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Title A Sensory-Adapted Dental Environment Improves Outcomes for Children with Autism Spectrum Disorder Undergoing Dental Care
Clinical Question In children aged 5-15 years with diagnosed autism spectrum disorder (ASD), does the use of a sensory adapted dental environment (SADE) compared to a regular dental environment (RDE) improve outcomes during dental care?
Clinical Bottom Line For children aged 5-15 years diagnosed with Autism Spectrum Disorder (ASD), the use of a sensory-adapted dental environment (SADE), compared to a regular dental environment (RDE), improves outcomes while undergoing dental care. Use of a SADE, compared to an RDE, improves outcomes including decreased physiological stress, decreased behavioral distress, and increased ability to successfully complete dental treatment in children with autism spectrum disorder undergoing dental care. This finding is supported by multiple moderate to high quality randomized controlled trials with sample sizes ranging from 22 to 162 children. SADE involves adaptations such as calming visual projections, music, and deep pressure which can be implemented in dental clinics with minimal training and may benefit other pediatric populations and children with sensory processing differences and dental anxiety.
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) 37266941Duker/2023162 children with autism, 6-12 years of ageRandomized Crossover Trial
Key resultsChildren had a significantly lower mean skin conductance level (measure of physiologic stress) in the SADE vs RDE (mean difference -1.22 μS, 95% CI -2.17 to -0.27, p=0.01). Video-coded frequency and duration of behavioral distress (but not questionnaire) measures were significantly lower in SADE vs RDE (Cohen d = -0.84 to -1.19).
#2) 35327765Fallea/202250 children with ASD, aged 9-10 yearsRandomized Crossover Trial
Key results68% of children were successfully treated in the SADE compared to only 20% in the RDE suggesting the adapted environment positively affected dental treatment. (p<0.001)
#3) 25931290Cermak/201522 children with autism, 22 typically developing children, 6-12 years of ageRandomized Controlled Trial
Key resultsBoth children with ASD and those developing typically had decreased physiological anxiety and distress behaviors in the SADE compared to RDE. Autistic children had a lower mean skin conductance level (SCL) in the SADE (7.74 μS) compared to the RDE (8.96 μS), mean difference -1.22 μS, 95% CI -2.17 to -0.27, p=0.01. Repeated measures ANCOVA models found a statistically significant effect of environment for SCL exam+prophylaxis+fluoride and exam+prophylaxis (p's=.01), and non-specific skin conductance responses (NS-SCR) exam+prophylaxis (p=.05). There were statistically significant group differences between ASD and typically developing (TD) for all EDA measures, SCL exam+prophylaxis+fluoride (p=.05) and exam+prophylaxis (p=.06), and for the NS-SCR measures (p's < .01
Evidence Search (autism OR ASD) AND (sensory OR multisensory) AND (dental OR dentistry) AND (environment OR adapted) AND (children OR pediatric population)
Comments on
The Evidence
The studies included are randomized controlled trials with moderate to large sample sizes, suggesting high quality evidence for SADE. The evidence comes from two randomized crossover trials (Fallea 2022 and Duker 2023) and one small pilot RCT (Cermak 2015). The studies found reduced behavioral and physiological indicators of dental anxiety and distress when dental care was provided in SADE compared to RDE. The studies have some limitations including small sample sizes, lack of blinding for some measures, and potential sampling bias. However, results were consistent across studies using objective measures of physiological anxiety. More research is still needed with larger sample sizes. Additional research should explore the impact of SADE on dental team members, examine the separate effects of visual, auditory, and tactile adaptations, and investigate expanding SADE to children with other conditions associated with sensory processing differences and dental anxiety.
Applicability The studies included school-aged children with autism spectrum disorders or sensory processing issues, suggesting the results may be applicable to this population. The sensory adaptations used such as music, dim lighting, and deep pressure wraps are feasible for most dental clinics to implement with minimal costs. However, more research is needed to determine which specific adaptations work best for children with different types of sensory modulation issues. SADE shows promise for improving dental care for children with autism. Additional research should examine expanding the use of SADE to other pediatric populations with sensory processing differences and dental anxiety.
Specialty/Discipline (Pediatric Dentistry)
Keywords Autism, ASD, sensory processing, adapted dental environment, pediatric dentistry, dental anxiety, special needs dentistry, patient cooperation, behavior management
ID# 3536
Date of submission: 10/17/2023spacer
E-mail mahmud@livemail.uthscsa.edu
Author Nida-e-Haque Mahmud, BDS, DDS, MSDS
Co-author(s) Mira Jang, DDS
Co-author(s) e-mail jangm1@livemail.uthscsa.edu
Faculty mentor/Co-author Dr. Maria-Jose Cervantes Mendez, DDS, MS, FAAPD
Faculty mentor/Co-author e-mail cervantesmen@uthscsa.edu
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