ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Dental Caries Prevalence is not Significantly Higher in Autistic Children Compared to Non-Autistic Children
Clinical Question Is there a significantly higher prevalence of dental caries in children patients with autism than in children without the disorder?
Clinical Bottom Line Children with autism may have increased caries risk due to poor oral hygiene, modified dietary habits and decreased compliance, but do not necessarily have increased caries prevalence. Based on the limited information provided by literature, the studies on caries and autistic children are inconsistent. Results are in conflict between the studies possibly due to sample selection.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21625735Jaber/201161 autistic children 61 non-autistic children (control)Case Contol Study
Key resultsThis study showed that autistic children had a dental caries prevalence of 77%, compared to a 46% in the control population, which was statistically significant (p<0.05). Furthermore, they found that autistic children had a significantly higher number of decayed, missing, or filled teeth (DMF 2.4) compared to the control group of non-autistic children (DMF 0.9).
#2) 18978390Loo/2008395 patients with ASD and 386 patients without ASDHistorical Chart Review
Key resultsThis study showed that patients with Autism Spectrum Disorder (ASD) were 70.5% less likely to have positive caries history than in patients without ASD (p<0.0001) when age and sex were both controlled. A number of 269 autistic patients (68.1%) were tested positive for dental caries compared to 332 patients (86%) in the non-autistic group. However, this study did not control for socioeconomic status of their subjects.
#3) 22521893Rai/2012101 children with autism and 50 healthy children (control)Case Control Study
Key resultsThis study showed that although there was a statistically significant difference (p<0.001) in the mean oral hygiene index scores between autistic children (1.2) and non-autistic children (1), there was no statistically difference found in the dental caries and the salivary pH between the two groups.
Evidence Search ("Autistic Disorder"[Mesh] AND "Child"[Mesh]) AND "Dental Caries"[Mesh]
Comments on
The Evidence
Though the 2011 Jaber study was done in the United Arab Emirates (UAE) and had a smaller sample size group, it had an equal number of subjects for either control and study groups (61 children each). The control group (non-autistic children) were chosen from friends or relatives of autistic patients to control for age, sex, socioeconomic status and general dental care background. Both groups were treated the same; all were examined for oral hygiene status and dental caries. However, though the DMFT may be higher in the autistic group (2.4), it is still lower when compared to the healthy general pediatric population in UAE (10.2), suggesting a lower caries prevalence in autistic kids. Therefore, perhaps if a large sample size or a different control group was chosen, a different result could be found. The evidence from the 2008 Loo was also valid with over 700 subjects and was approved by The Boston University Institutional Review Board. The researchers reviewed dental history charts observed and collected by dental professionals through routine visits. However, the authors did not control for socioeconomic status, which could have affected the severity and prevalence of dental caries. The last study was based in India but also had a good, albeit unbalanced sample group (151 total) and observed no statistically significant difference in dental caries between autistic children and non-autistic children. The inconsistent results to different studies may be due to different sample selections. A national survey on this subject may provide us with more information.
Applicability One might assume that children with autism may have a higher risk for developing dental caries due to many factors including poor oral hygiene and low compliance, no strong evidence is found to support this assumption. Although autism is not associated with increased caries prevalence or severity, emphasis on the importance of regular preventive measures must be stressed due to difficulty in managing children with autism due to limited level of cooperation when treatment needs arise.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry)
Keywords Autistic Spectrum Disorder, Dental Caries, Dental Care for Children, Oral Health
ID# 2693
Date of submission: 03/26/2014spacer
E-mail espanol@livemail.uthscsa.edu
Author Bridget Espanol
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Zheng Xu, DDS
Faculty mentor/Co-author e-mail xuz@uthscsa.edu
Basic Science Rationale
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