Challenges and solutions in managing dental problems in children with autism

Table 7 Summary of studies on parental and healthcare professional education on managing dental disorders in children with autism using the PICO framework

Ref.	Population	Intervention	Comparison	Outcome	Study design	Key findings	Study quality rating
Parry et al[59], 2021	Parents of autistic children	Partnership Working, System Change, and Training of Dental Staff	No structured intervention	Improved parent confidence and advocacy in dental settings	Qualitative Focus Group Study	Highlighted the need for tailored interventions and better understanding of sensory and communication barriers	Low quality
Chanin et al[60], 2023	Parents of autistic children (n = 235)	Parent perception assessment of child’s behavior during first dental visit	No structured parental feedback system	Age and ethnicity influenced dental visit success; parental perception significantly predicted behavior	Cross-sectional study	Demonstrated that coordinating with parents improved dental visit outcomes	Moderate quality
Fenning et al[57], 2022	Underserved autistic children (n = 119)	Parent Training for oral hygiene improvement	Psychoeducational dental toolkit	Increased twice-daily toothbrushing (78% vs 55% at 3 months); reduced plaque and caries development	RCT	Parent Training significantly improved oral hygiene, reducing problem behaviors and dental caries	High quality
Du et al[58], 2019	Preschool children with ASD and their parents (n = 257)	Assessment of oral health behaviors and barriers	Age- and gender-matched neurotypical children	ASD children brushed less frequently and required more parental assistance; parents had higher dental knowledge	Cross-sectional study	Highlighted need for specialized parental education programs	Moderate quality
Lewis et al[61], 2015	Parents of autistic children (Focus Groups)	Parental perspectives on dental care experiences	No structured support system	Need for individualized care approaches and increased parental involvement	Qualitative study	Identified variability in ASD children's dental care tolerance and emphasized family-centered approaches	Low quality
Polprapreut et al[62], 2022	Children with developmental disabilities (n = 263)	Analysis of parenting styles and unmet dental needs	Positive vs less positive parenting styles	Less positive parenting styles were linked to higher unmet dental needs (OR = 2.19)	Cross-sectional study	Highlighted role of parenting styles in dental health outcomes	High quality
Manopetchkasem et al[64], 2023	Parents of autistic children (n = 141)	Parental acceptance of Advanced BGTs	Parents with vs without prior BGT experience	Parents with experience rated BGTs more favorably	Cross-sectional study	Prior exposure to BGTs increased acceptance and reduced resistance	Moderate quality
Tahririan et al[56], 2021	Parents of autistic children (n = 100)	Knowledge, attitude, and performance regarding hospital dentistry	No structured education on hospital dental services	56% had poor knowledge; 69% reported low child cooperation	Cross-sectional study	Identified gaps in parental knowledge about hospital dental care	Moderate quality
Junnarkar et al[65], 2023	Parents of autistic children (n = 23)	Barriers and coping strategies in accessing dental care	No structured parental education program	Identified sensory issues, financial constraints, and lack of specialized dentists as main barriers	Qualitative study	Recommended improving parental awareness and financial support for multiple acclimatization visits	Low quality
Verma et al[63], 2022	Parents of autistic children	Assessment of unmet dental needs and barriers	No targeted intervention	Identified socio-psychological factors influencing dental care utilization	Cross-sectional study	Found financial and psychological barriers were key obstacles to dental care	Moderate quality
Marshall et al[66], 2008	Healthcare professionals treating autistic children	Evaluation of BGTs used in dental treatment	No structured training on BGTs	Parents accurately predicted child cooperation; positive reinforcement and tell-show-do were most accepted	Survey-based study	Basic BGTs were more accepted than advanced techniques; parental attitudes influenced acceptance	Moderate quality

ASD: Autism spectrum disorder; BGTs: Behavior guidance techniques; OR: Odds ratio; RCT: Randomized controlled trial.