Autism is a neurodevelopment disorder allied with atypical brain constitution and function due to which communication, speech, behaviour, and cognitive functions weaken. Autism patients have many emotional, physical, health-related issues and oral health is one of them. As oral health is a wide range reflection of our general health, thus to achieve a good overall health focus on oral health is equally important. Every child has a unique characteristic, thus their emotional, physical and health needs are different. Therefore, the aim of this paper is to review and discuss the literature related to oral health characteristics and treatment needs of children with Autism Spectrum Disorder to facilitate the provision of care by dental practitioners

Agrawal, Amit

Mukul, Sailesh Kumar

English

Atharva Scientific Publications (E-Jounals)

Agrawal & Mukul                                                                                         Oral Health Among Autistic Children  
Vol 6|Issue 3| Jul-Sept 2017                                                                                                               J Orofac Res 23 
Review Article 
Oral Health related treatment needs among Autistic Children: A Review  
Amit Agrawal
1
, Shailesh Kumar Mukul
2
 
From
 1
Associate Professor, Department of Pediatrics, Gandhi Medical college & Hamidia Hospital, Bhopal, India 
2
Head of Department of Dentistry, All India Institute of Medical Sciences, Patna, India 
Correspondence to: Dr. Amit Agrawal, Department of Pediatrics, Gandhi Medical college & Hamidia Hospital, Bhopal, India 
E-mail: agrawaldramit@yahoo.co.in 
Received -11 August 2017                                            Initial Review -19 August 2017                          Accepted-31 August 2017 
ABSTRACT 
Autism is a neurodevelopment disorder allied with atypical brain constitution and function due to which communication, 
speech, behaviour, and cognitive functions weaken. Autism patients have many emotional, physical, health-related issues 
and oral health is one of them. As oral health is a wide range reflection of our general health, thus to achieve a good overall 
health focus on oral health is equally important. Every child has a unique characteristic, thus their emotional, physical and 
health needs are different. Therefore, the aim of this paper is to review and discuss the literature related to oral health 
characteristics and treatment needs of children with Autism Spectrum Disorder to facilitate the provision of care by dental 
practitioners. 
Keywords: Autism, oral health, dental caries, periodontal health 
 
utism is a neurodevelopment disorder of brain 
which affects social interaction, verbal and non-
verbal communication and rhythmic behavior. 
All signs of autism usually appear before a child is three 
years old [1].  Initially, autism comes under one of the 
pervasive developmental disorders. The Pervasive 
developmental disorders are the disturbances of the brain 
development with deflation in genetics which includes 
Autistic, Aspergers, childhood disintegrative, Retts, and 
pervasive developmental disorders. According to the 5th 
edition of the Diagnostic and Statistical Manual of Mental 
Disorders in May 2013, all Autism related disorders 
merged under Autism Spectrum Disorder (ASD) or 
Autism [2]. 
 The American Child Psychiatrist Leo Kanner was the first 
person who explained Autism in 1943. All disorders 
related to autism are known as Kanner’s autism, childhood 
autism, or early infantile autism [3]. The typical triad of 
autism involves impairments – in social interaction, 
communication and the use of language associated with 
limited thoughts and rhythmic stereotyped patterns of 
behavior [4]. The behavior disturbances of autism include 
self-injurious destructive behavior, hyperactivity and 
panic-stricken cries [5]. Due to these tribulations children 
suffering from ASD lack of manual dexterity that requires 
for various day to day activities including brushing. As 
oral health is a wide range reflection of our general health, 
thus to achieve a good overall health focus on oral health is 
equally important. Every child has a unique characteristic, 
thus their emotional, physical and health needs are 
different. Therefore, the aim of this paper is to review and 
discuss the literature related to oral health characteristics 
and treatment needs of children with Autism Spectrum 
Disorder to facilitate the provision of care by dental 
practitioners. 
EPIDEMIOLOGY 
Mayada Elsabbagh et al conducted a systematic review of 
an epidemiological survey of autistic disorder in 2011, 
according to this the Global prevalence estimated for 
A 
Agrawal & Mukul                                                                                         Oral Health Among Autistic Children  
Vol 6|Issue 3| Jul-Sept 2017                                                                                                               J Orofac Res 24 
Autism disorder since the year 2000 is a median of 
17/10,000, in 2002 the prevalence estimate was 7 in 10000 
and in 2014 it has been estimated to be 1 in 68. Autism is 
four times more common in boys than in girl [6]. In India, 
the prevalence of autism is about 1 in 500 or 0.20 %. The 
incidence rate of autism in India is about approximately 1 
in 90,666 or 11,914 people. The rate of incidence 
extrapolations in India is 11,914 per year, 250 per month, 
57 per week, 8 per day, 1.4 per hour [7]. Various twin and 
family studies disclosed that some people are more 
genetically incline towards autism. Identical twin studies 
showed that “if one twin has autism there is a 90% chance 
to having autism in other twins also. A family having an 
autistic child has more risk or 5% chance of having a child 
with autism [8].  
 ETIOLOGY  
The exact etiology of ASD remains unclear however it 
appears due to the complex interaction between genetic 
and environmental, parental and psychological factors [9].  
Genetic mutation/or deletion, viral infections, encephalitis 
following vaccination, advanced parental age, fetal 
exposure to valproate, pre-mature birth and toxic 
environment are the possible risk factors for autism [10]. 
Advancement in medical technology leads to a decline in 
neonatal deaths and higher survival rates but increase the 
rate of children diagnosed with autism.  
DIAGNOSIS OF AUTISM 
There are no specific genetic, medical, or laboratory tests 
available to confirm the diagnosis of autism thus screening 
is quite difficult. Autism can be identified only by the 
presence of classical triad which includes in social 
interaction, communication and the use of language 
associated with limited thoughts and rhythmic stereotyped 
patterns of behavior. The most conspicuous feature in the 
diagnosis is the impaired of social interaction where 
children may refuse to accept cuddling and avoid making 
friends. A total absence of development of spoken 
language and lack of interest in playing is the classical sign 
of autism in preschool children [11].  
According to the Diagnostic and Statistical Manual of 
Mental Disorders (DSM-V) [3] the specific criteria for 
diagnosing Autism which includes: 
A. Qualitative impairment in reciprocal social interaction  
1. Lack of attentiveness in existence or feelings of others.  
2. No or atypical seeking of console at times of distress.  
3. No or impaired imitation.  
4.  No or abnormal social play.  
5. Gross impairment in the ability to make peer 
friendships. 
B. Qualitative impairment in communication and 
imagination  
1. No mode of communication.  
2. Markedly abnormal nonverbal communication.  
3. The absence of imaginative activity. 
4. Marked abnormalities in the production of speech.  
5. Noticeable irregularities in the form of content of 
speech.  
6. Obvious destruction in the ability to initiate or sustain a 
conversation, despite adequate speech.  
C. Markedly restricted repertoire of activities and 
interests 
1. Stereotyped body movements.  
2. Persistent preoccupation with parts of objects or 
attachment to unusual objects.  
3. Marked distress over changes in trivial aspects of the 
environment.  
4. Irrational persistence on following routines in precise 
detail.  
5. Clearly limited range of interests [2]. 
DENTAL CONSIDERATION IN AUTISTIC 
CHILDREN 
Children diagnosed with autism have various medical and 
oral health problems due to neurodevelopment 
disturbances. Poor dietary habits decreased or increased 
salivation due to medications; damaging intraoral habits 
contribute an intricacy to maintain good oral hygiene 
which increases the risk of oral health problems including 
dental caries, periodontal problems, delayed tooth 
eruption, bruxism, and trauma.  
The risks of traumatic injuries are higher among ASD 
children due to malocclusion. A study by Naidoo M et al 
found 85.2% prevalence of dental caries in autism children 
[12]. Similarly, a study by Al-Maweri SA et al showed that 
children with autism revealed a higher proportion of 
fistulae (9.5% vs. 2.4%), ulcerative lesions (7.1% vs. 
1.2%), gingival hyperplasia (4.8% vs. 0.0%), and cheilitis 
(4.8% vs. 2.4%). The mean dmft score was significantly 
higher in children with autism [13].  
Agrawal & Mukul                                                                                         Oral Health Among Autistic Children  
Vol 6|Issue 3| Jul-Sept 2017                                                                                                               J Orofac Res 25 
BARRIERS IN ORAL HEALTH 
Oral health and dental treatment needs ranked most 
profound among unmet health care needs of special 
children [14].  For cater to the comprehensive dental care 
for these group of children hurdles should be identified. 
Various studies conducted to identify barriers to cater the 
oral health among autistic patients. According to Thomas 
NA et al 83.9% of the respondents reported difficulty in 
managing the behavior of the children with ASD in dental 
clinics. Other barriers to cater to oral health are the child's 
inability to communicate and the dentist's lack of 
knowledge and training with ASD [15]. Lai et al reported 
that behavioral disturbances are the reason due to which 
dentist refuse to treat children with ASD. Due to these 
behavioral problems regular periodic dental visits are not 
possible which leads subsequently longer gaps between 
dental appointments [16, 17]. Literature also tales that 
dentists experience to play a considerable barrier to endow 
with quality dental care with special care needs children. 
Literature quotes that lack of knowledge and training 
(12.9%) in a dentist is a solid barrier to cater to oral health 
for ASD [16]. The reason for these obstacles is a lack of 
training or exposure with children having disabilities 
during the prescribed education of the dentist. As autism 
disorder associated with social interaction that makes 
parents or caregivers difficult to teach oral hygiene 
practices and gets the children in dental clinics. Because 
brushing and flossing is not usually a part of their daily 
routine, after some time they use to reject it due to their 
dislike to change [18]. Therefore, assessment of barriers to 
cater to oral health in ASD is very essential, after this we 
can cater a quality of dental care to them. 
CONCLUSION 
It concludes that children with ASD have a higher 
prevalence of dental diseases which constitutes poor oral 
hygiene. In order to this oral health education and 
promotion programs for parents, caretakers should be 
incorporated into special care schools. There is an extreme 
need for the enclosure of formal training in dental 
curriculum related to managing autistic patients. Various 
continuing education courses (CDE) should be conducted 
regularly to update the knowledge in this field would 
improve dental students’ competence in working with 
special needs children. 
REFERENCES 
1. Amaral DG, Schumann CM, Nordahl CW. 
Neuroanatomy of autism. Trends Neurosci. 
2008;31(3):137-45. 
2. American Psychiatric Association. Diagnostic and 
Statistical Manual of Mental Disorders. Washington: 
American Psychiatric Publishing 2013. Available on 
https://dhss.delaware.gov/dsamh/.../si2013_dsm5foraddic
tionsmhandcriminaljustice.pdf [Last Accessed on 
12/12/2016].  
3.  Patil A, Tamgond S, Sandhyarani B, et al. An Update on 
Dental Outlook for Autism. Autism Open Access. 
DOI:6:176:10.4172/2165-890.1000176. 
4. Definition of Autism-Autism Awareness. Available on 
https://autismawarenesscentre.com/definition-autism/. 
[Last Accessed on 12/12/2016].  
5. Cruz VSA, Cruz TAAA, Bandeira MAS, et al. 
Conditioning strategies in the dental care of patients with 
autism spectrum disorders. Rev Bras Odontol. 
2017;74(4):294-9. 
6. Olivie, H. Clinical practice: The medical care of children 
with autism. European Journal of Pediatrics. 
2012;171(5):741-749. 
7. Autism Spectrum Disorders - Rehabilitation Council of 
India. Available on 
http://www.rehabcouncil.nic.in/writereaddata/autism.pdf. 
[Last Accessed on 12/12/2016].  
8. National Institute of Neurological Disorders and Stroke. 
National Institute of Neurological disorders and Stroke. 
2009.Available on  https://www.nih.gov/about-nih/what-
we-do/nih-almanac/national-institue-neurological-
disorder-stroke-ninds. [Last Accessed on 26/12/2016]. 
9. S Zafar, Dorothy Boyd, A Siddiqi. Dental Management 
of a Child with Autism Spectrum Disorder and 
Attention-Deficit Hyperactivity Disorder. OHDM. 
2011;16(4):1-7 
10. Ratajczak HV. Theoretical aspects of autism: Causes - A 
review. J Immunotoxicol 2011; 8(1):68-79 
11. Chew LC, King NM, O’Donnell D. Autism: the 
aetiology, management and implications for treatment 
modalities from the dental perspective. Dent Update. 
2006; 33(2): 70-72. 
12. Naidoo M, Singh S. The Oral health status of children 
with autism Spectrum disorder in KwaZulu-Nata, South 
Africa. BMC Oral Health. 2018;18:165. 
13. Al-maweri SA, Halboub ES, Al- Soneidar WA, et al. 
Oral lesions and dental status of autistic children in 
Yemen: A case-control study. J Int Soc prevent 
Communit. Dent 2014;4(S3):199-203. 
Agrawal & Mukul                                                                                         Oral Health Among Autistic Children  
Vol 6|Issue 3| Jul-Sept 2017                                                                                                               J Orofac Res 26 
14. Newacheck PW, Hughes DC, Hung YY, Wong S, 
Stoddard JJ.. The Unmet Health Needs of America’s 
Children.Pediatrics. 2000;105:989-97. 
15. Thomas NA, Shetty P, Soumya B, Kodgi V. Barriers To 
Dental Care for Children with Autism Spectrum 
Disorder- A Pilot Study. IOSR Journal of Dental and 
Medical                   Sciences. 2016;15(9):100-105 
16. Lai B, Milano M, Roberts M, et al. Unmet Dental Needs 
and Barriers to Dental Care Among Children with 
Autism Spectrum Disorders.J Autism dev disord. 2012; 
42(7): 1294-303 
17. Brickhouse TH, Farrington FH, Best AM, et al. Barriers 
to dental care for children in Virginia with autism 
 
 
 
spectrum disorders. J Dent Child (Chic). 2009;76(3):188-
93 
18. Weil TN, Bagramian RA, Inglehart MR. Treating 
patients with Autism Spectrum Disorder-SCDA 
members’ attitudes and behavior. Spec Care Dent. 2011; 
31: 8-17. 
 
 
 
 
 
 
Funding: None; Conflict of Interest: None Stated. 
How to cite this article: Agrawal A, Mukul SA. Oral 
health related treatment needs among autistic children: 
A Review. J Orofac Res. 2017;6(3):23-26. 
 


Oral Health related treatment needs among Autistic Children: A Review

https://atharvapub.net/JOFR/article/download/2097/1676/

Oral Health related treatment needs among Autistic Children: A Review

Abstract

Similar works

Full text

Available Versions

Atharva Scientific Publications (E-Jounals)