). Sixty-eight percent of children with IQ or developmental test results (N = 880) had cognitive impairment. As severity of cognitive impairment increased from mild to profound, the male-female ratio decreased from 4.4 to 1.3. Forty percent of children with autism were identified only at educational sources. Schools were the most important source for information on black children, children of younger mothers, and children of mothers with less than 12 years of education. The rate of autism found in this study was higher than the rates from studies conducted in the United States during the 1980s and early 1990s, but it was consistent with those of more recent studies.
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A group of 43 patients with AD (mean age, 13.5; SD, 5.9 yrs) was identified from the University Hospital School Pediatric Dentistry Clinic. We reviewed the patients' charts to obtain demographic data, dental findings, and the management techniques used for treatment. The patients were divided Into groups according to Frankl's categories of behavior, ranging from definitely negative to positive. Descriptive data are provided for each group. Commonly used communications and pharmacological management techniques, as well as physical restraints, enabled us to treat all the patients in the traditional dental setting, when simple procedures were planned. Treatment under general anesthesia in the operating room was necessary in 37% of all patients when comprehensive care was required or difficult procedures were carried out. A questionnaire was also sent out to the caregivers to gather data on patients' nutrition and eating/chewing habits. In the sample surveyed, two-thirds of the individuals reportedly exhibited a normal eating pattern, while 14% pouched food. Soft, sweet, or sticky foods were preferred by 41% of the patients.
Article
Behavior of patients with autistic syndrome makes delivery of oral hygiene and dental treatment a problem. In this study, the oral health and needs of two groups of patients with autism were evaluated: noninstitutionalized children with a mean age of 11 and institutionalized adults with a mean age of 22. The latter group had severe periodontal problems; almost half required periodontal surgery. Many of the children also needed periodontal treatment. Adults were found to have lower decayed, missing, and filled teeth (DMFT) scores than functionally independent Israeli persons of the same age. This finding was surprising because institutionalized adults are predisposed to development of dental caries; they frequently consume sweets, have poor oral hygiene, and do not use fluoride. Noninstitutionalized children with autism had caries rates that were similar to rates of functionally independent peers.
Article
A successful clinical examination was achieved on the first attempt for 50 percent of the autistic patients. In general, autistic patients had a lower hygiene level than those in the control group, but a comparable caries index. Behavior management techniques included positive reinforcement; tell, show and do; and negative reinforcement.
Article
This article examines the extent to which caries prevalence and untreated caries vary in children by ethnicity and household income level. Data from the Third National Health and Nutrition Examination Survey, 1988-1994, for 10,332 children 2 to 18 years of age indicate that lower-income children and Mexican-American and African-American children are more likely to have a higher prevalence of caries and more unmet treatment needs than their higher-income and non-Hispanic white counterparts.
Article
A group of 43 patients with AD (mean age, 13.5; SD, 5.9 yrs) was identified from the University Hospital School Pediatric Dentistry Clinic. We reviewed the patients' charts to obtain demographic data, dental findings, and the management techniques used for treatment. The patients were divided into groups according to Frankl's categories of behavior, ranging from definitely negative to positive. Descriptive data are provided for each group. Commonly used communications and pharmacological management techniques, as well as physical restraints, enabled us to treat all the patients in the traditional dental setting, when simple procedures were planned. Treatment under general anesthesia in the operating room was necessary in 37% of all patients when comprehensive care was required or difficult procedures were carried out. A questionnaire was also sent out to the caregivers to gather data on patients' nutrition and eating/chewing habits. In the sample surveyed, two-thirds of the individuals reportedly exhibited a normal eating pattern, while 14% pouched food. Soft, sweet, or sticky foods were preferred by 41% of the patients.
Article
The present study indicates that experience and severity of dental caries in 1995 showed a clear decrease from observations in 1980 in Kaogsima City, Japan. This decline may be attributed to several factors such as the qualitative and quantitative improvements in treatment of caries, more regular visits to dental clinics, improved daily oral hygiene, and changes in dietary pattern.
Article
This study determined the prevalence of autism for a defined community, Brick Township, New Jersey, using current diagnostic and epidemiologic methods. The target population was children who were 3 to 10 years of age in 1998, who were residents of Brick Township at any point during that year, and who had an autism spectrum disorder. Autism spectrum disorder was defined as autistic disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), and Asperger disorder. The study used 4 sources for active case finding: special education records, records from local clinicians providing diagnosis or treatment for developmental or behavioral disabilities, lists of children from community parent groups, and families who volunteered for participation in the study in response to media attention. The autism diagnosis was verified (or ruled out) for 71% of the children through clinical assessment. The assessment included medical and developmental history, physical and neurologic evaluation, assessment of intellectual and behavioral functioning, and administration of the Autism Diagnostic Observation Schedule-Generic. The prevalence of all autism spectrum disorders combined was 6.7 cases per 1000 children. The prevalence for children whose condition met full diagnostic criteria for autistic disorder was 4.0 cases per 1000 children, and the prevalence for PDD-NOS and Asperger disorder was 2.7 cases per 1000 children. Characteristics of children with autism in this study were similar to those in previous studies of autism. The prevalence of autism in Brick Township seems to be higher than that in other studies, particularly studies conducted in the United States, but within the range of a few recent studies in smaller populations that used more thorough case-finding methods.
Article
This paper was commissioned by the committee on the Effectiveness of Early Education in Autism of the National Research Council (NRC). It provides a review of epidemiological studies of pervasive developmental disorders (PDD) which updates a previously published article (The epidemiology of autism: a review. Psychological Medicine 1999; 29: 769-786). The design, sample characteristics of 32 surveys published between 1966 and 2001 are described. Recent surveys suggest that the rate for all forms of PDDs are around 30/10,000 but more recent surveys suggest that the estimate might be as high as 60/10,000. The rate for Asperger disorder is not well established, and a conservative figure is 2.5/10,000. Childhood disintegrative disorder is extremely rare with a pooled estimate across studies of 0.2/10,000. A detailed discussion of the possible interpretations of trends over time in prevalence rates is provided. There is evidence that changes in case definition and improved awareness explain much of the upward trend of rates in recent decades. However, available epidemiological surveys do not provide an adequate test of the hypothesis of a changing incidence of PDDs.
Article
The need for improved oral hygiene routines in individuals with disabilities has been documented in many reports. The aim of this study was to evaluate whether visual pedagogy is a suitable way to teach children with autism how to brush their teeth. The investigation took the form of a prospective study including clinical examinations and structured interviews. Based on visual pedagogy, a series of pictures were produced that showed a structured method and technique of tooth brushing. The pictures were placed in the bathroom or wherever tooth brushing was performed. Fourteen children with autism aged between 5 and 13 years (mean age = 9.3 years), and their parents participated. Before the study, all parents found it difficult/very difficult to maintain good oral hygiene in their child. All children had visible plaque on their maxillary incisors and canines. After 12 months, the amount of visible plaque was reduced. After 18 months, most parents found maintaining good oral hygiene easier than before the study. All but one child/parent adopted the programme. Visual pedagogy is a useful tool in helping people with autism to improve their oral hygiene.
Article
A paucity of information exists in the dental literature about autism and its dental implications. The authors conducted a MEDLINE search for the period 2000 through 2006, using the term "autism," with the aim of defining the condition's clinical manifestations, dental and medical treatment and dental implications. Autism is a severe developmental brain disorder that appears in infancy, persists throughout life, and is characterized by impaired social interaction, abnormalities in communication (both verbal and nonverbal) and restricted interests. Often accompanying the disorder are behavioral disturbances - such as self-mutilation, aggression, psychiatric symptoms and seizures - that necessitate the administration of multiple medications to help the affected person participate effectively in the educational and rehabilitative process. Dentists caring for people with autism must be familiar with the manifestations of the disease and its associated features so that they can garner the maximum level of patient cooperation. They also must be familiar with the medications used to treat the associated features of the disorder because many of them cause untoward orofacial and systemic reactions and may precipitate adverse interactions with dental therapeutic agents.
Autism is a complex neurodevelopmental disorder characterized by impaired reciprocal social interaction, impaired communication, and restricted, repetitive, or stereotyped behaviors. Autism seems to affect more children than was previously believed, although this phenomenon may be due to broadening of the diagnostic criteria and increased awareness of the condition. Recent research has clearly indicated the importance of early identification, since early intensive treatment is associated with better long-term outcome. There are many controversies and competing theories about the etiology and treatment of autism, often leaving families confused about the best course of treatment and intervention. Pediatric primary health care clinicians have an important role in both the early identification and ongoing management of children with autism. It is, therefore, essential that primary care clinicians have up-to-date information about the science of autism.
Article
Over the past two decades, there has been an explosion of interest in autism and autism spectrum disorders. Knowledge and awareness of the condition has grown exponentially at all levels among the general public, parents, health professionals, the research community and, more recently, at parliamentary level. Alongside the increased understanding of these complex and disabling conditions is the acknowledgment of a broadening of the diagnostic criteria away from a narrow definition of autism to the autism spectrum with less clear diagnostic boundaries. Growing evidence of the importance of early diagnosis and intervention demands knowledge and skills from all professionals working with young children and in particular those involved in recognising early concerns about a child's development. This article outlines current clinical and research findings in relation to early diagnosis and considers the role of the paediatrician in this process. Reference is also made to the National Autism Plan for Children.
Article
The study assessed the oral health status of children with an autism spectrum disorder (ASD) to help establish the oral health needs of this population. Oral assessments were conducted on 39 children with an ASD and 16 children with other developmental disabilities (DD), solicited from 3 different schools. Conditions assessed were bacterial plaque, gingivitis, dental caries, restorations, bruxism, delayed eruption/missing teeth, oral infection, developmental anomalies, injuries, occlusion, salivary flow, and oral defensiveness. Chi-square and Fisher's exact test of significance were used to compare groups. Young children with an ASD who resided with parents showed significantly more signs of bruxism than the comparison groups. Likewise, older children who lived at the residential school manifested significantly more gingivitis. No other significant differences existed when age and residence were considered for children with an ASD. When comparing children with ASD to those with another DD, the latter group showed significantly more oral injuries, abnormal salivary flow, and developmental anomalies. Children with an ASD displayed the following percentages for clinically visible conditions: plaque (85%), gingivitis (62%), and caries (21%). Approximately half of the children with ASD were orally defensive. Children with an ASD appear to have oral conditions that might increase the risk of developing dental disease. The extent of risk is unclear and needs further investigation.
Article
This study evaluated potential predictors of cooperation during dental appointments for children with autism. Data were collected from 108 parent/child pairs and their dentists. Questions included: (1) medical/dental history; (2)functional language; (3) personal hygiene skills; (4) academic setting; and (5) achievements. Behavior was scored using the Frankl scale. Subjects were 80 males and 28 females 2.7 to 19 years old with a mean age of 9.8 years. Frankl scores were 65% uncooperative (definitely negative or negative) and 35% cooperative (positive or definitely positive). Multiple factors predicted uncooperative behavior: (1) appointment type (P=.03); (2) concurrent medical diagnoses (P=.04); (3) nonverbal/minimal or echololic language (P=.005); (4) inability to understand language appropriate for age (P=.02); (5) inability to follow multistep instructions (P=.04); (6) parents providing most/all tooth-brushing (P=.004); (7) partially or not toilet trained at 4+ years (P=.02); (8) inability to sit for a haircut (P=.01); (9) attending special education (P<.001); and (10) inability to read at 6+ years (P<.001). Five questions readily answered by a caregiver may indicate a child's cooperative potential. Preappointment inquiry about toilet training, toothbrushing, haircuts, academic achievement and language can give the dentist insight into the child's ability to respond positively to behavior guidance techniques based on communication.
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