Oral Health and Dental Needs in Adolescents with ASD: An Italian Study

Background:  There are few studies that investigate oral health and dental needs of children with autism. Many ASD subjects experience great difficulties in performing oral hygiene due to their limited manual dexterity, sensory and intellectual disabilities and thus are prone to poor oral health. Different studies conducted on caries prevalence and oral inflammation in ASDs  have shown contradictory results. Some studies report lower caries prevalence in autistic children, however this finding seems somewhat surprising. To date, there are no studies addressing this phenomenon in Italy

Objectives:  

The aim of this study is to determine the prevalence of caries and overall oral hygiene in ASD adolescents and compare them to adolescents belonging to the general population in Italy.

Methods:  

Thirty one (26 male-5 female) adolescents with ASD with a mean age of 15. 35 years diagnosed according to DSM V and ADOS-2 criteria  and treated at our Institute as permanent residents were selected for the study. . All subjects were checked by one examiner for oral hygiene status and dental caries while seated in a standard dental chair. The examiner used a standard dental mirror, an explorer and periodontal probe with William’s markings. The examination of the soft and hard tissues was done under both a flash light and regular room light. The DMFT index was used, with codes and criteria established by the WHO. The gingival status, evaluated according to the gingival index of Loe and Silness, was then recorded as generalized or localized gingival inflammation, depending on the amount of gingival redness and bleeding during the examination.

Results:  

Both teeth-brushing time and technique were incorrect in 31/31 and  in 28/31 cases respectively. Gingival status was assessable in 30/31 cases and the DMFT index in 23/31 cases due to insufficient cooperation. Mean age and mean ADOS total score of cooperative and un-cooperative subjects was not statistically different (8.36 vs 8.28; 14.95 vs 16.5). In this subset, the overall prevalence of dental caries was 34.7%  and the mean DMFT index was 1.43. The corresponding values in the general population control group (made up of 805 adolescents from the surrounding area) was 54.5%  and 2.04 respectively. The difference in the carious prevalence and DFMT index was significant (p<0.05) between the two groups. The prevalence of moderate/severe gingivitis was 78.2%, with  the corresponding value in the control group being 60%. In this case the difference was also statistically significant (p>0.05). However, there was no significant correlation between the ADOS severity total score and gingivitis degree ( r = 0.10; NS)

Conclusions:  

The oral hygiene status in autistic adolescents observed in this study is indeed poor, but does not appear to be directly correlated to autism severity. The prevalence of caries is in fact lower in ASD adolescents than in the general population. Further investigation is required to explain this rather counterintuitive finding.