Daily Dental Care, Dental Office Experiences, and Oral Health in Underserved Children with ASD

Poster Presentation
Friday, May 3, 2019: 5:30 PM-7:00 PM
Room: 710 (Palais des congres de Montreal)
R. M. Fenning1,2, R. steinberg Epstein3, E. Butter4, K. Hammersmith4, K. McKinnon-Bermingham5,6, M. Norris4, J. M. Moffitt2, D. Coury4, F. Lu7, E. Macklin7 and K. Kuhlthau7, (1)Center for Autism, Child and Adolescent Studies, California State University, Fullerton, Fullerton, CA, (2)Pediatrics, The Center for Autism and Neurodevelopmental Disorders, University of California, Irvine, Santa Ana, CA, (3)The Center for Autism & Neurodevelopmental Disorders, University of California, Irvine, Santa Ana, CA, (4)Nationwide Children's Hospital, Columbus, OH, (5)CalState Fullerton, Irvine, CA, (6)Cortica Advanced Neurological Therapies for Autism, Irvine, CA, (7)Massachusetts General Hospital, Boston, MA
Background: Dental care represents one of the most commonly reported unmet healthcare needs for children with ASD, a group vulnerable to excessive plaque, caries, and oral infections. Low socioeconomic and racial/ethnic minority status may further compound this risk, but limited research has focused on oral health in underserved families of children with ASD

Objectives: The present report is drawn from an ongoing clinical trial focused on enhancing daily dental hygiene and oral health outcomes in underserved children with ASD whose parents reported difficulty with dental care. Baseline data are presented to characterize in-home dental care, dental office visit experiences, and oral health status in this unique population, and to examine preliminary associations between health behaviors and oral health outcomes.

Methods: Participants included 112 families of children with ASD (M = 7.5, SD = 2.7, range = 3.1-13.3yrs) who reported difficulty with dental care. Families exhibited racial and ethnic diversity (45% Non-Caucasian, 39% Hispanic/Latino), and all were underserved (Medicaid-eligible). Children presented with a range of developmental and behavioral functioning (16% with ID; 61% clinical CBCL Total), and ASD symptom severity (ADOS-2 M = 7.3, SD = 1.8). Parents reported on dental history and in-home dental hygiene. A dental visit yielded standardized oral health measures and dentist ratings of child behavior.

Results: Fifty percent of children had participated in a dental visit within the past year; 20% had never been to a dentist. For the latter group, parental concern about child behavior was the most commonly reported barrier. Of children with a previous dental visit, 56% experienced prior use of physical restraint and 43% received pharmacological intervention. Only 44% of parents described their child’s last dental visit as complete. Regarding in-home dental hygiene, parents reported completing child tooth brushing at least once daily an average of 5.1 (2.4) days/week and twice daily an average of 3.1 (2.8) days/week. Fewer families reported attempting (40%) and completing (25%) flossing. Most families reported problems engaging their children in tooth brushing (75%) and flossing (73%). Thirty-one percent of children presented with untreated dental caries (decayed teeth M = .92, SD = 1.8), which exceeds general population averages, and 52% were rated by study dentists as displaying negative responses to the exam. Interestingly, higher frequency of at least once-daily tooth brushing was associated with poorer quality oral health as measured by the decayed, missing, and filled teeth index, r = 0.21, p <.05.

Conclusions: Findings reveal heightened risk for unmet dental needs and poorer quality oral health in our sample of underserved children with ASD. The inverse association between dental hygiene and oral health suggests that parents may be attempting to respond to children’s increased needs through at-home care. However, parents also reported significant difficulty engaging children in daily dental hygiene, which may result in compromised quality. Follow-up analyses will focus on identifying child and family factors predictive of children’s participation in dental care and oral health status. Enhanced understanding of health behaviors and dental experiences is critical to advancing service models and care for this population.

See more of: Pediatrics
See more of: Pediatrics