Interventions to Improve Oral Care for Individuals with ASD: A Systematic Review

Background: Oral health is important to both physical and psychological health. Certain populations, such as individuals with autism spectrum disorders (ASD), experience greater oral care challenges as compared to their typically developing peers, suggesting that innovative and efficacious interventions to facilitate care are needed. However, little research currently exists examining oral interventions for individuals with ASD.

Objectives: The purpose of this study was to systematically review interventions designed to improve oral health in individuals with ASD.

Methods: Systematic review methodology as outlined in the Cochrane Handbook for Systematic Reviews of Interventions was used for this paper. Six electronic databases were searched, including: PubMed, CINAHL, Web of Science, Clinical Trials, COCHRANE, and PsycINFO using the keywords “oral/dental health/care,” “intervention,” and “autism.” Inclusion criteria for article selection included: (1) implementation and investigation of a home and/or dental office intervention to impact oral care health and/or experiences, (2) participants diagnosed with ASD, (3) published in a peer-reviewed journal, and (4) published in English, Spanish, Korean, and/or Portuguese. No restrictions were placed on year of publication or level of evidence, but pharmacological interventions were excluded. Two reviewers independently screened all articles for inclusion. Of the articles included, three reviewers independently extracted data. Methodological quality of studies was assessed by two reviewers using Reichow, Volkmar, & Cicchetti’s Evaluative Method for Determining Evidence Based Practice (EBP) in Autism; disagreements were resolved by a third reviewer.

Results: The search produced 325 articles, with only six studies meeting all inclusion criteria. Using the EBP guidelines, one study was scored as a strong indicator of evidence, one as an adequate indicator, and the remaining four as weak. Three interventions examined in-home caregiver education programs to improve oral care in the home and prepare individuals with ASD for future dental visits (weak quality); the remaining three evaluated strategies to reduce behavioral and sensory difficulties exhibited in the dental office (one adequate, one weak, and one strong). Only one study of the total six included adults with ASD, with the others focused solely on pediatric ASD populations. The intervention scored as ‘adequate’ examined the use of electronic screen media, such as video peer modeling, and watching movies with video goggles, to reduce fear and uncooperative behavior during dental visits. The only intervention study rated as ‘strong’ was designed and implemented by an interdisciplinary team led by occupational therapists. This study focused on modifying the sensory environment in order to decrease the behavioral and physiological distress of children with ASD at the dentist.

Conclusions: These findings suggest that preliminary evidence exists supporting the use of behavioral and sensory interventions to improve the experience of individuals with ASD at the dentist. However, there is a need for further large-scale studies investigating the efficacy and effectiveness of these interventions in individuals with ASD across the lifespan, including adolescents and adults with ASD.