Caries Risk Assessment and Caries Status of Children with Autism

Resident: Swan
Date: 5/18/2011
Article Title: Caries Risk Assessment and Caries Status of Children with Autism
Authors: Marshall et al.
Journal: Pediatric Dentistry Jan/Feb 2010

Main Purpose: To describe the dental caries status of children with autism and to explore associations between caries status and several of the caries risk indicators of the CAT. (Caries risk Assessment Tool-adopted by AAPD in 2002, revised 2006)
Methods: 99 Children with autism were recruited from a hospital, a dental school (residency), and 9 private practice offices between 2003/2004. Data was collected via parent interviews, registration information, dentist treatment notes/charting, radiographs, parent surveys given post-appointment.
Factors indluded for analysis were concurrent diagnoses, medications, diet preferences, oral hygiene details, previous hx of dental tx under GA, past and current autism tx interventions, ease of tooth-brushing, parents' education level, patient demographics, dentist tx notes (oral hygiene/caries findings).

***Testing of reliability between examiners was not done, and no standardized rating for oral hygiene was used.

Results: New caries lesions diagnosed for 40 children (40%). 65 (65%) had hx of caries. Mean total DMFT (primary and permanent) was 3.7. 60% of children 7 and younger had new caries, while 34% older than 7 had new caries. Asians had highest % of patients with new caries (56%) while African Americans had lowest (0) (Not statistically significant).

Some significant findings:
From CAT Part I:
-47% of patients were taking medication. Of those, 65% experienced dry mouth as side effect.
-1/4 of parents indicated difficulty in finding a dental home for their child.
-No association was found between caries status and food rewards, self-restricted diet, or physician-recommended diet.
-Not significant, but all three of kids who never had teeth brushed had new caries and mean DMFT of 7.3. No association between hygiene habits, primary tooth-brusher, toothbrush used, toothpaste usage was found.

From CAT Part II:
-oral hygiene rated as good/excellent for 43%, poor for 17%. Worse oral hygiene equated to more caries. (New caries for good hygiene=28%, for poor hygiene=59%
-having radiographs available (62%) made for significantly greater DMFT

Discussion: Autism has historically been a marker of high caries risk for several reasons: 1. medications causing xerostomia, 2. preference for soft/sweet foods, 3. poor oral hygiene, 4. requiring help with brushing.
In this study, the only risk indicator associated with increased caries was increased visible plaque, indicated by dentist rating of oral hygiene
***Autism should be viewed as an indicator of high risk for caries. This study suggests an increased risk for caries, especially in the <7 crowd.
The psychoactive meds taken by these patients would seem to increase caries risk with their xerostomic side effects; however, increased risk wasn't associated with their use. This has been supported by other studies. Another risk factor identified in this study was the patients' preference for soft/sweet foods, although an associated increase of caries wasn't seen.

Autistic children tend to prefer structures, routines, rituals. Each child in school should have an IEP (Individualized Education Plan) tailored to them. These children would likely benefit from addition of tooth-brushing after every meal as an addition to their IEP. We should each consider providing a formal request to the child's school requesting this.

Basic prevention strageties for children with autism:
1. routine care visits, 2. fluoride treatments, 3. diet counseling, 4. oral home care

Study limitations: dentists did not use standardized hygiene rating scale. (Authors believe standardized scale would show similar results). Also, testing of reliability between examiners should be done in future studies. Parents in this study demonstrated a high level of involvement in their child's oral health, as many still helped brush into the teenage years.