Challenges and solutions in managing dental problems in children with autism

Table 3 Summary of studies on challenges faced by children with autism spectrum disorder and their parents in dental care using the PICO framework

Ref.	Population	Intervention/Exposure	Comparison	Outcome	Study design	Key challenges identified	Clinical implications	Study quality rating
Alvares et al[20], 2023	Parents of children with ASD (n = 140)	Parental reports on oral health and barriers to care	None	26% of ASD children had untreated dental problems; 33% required general anesthesia for dental procedures	Cross-sectional study (Australian Autism Biobank)	Intellectual disability increased dental care challenges; sensory difficulties made access harder; functional limitations linked to greater dental problems	Need for personalized ASD-friendly dental care models; expand desensitization programs for children with ASD	Moderate quality
Alshihri et al[23], 2021	Parents of ASD children (n = 142)	Barriers to accessing professional dental care	None	68.3% of parents found it difficult to access dental care; 75.4% cited cost as a major barrier	Cross-sectional survey	Cost, lack of ASD-trained dentists, and child’s behavior were the main challenges; medical insurance and past dental experiences influenced access	Improve insurance coverage for ASD-specific dental care; increase training for dental professionals in ASD patient management	Moderate quality
Taneja and Litt[28], 2020	Parents of ASD children (n = 46)	Caregiver-reported barriers to dental care	Parents of neurotypical children with chronic illnesses (n = 37)	39% of ASD caregivers reported uncooperative child behavior as a key barrier	Case-control survey	Finding ASD-trained dentists was a major issue; parents of severe ASD cases reported the most difficulties	Promote ASD-specific behavior management training for dentists; develop caregiver education programs on oral hygiene techniques	Moderate quality
Barry et al[24], 2014	Parents of ASD children (n = 112)	Access and barriers to dental care	Parents of neurotypical children	ASD children had greater difficulties traveling to dental clinics; predicted more negative behaviors in dental settings	Case-control questionnaire	Difficulty accessing ASD-adapted dental clinics; travel to the dental office was harder for ASD children	Establish mobile dental services and home-based preventive care	Moderate quality
Azevedo Machado et al[29], 2022	Parents of ASD children and adolescents (n = 1001)	Impact of COVID-19 on dental care	None	61.6% of parents reported significant routine disruption; 59.3% believed their child feared PPE use	Cross-sectional online survey (Brazil)	Fear of PPE and changes in routine disrupted care; dental visits decreased during the pandemic	Develop tele-dentistry models for ASD children; train dentists to use ASD-friendly PPE and gradual exposure techniques	Moderate quality
Logrieco et al[27], 2021	Parents of ASD children (n = 57) & dentists (n = 61)	Experiences of ASD children, parents, and dentists during dental visits	Parents of neurotypical children (n = 275)	ASD children had higher dental anxiety; dentists found it difficult to manage ASD behaviors	Comparative study (Italy)	Lack of ASD-trained dentists was a major concern; caregivers struggled to find professionals	Increase dental training programs in ASD care; improve dentist-parent communication on behavior strategies	Moderate quality
Baek et al[22], 2024	ASD children (n = 209780)	Frequency and cost of dental visits	Neurotypical children	ASD children had fewer visits but higher costs; ASD children had higher rates of dental trauma	Population-based cross-sectional study (Korea)	Financial burden was higher for ASD families; trauma rates were significantly elevated	Improve affordable access to ASD-friendly dental services; increase preventive dental trauma education	High quality
Marshall et al[19], 2007	ASD children (n = 108)	Factors influencing cooperation in dental settings	None	65% of ASD children were uncooperative; language, sensory issues, and routine disruption affected cooperation	Survey-based study	Nonverbal children were less likely to cooperate; poor sensory adaptation increased uncooperative behavior	Implement structured pre-visit sensory adaptation; use individualized behavior management techniques	Moderate quality
McKinney et al[30], 2014	ASD children (n = 2772)	Predictors of unmet dental needs	None	15.1% of ASD children had unmet dental needs; lack of a medical home increased risk (AOR = 4.46)	National survey analysis (US)	Children with ASD and intellectual disability had worse access; lack of a primary healthcare connection increased risk	Integrate dental screenings into pediatric medical visits; improve referral pathways between doctors and dentists	High quality
Brickhouse et al[26], 2009	Parents of ASD children (n = unknown)	Barriers to dental care in Virginia	None	Difficult behavior and lack of ASD-trained dentists were the biggest barriers	Survey-based study	ASD children visited the dentist less frequently; difficulty finding willing and trained providers	Develop ASD training for general dentists; improve dental accessibility through policy reforms	Moderate quality
Loo et al[21], 2009	ASD children (n = 395)	Behavioral management in dental care	Neurotypical children (n = 386)	ASD children were more uncooperative; severe ASD cases required general anesthesia more often	Retrospective chart review	ASD patients with higher caries severity and sensory issues were harder to manage	Train dentists in non-pharmacological behavioral guidance techniques	Moderate quality
Wiener et al[25], 2016	Parents of ASD children (n = 16323)	Caregiver burdens and dental care access	None	16.3% of ASD children had unmet preventive dental needs; financial and employment burdens increased risks	National survey analysis	Financial and time constraints prevented access to preventive care	Improve dental insurance coverage and flexible scheduling for ASD families	High quality

ASD: Autism spectrum disorder; COVID-19: Coronavirus disease 2019; PPE: Personal protective equipment; US: United States.