Oral care interventions for autistic individuals: A systematic review

Abstract

Oral care–related challenges are well documented in the autistic community. This review examined interventions designed to improve oral health in autistic individuals across the lifespan. Through a systematic process, 36 studies were identified which focused on improving home-based oral care skills and routines, and reducing fear, anxiety, and/or negative behaviors in the dental clinic. Studies incorporated preparatory interventions to support home-based hygiene activities or improve an approaching dental encounter (n = 29), most often using visual aids, and/or strategies to manage behavioral difficulties exhibited in the dental office (n = 17). Some studies used both approaches (n = 10), combining visual aids prior to a visit with behavior management in the dental office. Using an evidence-based rubric, methodological quality of most articles was only “adequate” (n = 8) or “weak” (n = 23). Findings provide preliminary support for preparatory home-based visual interventions to improve toothbrushing and/or ready patients for dental visits, and distraction or sensory-reducing interventions to improve experiences in the dental clinic. Only one study purposefully recruited autistic adults and no studies included intervention elements tailored to race/ethnicity, culture, and/or socioeconomic status. This review highlights the need for high-quality studies investigating the impact of oral care–related interventions for autistic individuals and identifies a gap in interventions for autistic adults and those from minoritized populations. Lay abstract Oral care–related challenges are well documented in the autistic community; dental care remains one of the most prevalent unmet health needs among autistic individuals. This review examined interventions designed to improve oral health in autistic individuals from children and adult populations. Through a systematic process, 36 studies were identified. These studies focused on improving home-based oral care skills and routines and reducing fear, anxiety, and/or negative behaviors in the dental clinic. Studies incorporated different types of techniques for facilitating oral care practice, including preparatory interventions to support home-based hygiene activities or improve an approaching dental encounter (n = 29), most often using visual aids, and/or strategies to manage behavioral difficulties exhibited in the dental office (n = 17). Some studies used both approaches (n = 10), combining visual aids prior to a visit with behavior management. Using an evidence-based rubric, we reviewed the methodological quality of the studies and found that most were only “adequate” (n = 8) or “weak” (n = 23) in reporting their evidence. This review has two key findings: (1) there is support for preparatory home-based visual interventions to improve toothbrushing and/or ready patients for dental visits; and (2) distraction or sensory-reducing interventions may also improve experiences in the dental clinic. Only one study purposefully recruited autistic adults, and no studies included intervention elements tailored to race/ethnicity, culture, and/or socioeconomic status. This review highlights the need for more studies investigating the impact of oral care–related interventions for autistic individuals of all ages and identifies a gap in interventions for autistic adults and those from minoritized populations.