Challenges and solutions in managing dental problems in children with autism

Table 2 Summary of studies on the prevalence of dental disorders in children with autism spectrum disorder using the PICO framework

Ref.	Population	Intervention/Exposure	Comparison	Outcome	Study design	Key risk factors identified	Clinical implications	Study quality rating
Burgette and Rezaie[13], 2020	Children with ASD (n = 1228)	Caregiver-reported dental caries	Neurotypical children (n = 43927)	ASD children had 40% higher odds of developing dental caries (AOR = 1.4, 95%CI = 1.2–1.7)	Cross-sectional study using 2016 National Survey of Children's Health	Behavioral difficulties in oral hygiene; Dietary habits high in sugar; Limited access to specialized dental care	Need for early preventive measures, including caregiver education and fluoride use; Policy changes to improve insurance coverage for ASD dental care	High Quality
Azimi et al[15], 2022	Children with ASD and/or Intellectual Disability (ID)	Dental procedures under general anesthesia in hospitals	Neurotypical children	ASD/ID children had more extractions (68.7%) and fewer restorations (16.2%) Indigenous children had worse outcomes	Population-based cohort study (Western Australia)	Delayed diagnosis leading to severe decay; Sensory issues preventing routine care; Socioeconomic disparities (Indigenous children had worse outcomes)	Increase ASD-friendly preventive dental programs to avoid invasive treatments; Address racial and socioeconomic disparities in dental care	Moderate Quality
Babu and Roy[14], 2022	Children with ASD (n = 50)	Dental caries and salivary electrolyte analysis	Neurotypical children (n = 50)	ASD children had higher DMFT scores Altered salivary composition: Increased magnesium & decreased calcium, sodium, potassium.	Case-control study	Salivary imbalance may contribute to enamel erosion; Nutritional deficiencies (low calcium, sodium, and phosphorus)	Potential use of salivary biomarkers for early detection of caries risk; Saliva-enhancing therapies should be explored	High Quality
Azimi et al[16], 2022, WA study	Children with ASD and/or Intellectual Disability (ID)	Hospitalization for dental conditions	Neurotypical children	Higher hospitalization rates due to severe untreated dental disease Socioeconomically disadvantaged ASD children were at the highest risk	Retrospective cohort study (1983-2010)	Lack of preventive dental visits; Severe dental disease requiring extractions; Lower socioeconomic status	Mobile dental clinics & school-based interventions to improve access; Early screening programs in ASD children	Moderate quality
Lai et al[17], 2012	Children with ASD (n = 568)	Identifying barriers to dental care	General pediatric population	12% of ASD children had unmet dental needs Main barriers: Behavioral challenges, cost, and lack of insurance	Survey-based cross-sectional study	Caregiver’s own dental visit history influenced child’s access; Lack of ASD-trained dentists; Behavioral resistance to treatment	Expand insurance coverage for ASD-specific dental care - Train more dentists in ASD-friendly treatment approaches	Moderate Quality
de Souza et al[18], 2024	Children with ASD (n = 100)	Utilization of dental services	General pediatric population	25% had never been to a dentist Primary care engagement improved access	Cross-sectional study (Brazil)	Lack of awareness about the importance of dental care; Activity limitations due to ASD severity; Male caregivers were less likely to seek dental care for their children	Strengthen the role of primary care providers in promoting dental visits; Improve caregiver education and awareness	Moderate Quality

AOR: Adjusted odds ratio; ASD: Autism spectrum disorder; DMFT scores: Number of decayed (D), missing due to caries (M) and filled (F) teeth (T); ID: Intellectual disability.