Oral care and sensory sensitivities in children with autism spectrum disorders

Stein, Leah I.; Polido, José C; Mailloux, Zoe; Coleman, Gina Geppert; Cermak, Sharon A.

doi:10.1111/j.1754-4505.2011.00187.x

Cited by 178 publications

(274 citation statements)

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“…Children with autism spectrum disorder (ASD) often have oral care challenges that are exacerbated by sensory processing difficulties , 2013Stein, Polido, Mailloux, Coleman, & Cermak, 2011). Such children are highly anxious and exhibit negative behavioral reactions when exposed to standard sensory characteristics of the dental operatory, such as bright fluorescent lights, touch in or around the mouth, and the taste and smell of various oral care products, making it difficult for dentists to provide treatment (Stein et al, 2013).…”

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“…Such children are highly anxious and exhibit negative behavioral reactions when exposed to standard sensory characteristics of the dental operatory, such as bright fluorescent lights, touch in or around the mouth, and the taste and smell of various oral care products, making it difficult for dentists to provide treatment (Stein et al, 2013). Stein et al (2013) used cut scores of sensory responsivity to identify children with ASD who were overresponsive to sensory stimuli versus those who were not. In this study, 65% of parents of overresponders with ASD, compared with 39% of parents of children with ASD who were not overresponsive to stimuli, reported moderate to severe behavioral challenges at the dentist.…”

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Feasibility of a Sensory-Adapted Dental Environment for Children With Autism

Cermak

Duker

Williams

et al. 2015

The American Journal of Occupational Therapy

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OBJECTIVE. To provide an example of an occupational therapy feasibility study and evaluate the implementation of a randomized controlled pilot and feasibility trial examining the impact of a sensory-adapted dental environment (SADE) to enhance oral care for children with autism spectrum disorder (ASD). METHOD. Twenty-two children with ASD and 22 typically developing children, ages 6–12 yr, attended a dental clinic in an urban hospital. Participants completed two dental cleanings, 3–4 mo apart, one in a regular environment and one in a SADE. Feasibility outcome measures were recruitment, retention, accrual, dropout, and protocol adherence. Intervention outcome measures were physiological stress, behavioral distress, pain, and cost. RESULTS. We successfully recruited and retained participants. Parents expressed satisfaction with research study participation. Dentists stated that the intervention could be incorporated in normal practice. Intervention outcome measures favored the SADE condition. CONCLUSION. Preliminary positive benefit of SADE in children with ASD warrants moving forward with a large-scale clinical trial.

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confidence: 99%

Feasibility of a Sensory-Adapted Dental Environment for Children With Autism

Cermak

Duker

Williams

et al. 2015

The American Journal of Occupational Therapy

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“…It reinforces the need to consider their opinion when performing different procedures 8,15,[16][17][18] .…”

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confidence: 99%

“…Autistic children's parents expect the professional who attends them has knowledge, skills and attitudes to treat their children according to their special needs 14 , which are generally more difficult to care than those of other groups with intellectual or developmental deficits 15 .…”

Section: Hernández C and Oyarzún Pmentioning

confidence: 99%

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Perceptions of autistic children’s parents about dental care: Preliminary study. Concepción, 2012.

Hernández

Oyarzún

2014

Joralres

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Sensory Adaptations to Improve Physiological and Behavioral Distress During Dental Visits in Autistic Children

Stein Duker,

Como,

Jolette

et al. 2023

JAMA Netw Open

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ImportanceAutistic children have poorer oral health and greater oral care challenges, which are often associated with sensory overresponsivity, than neurotypical peers. It is important to identify innovative solutions enabling dentists to successfully perform standard clinic-based procedures for this population.ObjectiveTo determine whether a sensory-adapted dental environment (SADE) reduces physiological and behavioral distress in autistic children undergoing dental cleanings, compared with a regular dental environment (RDE).Design, Setting, and ParticipantsThis randomized crossover trial was conducted at a pediatric dentistry clinic in a large urban children’s hospital between May 2016 and April 2022. Coders were blinded to study condition for physiological but not behavioral measurements. Autistic children aged 6 to 12 years were identified and invited to participate. Interested families were enrolled consecutively; after confirmation of autism diagnosis, children were randomized. Analysis for this per-protocol study were conducted from April to October 2022.InterventionEach child underwent 1 RDE and 1 SADE dental cleaning, administered in randomized and counterbalanced order approximately 6 months apart. SADE included modified visual, auditory, and tactile stimuli.Main Outcomes and MeasuresThe primary outcome was physiological stress, assessed by electrodermal activity. The secondary outcome was behavioral distress measured from video recordings.ResultsAmong 452 families invited to participate, 220 children were enrolled, and 162 children (mean [SD] age, 9.16 [1.99] years; 136 [84.0%] male) with confirmed autism were randomized, with 83 children receiving RDE first and 80 children receiving SADE first. Most children (94 children [58.0%]) had moderate autism severity. Children had significantly lower physiological stress during dental care in SADE compared with RDE (mean difference in skin conductance level, −1.22 [95% CI, −2.17 to −0.27] μS), suggesting decreased sympathetic activity and increased relaxation during SADE dental care. No significant differences were found in nonspecific skin conductance responses (mean difference, −0.30 [95% CI, −0.86 to 0.25] per min). Video-coded frequency and duration of behavioral distress (but not questionnaire) measures were significantly lower in SADE vs RDE (Cohen d = −0.84 to −1.19). Physiological stress was associated with behavioral distress during the dental cleaning (eg, nonspecific skin conductance responses associated with the Frankl Scale: β = −0.29; 95% CI, −0.39 to −0.19); age, IQ, and expressive communication moderated the intervention’s success. No participants withdrew due to adverse effects.Conclusions and RelevanceIn this randomized crossover trial of autistic children, using SADE was safe and efficacious in decreasing physiological and behavioral distress during dental care. This is important because enhancing oral care is critical for autistic children; this intervention may also be beneficial for populations beyond autism.Trial RegistrationClinicalTrials.gov Identifier: NCT02430051

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Oral care and sensory sensitivities in children with autism spectrum disorders

Cited by 178 publications

References 21 publications

Feasibility of a Sensory-Adapted Dental Environment for Children With Autism

Feasibility of a Sensory-Adapted Dental Environment for Children With Autism

Perceptions of autistic children’s parents about dental care: Preliminary study. Concepción, 2012.

Sensory Adaptations to Improve Physiological and Behavioral Distress During Dental Visits in Autistic Children

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