Francesca Artiga, DDS

A group of disorders with similar features

Classic Autism PDD Asperger's Syndrome Retts Syndrome Childhood Disintegrative Disorder

Symptoms

Social impairment Communication difficulties Repetitive and stereotypical behaviors

According to the CDC prevalence of ASD is 1/88 Occurs in all racial, ethnic, and socioeconomic groups 5x more common in boys

Children with ASD are more likely to have decreased caries prevalence compared to unaffected peers, however were more likely to need GA (Loo, Graham, Hughes, 2008) ASD is an indicator of high caries risk, with oral hygiene being most influential factor (Marshall, Sheller, & Mancl, 2010) Parents of children with ASD are more likely to report their childrens oral health as fair or poor (KopyckaKedzierawski & Auinger 2008) Children with SHCN, including ASD, have more aversions to dental treatment, more treatment complications, and difficulty with access to dental care (Nelson et al, 2011) Medical expenditures 4.1-6.2 times greater for those with ASD (Shimabukuro, Grosse, & Rice, 2008)

To evaluate oral health practices, knowledge, and attitudes of parents of children with and without ASD Hypothesis: parents of children with ASD would have greater knowledge of oral health compared to parents of children without ASD based on increased health, education, and social services and programs

Survey 35 items identifying:

Demographic information Oral health practices Oral health knowledge Oral health attitudes

Alexas PLAYC at Rady Childrens Hospital 36 parents recruited

Parents of 21 children with ASD Parents of 15 children without ASD

Parents of children with and without ASD were compared using Vassar stats independent t-tests or chi-squared analysis

Child with Autism (% yes) Parent Sex (% male) Child 1 sex (% male) Child 2 sex (% male) Parents education High School Some College/Associates Degree College Graduate Graduate/Professional Degree Dental Insurance Private (%) HMO/DPO (%) Government Subsidized (%) No Insurance (%) Parents age (years) Age Child 1 (years) Age Child 2 (years)

21 8 27 10 1 5 15 15 24 7 1 4
Mean (SD)

58 22 75 55 3 13 42 42 67 19 3 11
Range

36.9 5.2 3.8 1.2 2.6 1.3

27-50 2-6 1-5

W/out ASD (n=15)

With ASD (n=21)

Brushing own teeth a Assisting child with brushing Uses fluoridated toothpaste a Drinks tap water a
Uses dental floss a Uses fluoride rinse a Uses pacifier b Sucks thumb b
a Response b

3.8
a

3.5 3.4 2.9 2.4

1.7 1.3 1.2 1.2

1.41 -.94 .63 .30

.59 1.16 -.41 -.53

.17 .35 .53 .77

.56 .25 .68 .59

3.2 3.1 2.6

1.9 1.6 1.1 1.1

choices are: 1= Never, 2 = <1/day, 3 = 1X/day, 4 = 2X/day, 5 = >2X/day Response choices are: 1= Never, 2 = <half the time, 3 = half the time, 4 = almost always, 5 = always

80 70

73.33 71.43

W/out ASD With ASD

60
50 40 30 20 10 0 Every 6 months Every 12 months Response
6.66
19.05

x2=1.66 p=.44

20 9.52

Not yet gone

60
53.33

W/out ASD With ASD

X2= 6.07 p=.19

50 40
33.33 33.33 23.81 14.29 4.76 0 6.66

30 20 10

23.81

6.66

Never

1-3X

4-6X Responses

7-9X

10 or more

50 45 40 35

46.67

W/out ASD With ASD x2=5.89 p=.21

33.33

30
% 25 20 15 10 5 0
0 19.05 23.81 19.05 23.81

13.33
6.66

14.29

Never

1-3X

4-6X Responses

7-9X

10 or more

W/out ASD 90 80 70 60 % 50 40 30 20 10 0
9.52 0 4.76 53.33 46.66 85.71

With ASD x2=6.81 p=.03

Never

1-3X/week Responses

>4X/week

W/out ASD (n=15)

With ASD (n=21)

X2

Baby teeth guide adult teeth into the right place (% correct) Mother/caregiver is main source of cavity causing bacteria (% correct) Sugar in apple juice vs. soda (% correct) Fluoride helps prevent caries (% correct) Fluoride helps caries inhibition (% correct) Age of first tooth <4 months 5-9 months 9-18 months Most important brushing time (% correct) Bedtime Incorrect response

60 13.33

66.66 14.29

0 .17

1.00 .68

33.33 86.66 40
6.66 80 13.33 80 20

76.19 61.90 23.81

14.29 71.43 14.29

4.97 1.58 0.45

0.55

.03 .21 .50

.76

0.13 80.95 19.05

0.72

W/out ASD (n=15)

With ASD (n=21)

X2

Children need assistance in toothbrushing until age (%

correct)

3.80 40 60 13.33 40 20 13.33 13.33 60 40 0 80 20 6.1 33.33 66.66 2.37 4.76 52.38 9.52 19.05 14.29 1.87 85.71 14.29 3.24 19.05 66.66 14.29
t

.43

8 years old Incorrect response Age weaned from bottle/sippy cup (% correct) 6-9 months 10-14 months 15-19 months 20-24 months Dont know Age of first dental visit (% correct) 1 year old 3 years old Most cariogenic foods (% correct) Dairy Carbohydrates Dont Know Total Knowledge Score (out of 11 questions)

.67

.17

.20

6.0

.14

.90

W/out With ASD ASD (n=15) (n=21)

Not necessary to fix cavities in baby teeth Balanced diet necessary for oral health Child is effective at toothbrushing Dental visit by the eruption of the first tooth 1.7 6.7 2.7 3.4 2.0 6.1 2.6 3.7

t -0.75 1.26 0.21 -0.60

p 0.46 0.22 0.83 0.55

Prolonged pacifier use affects tooth development

Prolonged bottle feeding can cause tooth decay Tooth decay is caused by bacterial transmission

6.1
6.5 3.1

5.7
5.9 3.1

0.89
1.44 -.01

0.38
0.16 0.99

*Response choices: strongly disagree, disagree, somewhat disagree, neutral, somewhat agree, agree, strongly agree

Sample size Generalizability is unclear Random sample Original study Few studies assess oral health assessment of parents of children with ASD

Overall, there were no significant differences in the oral health practices, knowledge, and attitudes of parents with and without ASD. Parental education level is not a predictor of oral health knowledge. Oral health practices did not differ significantly among both groups except for consumption of cariogenic drinks for children with ASD. Overall oral health knowledge for both groups were low (average 6 out of 11 knowledge questions) and did not differ significantly among both groups. Oral health attitudes did not differ significantly among both groups.