O1042: Sensory Adapted Dental Environments Improve Physiological and Behavioral Distress in Children with Autism Spectrum Disorder

Background: Many children with autism spectrum disorder (ASD) have poorer oral health and greater oral care challenges compared to their neurotypical peers. Prior research suggests these challenges are associated with sensory over-responsivity, which may lead to distressing oral care experiences, ultimately discouraging proper oral care for children with ASD. Therefore, it is important to identify innovative solutions that enable dentists to successfully perform standard clinic-based procedures for children with ASD. This study examined the efficacy of a sensory adapted dental environment to reduce physiological and behavioral distress in children with ASD undergoing dental cleanings.

Methods: Participants were 220 children with ASD 6-12 years. In a randomized controlled crossover design, children underwent two dental cleanings, one in a regular dental environment (RDE) and one in a sensory adapted dental environment (SADE), administered in a randomized and counterbalanced order approximately six months apart. Visual, auditory, and tactile stimuli were modified in the SADE. Outcomes included: (1) physiological stress and anxiety measured by electrodermal activity, a non-invasive way to measure sympathetic nervous system activation; (2) behavioral distress measured by objective coding of video-recordings of children's behavior by researchers and two dentist-report surveys [Frankl Scale (4-point Likert Scale); Anxiety/Cooperation Scale (6-point Likert Scale)]; and (3) child- and parent-report satisfaction with the SADE. Mixed effects regression models were performed with adjustments for attained age and visit order.

Results: Implementation of the SADE had high satisfaction as reported by caregivers (overall mean 4.6 out of 5) and children (overall mean 4.2 out of 5). In addition, parents overwhelmingly agreed that the SADE made their child's experience better (overall mean 4.4 out of 5). Significantly lower physiological stress and anxiety was found in the SADE condition, compared to the RDE, in all phases of the dental visit – baseline (p <.0001), oral examination (p <.05), prophylaxis/cleaning (p=.02), and fluoride application (p <.002), suggesting decreased sympathetic activity and increased relaxation during dental care in the SADE. Video-coded measures of behavioral distress were also significantly lower in the SADE, compared to the RDE, for both frequency and duration of distress behaviors (all p’s < 0.001). However, no significant differences in behavioral distress were found using the Likert-scale dentist-report measures of uncooperative behavior. Findings also support that physiological stress was predictive of behavioral distress and child-report of sensory discomfort during the dental cleaning.

Conclusion: Enhancing oral care is critical for children with special health care needs. Using a SADE during dental cleanings is a highly satisfying experience for children with ASD and their caregivers, and is efficacious in decreasing physiological and behavioral distress during care. The use of a SADE for children with special health care needs and/or dental fear/anxiety has recently been added to the American Academy of Pediatric Dentistry’s List of Behavioral Guidance Best Practices.