Effectiveness of a tooth-brushing programme using the picture exchange communication system (PECS) on gingival health of children with autism spectrum disorders

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

“…Studies selected were divided into two groups according to their primary outcome. 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].…”

“…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,. 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).…”

“…Regarding the type of study, five were RCTs [20,23,27,29,31] and 18 were non-randomized studies, of which 11 papers were interrupted time series studies (ITSSs) [4,14,15,[17][18][19]22,25,26,28,32], two were controlled before and after studies (CBAs), and five were before and after comparison studies (BAs) [16,30,[33][34][35]. Regarding the type of study design, 12 studies were single-arm trials [4,[15][16][17][18][19]25,26,28,30,33,34], 10 were double-arm trials [14,[20][21][22][23][24]29,[31][32][33], and one was a multi-arm trial [27]. Eight papers had a sample size greater than 50 participants [4,17,19,…”

“…Eight papers had a sample size greater than 50 participants [4,17,19,21,22,27,28,32]. Regarding study length, only 13 studies lasted more than six months [14][15][16][17][18][19]21,22,24,25,27,28,30], with a follow-up evaluation that ranged from one week to 12 months.…”

“…The Pictured Exchanged Communication System was used in eight studies [14][15][16]23,25,26,29,35], other kinds of images were used in 10 studies [4,[17][18][19]21,24,28,30,31,34], and video and/or video plus images were used in five studies [20,22,27,32,33]. The intervention protocol foresaw the administration of visual tools on a daily basis in 11 studies [14][15][16][17][18][19][20][21][22]30,31], on weekdays in one study [28], on a weekly basis in six studies [4,26,29,[32][33][34], once in five studies [23][24][25]27,35], and on a weekly followed by a daily basis in one study [4].…”