Parent Training for Dental Care in Underserved Children With Autism: A Randomized Controlled Trial

Abstract

OBJECTIVE Children with autism spectrum disorder (ASD) have difficulty participating in dental care and experience significant unmet dental needs. We examined the efficacy of parent training (PT) for improving oral hygiene and oral health in underserved children with ASD. METHOD Families of Medicaid-eligible children with ASD (ages 3–13 years, 85% boys, 62% with intellectual disability) reporting difficulty with dental care participated in a 6-month randomized controlled trial comparing PT (n = 60) with a psychoeducational dental toolkit (n = 59). Primary outcomes were parent-reported frequency of twice-daily toothbrushing and dentist-rated visible plaque. Secondary outcomes included parent-reported child behavior problems during home oral hygiene and dentist-rated caries. Dentists were blind to intervention assignment. Analyses were intention to treat. RESULTS Retention was high at posttreatment (3 months, 93%) and 6-month follow-up (90%). Compared with the toolkit intervention, PT was associated with increased twice-daily toothbrushing at 3 (78% vs 55%, respectively; P < .001) and 6 (78% vs 62%; P = .002) months and a reduction in plaque at 3 months (intervention effect, −0.19; 95% confidence interval [CI], −0.36 to −0.02; P = .03) and child problem behaviors at 3 (−0.90; 95% CI, −1.52 to −0.28; P = .005) and 6 (−0.77; 95% CI, −1.39 to −0.14; P = .02) months. Comparatively fewer caries developed in children receiving the PT intervention over 3 months (ratio of rate ratios, 0.73; 95% CI, 0.54 to 0.99; P = .04). CONCLUSIONS PT represents a promising approach for improving oral hygiene and oral health in underserved children with ASD at risk for dental problems.