Oral Health Statuses of Children and Young Adults with Autism Spectrum Disorder: An Umbrella Review

Abstract

This study aimed to comprehensively evaluate the oral health statuses of children and adults within the autism spectrum disorder (ASD) population through an umbrella review approach. The prevalence of dental caries, periodontal disease, and associated variables were investigated across selected studies. A systematic search was conducted across databases including PubMed, Scopus, EMBASE, Science Citation Index, Science Direct, Web of Science, MEDLINE, and Wiley Online Library to identify relevant studies. The assessed variables included dental caries prevalence, periodontal disease prevalence, oral hygiene indicators, and the necessity of dental treatment. The pooled prevalence rates, odds ratios, and standardized mean differences were calculated where applicable. The pooled prevalence of dental caries among ASD individuals ranged from 60.6% to 67.3%, while the periodontal disease prevalence ranged from 59.8% to 69.4%. High rates of dental treatment under general anesthesia were reported. Heterogeneous dental caries and periodontal disease prevalence rates were identified, highlighting the need for collaboration and preventive care. Several studies also reported higher prevalence rates of dental trauma and self-inflicted oral injuries among individuals with ASD. However, the review also identified significant methodological limitations in the included studies, including inconsistency in oral health assessment methods and potential bias. The necessity for targeted policies due to high prevalence rates and the requirement for integrated care systems in high DMFT regions were also observed. The umbrella review synthesized diverse findings, revealing variations in dental caries and periodontal disease prevalence among ASD individuals. This review underscores the need for tailored interventions and policies to address oral health disparities. It highlights the necessity of integrated care systems, methodological improvements, and longitudinal studies to comprehensively address the multifaceted oral health challenges within the ASD population.

Investigation of Dental and Oral Health in Children and Adolescents with Special Support Needs from a Child and Adolescent Psychiatric Perspective

“…Regarding the importance of dental and oral health issues, there are no significant differences observed among the three target groups in the overarching analysis, prompting us to dissolve the clear distinction between these subgroups and subsume them under the term “Children and Adolescents with Special Support Needs”, abbreviated as CA-SN hereafter. The subsumption of various vulnerable patient groups with disabilities or other impairments, such as physical or mental disabilities, psychological behavioral disorders or developmental disorders, like autism spectrum disorder, under the titles “special needs”, “special support needs” or “special healthcare needs” is quite common in dentistry, and the terms are also used synonymously with each other to some extent [ 11 , 12 , 13 , 14 , 15 , 16 , 22 , 23 , 24 , 25 ].…”

“…Causes for the poorer oral health status in CA-SN, from an international dental perspective, include irregular dental hygiene, often stereotypical unhealthy eating habits, decreased cooperation, a lack of dentists trained in special care dentistry, the absence of barrier-free clinics and the lack of specialized treatment concepts [ 22 , 23 , 24 , 26 , 27 ]. These dental perspectives align with the data gathered from the CAPPS and the national dental perspectives, mentioned in the introduction.…”

“…The survey illustrates that there is indeed an overlap between CAPPS and dentists in the explanatory approaches to poorer dental and oral health in CA-SN, referring to, for example, behavioral causes, illness-related causes and communication barriers [ 22 , 24 , 26 , 27 ]. Furthermore, the collected data cautiously suggest that CAPPS, in addition to the poorer dental and oral health status of CA-SN, tend to identify familial or psychosocial factors, such as the overwhelming of caregivers or the low priority given to dental health, while the dental profession is more likely to point out structural deficits, such as the lack of continuing education and training, the lack of research or the lack of financial incentives [ 22 , 23 , 24 , 26 , 27 ].…”

“…It is imperative to pay particular attention to the oral health of these vulnerable groups, as internationally, CA-SN have a higher risk of developing dentogenic diseases (e.g., caries), which are often treated belatedly due to the reasons mentioned above, leading to the increased severity of the diseases [ 23 , 24 , 26 , 28 , 29 , 30 ]. Consequently, CA-SN often require more invasive procedures (e.g., general anesthesia) [ 25 ].…”

“…On an international level, the dental profession emphasizes the necessity of establishing larger networks and collaborations with psychotherapists, psychiatrists and dentists to facilitate low-threshold and early access to adequate dental care [ 23 , 26 , 28 ]. In the Saudi Arabian sample, it was shown that almost 20% of parents would contact their (trusted) general practitioner if their child experienced dental pain [ 31 ].…”