Sensory-Adapted Dental Environments: Oral Care in Children With Autism Spectrum Disorder

SIGNIFICANCE: Many children with autism spectrum disorder (ASD) have poorer oral health and greater oral care challenges compared with typically developing (TD) children. Prior research suggests these challenges are associated with sensory overresponsivity (SOR), which may lead to distressing oral care experiences, ultimately discouraging parents from ensuring proper oral care in their child with ASD.

INNOVATION: It is important to identify innovative solutions that enable dentists to perform standard clinic-based procedures for children with ASD. In this study, we modified the sensory characteristics of the dental office to decrease SOR and thereby enhance oral care. Our hypothesis was that children with ASD (and TD children to a lesser extent) will exhibit less behavioral and physiological distress and pain in the sensory-adapted dental environment (SADE) as compared to the regular dental environment (RDE).

APPROACH: Oral care is essential for physical and psychological health, but children with ASD often experience barriers to oral care. One such barrier is SOR, which can lead to uncooperative behaviors, impeding care. It is imperative to identify solutions that enable dentists to perform dental cleanings successfully in this population. In this study, we sought to determine whether a SADE could decrease physiological and behavioral distress and pain in children with ASD. If successful, these modifications have the potential to improve oral care for children.

METHOD: In a pilot and feasibility study funded by the National Institute of Dental and Craniofacial Research, we used a randomized crossover to examine behavioral/physiological distress and pain in ASD and TD groups. Children aged 6 to 12 yr (ASD, n = 22; TD, n = 22) underwent two cleanings in differing environments (RDE and SADE) in a counterbalanced manner. Dental cleanings were video-recorded, and behavioral stress was coded using the Children’s Dental Behavior Rating Scale; stress behaviors were also measured by traditional dentist-report tools. Physiological stress was measured using electrodermal activity (EDA), a noninvasive way to measure sympathetic nervous system activation. Perception of pain was measured by child report using the Faces Pain Scale—Revised. Effect sizes, adjusted for visit order, were computed for the dental environment factor for each group to indicate the strength of the treatment effect.

RESULTS: Effect sizes for measures of physiological distress as measured by EDA were small to moderate in both groups (TD = .38 to .40; ASD = .44 to .46), indicating a significant decrease in physiological stress in the SADE as compared to the RDE. Both dentist-report and researcher-coded measures of behavioral distress evidenced small, nonsignificant effect sizes, but all measures were in the hypothesized direction (TD = .04 to .29; ASD = .13 to .42). Child report of pain intensity exhibited moderate effect sizes in the expected direction, with less pain reported in the SADE (TD = .49; ASD = .62).

CONCLUSION: This study suggests that a SADE has the potential to decrease the physiological and behavioral stress and perception of pain in children, especially those with ASD. These preliminary findings of positive benefit warrant a large-scale trial to provide acceptable power and to enable examination of moderating and mediating variables. Additionally, these findings highlight the potential for occupational therapists to be part of an interdisciplinary team in oral health settings; collaboration with dentistry is a new and evolving area for occupational therapy practice and research.