Ismail Nabil AlBhaisi, Department of Restorative Dentistry, Faculty of Dentistry, Al-Azhar University, Gaza, PalestineFollow
Shahida Mohd-Said, Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaFollow
Yan Jia Lim, Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaFollow
Tuti Ningseh Mohd-Dom, Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaFollow
Ahmad Shuhud Irfani Zakaria, Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaFollow
Colman Patrick McGrath, Department of Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, University of Hong Kong, Hong KongFollow

Objective: This review aimed to seek insights into the challenges faced by caregivers and children with autism spectrum disorder (ASD) when performing and accessing oral care and their recommendations to overcome the matter. Methods: Six electronic databases were used to search for published English full articles using a standardised strategy and grouped using thematic analysis as findings to the study’s goal. Results: The initial screening found 46 relevant articles, but 21 were deemed eligible. Studies were mostly observational (18 crosssectional surveys and 3 case-controls), retrieving data from online or face-to-face surveys and insurance health info. The perceptions and potential solutions made by parents, teachers, doctors, and individuals with ASD were diverse but mostly consistent in most studies with a focus on issues of oral health as low priority, incompetency in oral health care performance at home, children’s cooperation and involuntary behaviours in dental settings, and constraints in related resources. Conclusion: Carers’ lack of awareness and prioritisation of treatment for children with ASD, challenges in performing oral care at home, concerns over oral health care provided by caregivers in educational institutions and dental clinics, and challenges in accessing more supportive oral health care services were highlighted as barriers to oral care.

1. Al-Maweri SA, Halboub ES, Al-Soneidar WA, Al-Sufyani GA. Oral lesions and dental status of autistic children in Yemen: A case-control study. J Int Soc Prev Community Dent. 2014; 4(Suppl 3):S199-203.

2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

3. Ismail NAS, Ramli NS, Hamzaid NH, Hassan NI. Exploring eating and nutritional challenges for children with autism spectrum disorder: Parents’ and special educators’ perceptions. Nutrients. 2020; 12(9):2530.

4. Lam PP, Du R, Peng S, McGrath CP, Yiu CK. Oral health status of children and adolescents with autism spectrum disorder: A systematic review of case-control studies and meta-analysis. Autism. 2020; 24(5):1047-66.

5. Eslami N, Movahed T, Asadi M. Parents’ perceptions of the oral health-related quality of life of their autistic children in Iran. J Clin Pediatr Dent. 2018; 42(6):422-6.

6. Hastings RP. Child behaviour problems and partner mental health as correlates of stress in mothers and fathers of children with autism. J Intellect Disabil Res. 2003; 47(Pt 4-5):231-7.

7. Jx L, Si O, Vy L, Ar FN. Parenting stress among Malaysian parents of children with Autism Spectrum Disorder (ASD). Med Health. 2017; 12(1):42-55.

8. Nikmat AW, Ahmad M, Oon NL, Razali S. Stress and psychological wellbeing among parents of children with autism spectrum disorder. ASEAN J Psychiatr. 2008; 9(2):65-72.

9. Cappe E, Wolff M, Bobet R, Adrien JL. Quality of life: A key variable to consider in the evaluation of adjustment in parents of children with autism spectrum disorders and in the development of relevant support and assistance programmes. Qual Life Res. 2011; 20(8):1279-94.

10. Oxford University Press dictionary [Internet]. Oxford (UK): Oxford Learner’s Dictionaries; c2021. Carer. Available from: https://www.oxfordlearnersdictionaries.com/definition/english/ carer?q=carer

11. Oxford University Press dictionary [Internet]. Oxford (UK): Oxford Learner’s Dictionaries; c2021. Caregiver. Available from https://www.oxfordlearnersdictionaries.com/definition/english/ caregiver?q=Caregiver

12. Barry S, O’Sullivan EA, Toumba KJ. Barriers to dental care for children with autism spectrum disorder. Eur Arch Paediatr Dent. 2014; 15(2):127- 34.

13. Lai B, Milano M, Roberts MW, Hooper SR. Unmet dental needs and barriers to dental care among children with autism spectrum disorders. J Autism Dev Disord. 2012; 42(7):1294-303.

14. Weil TN, Bagramian RA, Inglehart MR. Treating patients with autism spectrum disorder--SCDA members’ attitudes and behavior. Spec Care Dentist. 2011; 31(1):8-17.

15. Alshihri AA, Al-Askar MH, Aldossary MS. Barriers to professional dental care among children with autism spectrum disorder. J Autism Dev Disord. 2021; 51(8):2988-94.

16. Chi DL, Momany ET, Mancl LA, Lindgren SD, Zinner SH, Steinman KJ. Dental homes for children with autism: A longitudinal analysis of Iowa Medicaid’s I-Smile program. Am J Prev Med. 2016; 50(5):609-15.

17. Duker LIS, Henwood BF, Bluthenthal RN, Juhlin E, Polido JC, Cermak SA. Parents’ perceptions of dental care challenges in male children with autism spectrum disorder: An initial qualitative exploration. Res Autism Spectr Disord. 2017; 39:63-72.

18. Fahlvik-Planefeldt C, Herrström P. Dental care of autistic children within the non-specialized Public Dental Service. Swed Dent J. 2001; 25(3):113-8.

19. Floríndez LI, Floríndez DC, Floríndez FM, Como DH, Pyatak E, Baezconde-Garbanati L, Polido JC, Cermak SA. Oral care experiences of latino parents/caregivers with children with autism and with typically developing children. Int J Environ Res Public Health. 2019; 16(16):2905.

20. Floríndez LI, Como DH, Floríndez DC, Vigen C, Floríndez FM, Cermak SA. Identifying gaps in oral care knowledge, attitudes, and practices of latinx parents/caregivers of children with and without autism spectrum disorders. Health Equity. 2021; 5(1):185-93.

21. Kranz AM, Ross R, Sorbero M, Kofner A, Stein BD, Dick AW. Impact of a Medicaid policy on preventive oral health services for children with intellectual disabilities, developmental disabilities, or both. J Am Dent Assoc. 2020; 151(4):255-64.e3.

22. Mansoor D, Al Halabi M, Khamis AH, Kowash M. Oral health challenges facing Dubai children with Autism Spectrum Disorder at home and in accessing oral health care. Eur J Paediatr Dent. 2018; 19(2):127-33.

23. Nelson LP, Getzin A, Graham D, Zhou J, Wagle EM, McQuiston J, McLaughlin S, Govind A, Sadof M, Huntington NL. Unmet dental needs and barriers to care for children with significant special health care needs. Pediatr Dent. 2011; 33(1):29-36.

24. Parry JA, Newton T, Linehan C, Ryan C. Dental visits for autistic children: A qualitative focus group study of parental perceptions. JDR Clin Trans Res. 2021; 8(1):23800844211049404.

25. Puthiyapurayil J, Anupam Kumar TV, Syriac G, R M, Kt R, Najmunnisa. Parental perception of oral health related quality of life and barriers to access dental care among children with intellectual needs in Kottayam, central Kerala-A cross sectional study. Spec Care Dentist. 2022; 42(2):177-86.

26. Schultz ST, Shenkin JD, Horowitz AM. Parental perceptions of unmet dental need and cost barriers to care for developmentally disabled children. Pediatr Dent. 2001; 23(4):321-5.

27. Stein LI, Polido JC, Mailloux Z, Coleman GG, Cermak SA. Oral care and sensory sensitivities in children with autism spectrum disorders. Spec Care Dentist. 2011; 31(3):102-10.

28. Tong HJ, Lee HY, Lee YT, Low Y, Lim CR, Nair R. Factors influencing the inclusion of oral health education in individualized education plans of children with autism spectrum disorders in Singapore. Int J Paediatr Dent. 2017; 27(4):255-63.

29. Wiener RC, Vohra R, Sambamoorthi U, Madhavan SS. Caregiver burdens and preventive dental care for children with autism spectrum disorder, developmental disability and/or mental health conditions: National survey of CSHCN, 2009- 2010. Matern Child Health J. 2016; 20(12):2573-80.

30. Alshatrat SM, Al-Bakri IA, Al-Omari WM. Dental service utilization and barriers to dental care for individuals with Autism Spectrum Disorder in Jordan: A case-control study. Int J Dent. 2020; 2020:3035463.

31. Du RY, Yiu CKY, King NM. Oral health behaviours of preschool children with Autism Spectrum Disorders and their barriers to dental care. J Autism Dev Disord. 2019; 49(2):453-9.

32. Koneru A, Sigal MJ. Access to dental care for persons with developmental disabilities in Ontario. J Can Dent Assoc. 2009; 75(2):121.

33. Braun V, Clarke V. Thematic analysis. In: Cooper H, Camic PM, Long DL, Panter AT, Rindskopf D, Sher KJ, editors. APA handbook of research methods in psychology Vol. 2 Research designs: Quantitative, qualitative, neuropsychological, and biological. Washington DC: American Psychological Association; 2012. pp. 57-71.

34. Toran H, Westover JM, Sazlina K, Suziyani M, Mohd Hanafi MY. The preparation, knowledge and self-reported competency of special education teachers regarding students with autism. Pertanika J Soc Sci Humanit. 2016; 24(1):185-96.

35. Chu SY, Park H, Lee J, Shaharuddin KKB, Gan CH. Self-stigma and its associations with stress and quality of life among Malaysian parents of children with autism. Child Care Health Dev. 2020; 46(4):485-94.