Sensory Sensitivity and Oral Care in the Dental Office in Children with Autism Spectrum Disorders

Background:  

Children with autism spectrum disorders (ASD) often have challenges with oral care, both in the home and dental office, which can negatively impact their oral health and increase risk for oral caries and disease (Brickhouse et al., 2009; Marshall et al., 2010; Pilebro & Backman, 2005). Difficulties processing sensory stimuli in children with ASD are common (Baranek et al., 2007; Ben-Sasson et al., 2009), but although sensory over-responsiveness has been mentioned as a factor contributing to challenges in oral care, it has rarely been empirically studied. 

Objectives:  

1. To investigate the differences between children with ASD and their typically developing counterparts in regards to prevalence and magnitude of sensory over-responsivity across different sensory domains, as related to oral care.
2. To examine possible relationships between over-responsivity to sensory stimuli and difficulty with dental cleanings and uncooperative behaviors during oral care. 

Methods:  

The research design consisted of a correlational assessment of the relationship between ASD, sensory processing difficulties, and oral care problems. Data were based on parental responses to a 37-item survey about oral care in the home and dental office   A total of 398 English- and Spanish-speaking parents of children ages 2-18 years were recruited from California (n=196 ASD, n=202 typical). 

Results:  

Parents of children with ASD reported their child to be “moderately to very” oversensitive to sensory stimuli significantly more than parents of typically-developing children across all sensory modalities (touch, oral, taste, smell, sound, vibration, movement, light; p<.0001 for all modalities). Significantly more parents of children with ASD reported difficulty with routine dental cleanings compared to parents of typically-developing children (60%:13%, p<.0001). Additionally, significantly more parents of children with ASD, as compared to typical children, reported that their child’s uncooperative behaviors increased in the dental office (49%: 5%, p<.0001).  Cut scores of sensory responsivity were created based on the distribution of scores in the typical group. Children whose parents reported “moderate to extreme” sensitivity on three or more of the eight sensory variables were categorized as "sensory over-responders" while children whose parents reported moderate to extreme sensitivity on two or fewer variables were placed in the "typical-responder" group. Significantly more children in the ASD group were over-responders than typically-developing children (74%: 15%, p<.0001). With both groups (ASD and typical) combined, 62% of parents of over-responders reported moderate to extreme difficulty with routine cleanings, as compared to 16% of parents of typical-responders (p<.0001). Likewise, of the combined over-responder group, significantly more parents reported that their child exhibited an increase in uncooperative behaviors in the dental office as compared to parents of typical-responders (45%: 12%, p<.0001). 

Conclusions:

Results indicate that according to parental report children with ASD, as compared to their typically-developing counterparts, exhibit a greater prevalence and magnitude of sensory over-responsivity across touch, oral, taste, smell, sound, vibration, movement and light sensory domains, and that over-responsivity is significantly associated with both difficulty with dental cleanings as well as increased uncooperative behaviors during dental care.