Dental care protocol based on visual supports for children with autism spectrum disorders

Abstract

BackgroundSubjects with Autism Spectrum Disorders (ASDs) have often difficulties to accept dental treatments. The aim of this study is to propose a dental care protocol based on visual supports to facilitate children with ASDs to undergo to oral examination and treatments.Material and Methods83 children (age range 6-12 years) with a signed consent form were enrolled; intellectual level, verbal fluency and cooperation grade were evaluated. Children were introduced into a four stages path in order to undergo: an oral examination (stage 1), a professional oral hygiene session (stage 2), sealants (stage 3), and, if necessary, a restorative treatment (stage 4). Each stage came after a visual training, performed by a psychologist (stage 1) and by parents at home (stages 2, 3 and 4). Association between acceptance rates at each stage and gender, intellectual level, verbal fluency and cooperation grade was tested with chi-square test if appropriate.ResultsSeventy-seven (92.8%) subjects overcame both stage 1 and 2. Six (7.2%) refused stage 3 and among the 44 subjects who need restorative treatments, only three refused it. The acceptance rate at each stage was statistically significant associated to the verbal fluency (p=0.02; p=0.04; p=0.01, respectively for stage 1, 3 and 4). In stage 2 all subjects accepted to move to the next stage. The verbal/intellectual/cooperation dummy variable was statistically associated to the acceptance rate (p<0.01).ConclusionsThe use of visual supports has shown to be able to facilitate children with ASDs to undergo dental treatments even in non-verbal children with a low intellectual level, underlining that behavioural approach should be used as the first strategy to treat patients with ASDs in dental setting. Key words:Autism spectrum disorders, behaviour management, paediatric dentistry, visual learning methods.

Is Visual Pedagogy Effective in Improving Cooperation towards Oral Hygiene and Dental Care in Children with Autism Spectrum Disorder? A Systematic Review and Meta-Analysis

“…Therefore, forty-one papers were assessed; eighteen papers were discarded ( Table S3 ). Twenty-three studies were finally included in this systematic review: nine studies concerned tooth brushing and oral hygiene skills in children with ASDs and 14 studies concerned their cooperation during dental procedures ( Figure 1 ) [ 4 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. The majority of the papers included (21 studies) were published in the last decade, with 10 papers published from 2018 to 2020 [ 14 , 16 , 17 , 19 , 21 , 22 , 23 , 26 , 28 , 32 ] ( Table 1 ).…”

“…In the first group, articles that investigated the effectiveness of visual pedagogy in improving oral hygiene skills in children with ASDs were included [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. In the second group, articles that investigated the effectiveness of visual pedagogy in improving the patient’s cooperation during dental care were included [ 4 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. To facilitate the synthesis, the results were summarized in tables.…”

“…Children with ASD are greatly challenged when facing new experiences, and the dental environment is of particular concern due to the presence of several noises, smells, and visual stimuli that might exacerbate fear and anxiety [ 1 , 2 , 3 ]. Concerns about dental care may lead parents to avoid regular dental examinations [ 4 ]. A good level of oral hygiene is quite difficult to maintain, since they often refuse brushing and flossing [ 5 , 6 ], increasing the risk of dental caries and gingivitis compared to children not affected by ASD.…”

“…The core of visual pedagogy is that children with ASDs become familiar with the storytelling that they will remember when in the dental office. A high number of studies have already been carried out on this approach, proving this to be effective in reducing anxiety and increasing compliance [ 4 , 5 , 13 ].…”

Oral health difficulties in children and adolescents with autism spectrum disorder: Parental perception

“…The authors of the study therefore assumed that if proper tooth brushing habits were established at home, the clinical situations would be more easily accepted [23]. Similarly, the use of visual aids has shown to be able to facilitate children with ASD to undergo dental treatments [24]. Another study also proved that sensory adapted dental environment decreased anxiety and discomfort for children with ASD compared to the regular dental environment [25].…”