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Research Results: Parent Training and Dental Care for Children with Autism Spectrum Disorder

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Every day, families ask their children questions to remind them to do a chore, practice basic hygiene and self-care, or to help teach basic life skills. Perhaps the first and last question of the day in many homes is: did you brush your teeth? For some, that one question helps a child to develop the habit of brushing their teeth when they wake up and when they go to bed.

But for others, brushing teeth or getting dental care in an office is not so straightforward.

Children with autism spectrum disorder (ASD) have trouble participating in dental care and thus may have important unmet dental needs. Some children with ASD have trouble routinely brushing their teeth and feel a lot of stress during dental visits.

In this month’s Pediatrics,  the authors of “Parent Training for Dental Care in Underserved Children with Autism: A Randomized Controlled Trial” share results from a study discussing parent training and the role of a toolkit to improve oral hygiene and oral health in underserved children with ASD (10.1542/peds.2021-050691).

What is the focus of the trial? Why did the researchers choose this focus?

The researchers noticed that most dental care research for children with ASD focused on getting children to cooperate during the dental visit. Instead, these researchers decided to focus their research on the poor oral hygiene (brushing and flossing) in children with ASD and the close links between oral hygiene, oral health, and overall well-being.

The researchers used 2 key elements to design their research trial:

  • The important role that families play in supporting their children with ASD
  • Successful history of behavioral interventions to target daily living skills for children with ASD

Who was in the research trial?

Families of Medicaid-eligible children with ASD who had trouble participating in dental care and who had not had dental screening or exams in the past 6 months joined the research trial. The children with ASD ranged in age from 3 to 13 years old, 85% were male and 62% had an intellectual disability.

How did the authors conduct the trial?

60 families received parent teaching and 59 families used an education toolkit.

The Physical Health Dental Toolkit included: a family-friendly resource about oral hygiene and dental visits; an Oral-B Vitality Floss Action electric toothbrush; a 6-month supply of oral hygiene materials (electric toothbrush heads, fluoride toothpaste, and flossers), and mock dental tools (for example, a dental mirror). Manual toothbrushes were also provided to encourage the whole family to brush.

The families who received “Parent teaching” were given the toolkit and also received 7 in-person individual sessions, a home visit, a dental office coach, and 4 phone support sessions. The teaching sessions centered on behavioral techniques that work with children with ASD and strategies used for children without ASD to address fear of the dentist and help them relax during dental care. Families in the Parent Teaching group also had access to a study library of video models, social stories, and parent handouts.  

Children with ASD met with the same dentist three times: to measure baseline, at 3 months, and at 6 months. Families and the dentists reported changes at each point in the timeline.  

The trial compared how well each method worked for the two sets of families.

What were the results of the trial?

The researchers tracked several things:

  • How often the child brushed their teeth
  • Any behavior problems during brushing
  • The dentist’s report of plaque and health of teeth.

Families in both groups noted improved tooth brushing. However, children in the parent teaching approach had less visible plaque on teeth and fewer behavior issues.

Read the article to learn about all of the results.

What can you do with this article?

  1. If you have a child with ASD who struggles with brushing their teeth or going to the dentist, consider taking this article to your child’s doctor or dentist to discuss. You can also share a video abstract overview of the article HERE.
  2. If your child with ASD has an Individualized Education Plan (also known as IEP) that includes behavioral interventions for daily living skills, consider sharing those parts of the plan with your child’s dentist or doctor and talk about how the interventions have worked for your child. You can use examples of behavioral interventions for other daily living skills to work together to come up with ideas to tackle oral hygiene.
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