Knowledge, attitude, and practice on oral hygiene status in autistic children

Transcription

1 Research Article Knowledge, attitude, and practice on oral hygiene status in autistic children P. Chaitanya Shree 1, V. Rakshagan 2, S. Dhanraj 2, Ashish R. Jain 2 * ABSTRACT Aim and Background: The aim of the study was to assess the oral hygiene status in autistic children. Autism is one of the most severe neuropsychiatric disorders. Autistic individuals are characterized by impairment in social interaction with a restricted range of interests and often, stereotyped repetitive behaviors. This study is done to assess the oral hygiene status of autistic children. Materials and Methods: The survey was conducted in Apollo Hospital in Chennai. 65 children were used for this study. Questionnaires were prepared, and parents/caretakers were distributed. They were asked to answer questions regarding the oral health of the child. Results: Majority of the children brushes once in a day. From the study, it is understood that they do not use any special type of brush. They brush themselves. Many of them have complaints of bad breath. Most of the children consumes only balanced diet. Majority of the children consumes cool drinks and junk food. Most of the children use mouthwash and most of the children do not experience tooth discoloration. Majority of the children visits the dentist only when needed. According to the parent s report, many children did not show any signs of dental pain or dental problems. Some were not aware of oral hygiene practices. Conclusion: Caries experience in autism child does not gonna affect in any of the pathological ways; however, lifestyle of autism child is most commonly associated with poor oral hygiene, improper motor coordination, gastrointestinal disorder, sleep dysfunction, and pica (tendency to eat things that are not food), this study aims at assessing the oral hygiene status among the control group. People should be aware of oral hygiene practices. KEY WORDS: Autism, Caries, Dental care, Gingivitis, Leo kanner, Neuropsychiatric, Oral hygiene INTRODUCTION Autism is one of the most severe neuropsychiatric disorders. Autistic individuals are characterized by impairment in social interaction with a restricted range of interests and often, stereotyped repetitive behaviors. [1] Studies on oral health conditions in children with autism are sparse. [1] It was first described in 1943 by Leo Kanner. Kanner reported his observations of a group of children as they expressed impaired social and behavioral interactions, verbal and nonverbal communication deficiencies, and developmental retardation. [2,3] The risk of dental caries and gingivitis is expected to be higher in these patients due to improper brushing and flossing because of the difficulties the trainers and parents encounter when they brush the children s teeth. [4] Children with autism Access this article online Website: jprsolutions.info ISSN: spectrum disorder (ASD) are characterized by a triad of symptoms, namely lack of social reciprocal responsiveness, language and communication deficit, and rigid repetitive behavior. [5] Autism affects many parts of the brain; how this occurs is not understood. [6,7] It is a brain development disorder that usually appears during childhood [Figure 1] or during the infant period and follows a steady course without remission. [6] It is said that caries prevalence among children with autism was high when compared with children without autism but according to the World Health Organization classification this caries level is considered to be low. [6] Autism varies widely in symptoms and severity, and some people have coexisting disabilities, such as mental retardation or epilepsy. [8] Children with autism have problems with language, behavior, and social skills [Figure 1 and 2]. These conditions can make the affected children more prone to oral diseases and complicate their dental care. [9] Autistic children may also have damaging oral habits such as bruxism, tongue 1 Department of Prosthodontics and Crown and Bridge, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India, 2 Department of Prosthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India *Corresponding author: Dr. Ashish R. Jain, Department of Prosthodontics, Saveetha Dental College and Hospital, Saveetha University, Poonamallee high road, Chennai , Tamil Nadu, India. Phone: dr.ashishjain_r@yahoo.com Received on: ; Revised on: ; Accepted on:

2 Figure 1: Child suffering from autism from different ethnic backgrounds and social classes. Males are mostly affected when compared to females. A new study was recently released by national survey of children s health stating that autism affects 1 in every 110 American children and 1 in 70 boys (centers for disease control and prevention, 2007). Majority of the studies revealed that caries susceptibility and periodontal disease prevalence were not so higher in autistic children compared to non-autistic individuals, but few studies reported an increased prevalence of caries susceptibility among autistic children, which may be due to the increased consumption of soft drink and sweet food in addition to the pouching of food due to inferior mastication abilities in autistic children. [12,13] MATERIALS AND METHODS Figure 2: Child with autism disorder The survey was conducted in Apollo Hospital in Chennai. Initially, 100 survey were created, but only 65 responded to them. Hence, 65 children were used for our study. From that 65, 31 are males and 34 are females. Questionnaires were prepared, and parents/ caretakers were distributed. They were asked to answer questions regarding the oral health of the child. They were asked about their oral health and food practice. RESULTS Out of 65, 44 children brush once a day and 21 brush twice [Figure 3]. The children brush themselves [Figure 4] and they don t use any special kind of brush [Figure 5]. Nearly 41 children had the complaint on bad breath [Figure 6]. Mostly the children eat only balanced diet [Figure 7] and majority of the children visits the dentist only when needed [Figure 8]. Most of the children consumes junk food [Figure 9] and cool drinks [Figure 10]. Majority of the children use mouthwash [Figure 11]. Majority of the children has experienced tooth discolouration [Figure 12]. Figure 3: Times the child brushes per day thrusting, picking at the gingiva, and lip biting. [9] Autism is also recognized as an organic disorder characterized by abnormalities in the brain, especially in the limbic system and cerebellum. [10] Autistic individuals do not have a higher degree of peripheral vision; rather a more centrally focused vision and attention pattern is the case. [10] Autism disorder is otherwise known as Kanner s autism, childhood autism, and early infantile autism. [3,11] There are no biological tests for autism. Diagnosis is made between 2 and 4 years on the basis of presence and extent of three domains: Impairment in social interaction, impairment in communication and repetitive or restrictive behavior, and with symptoms varying from mild to severe. [7] Autism affects individuals DISCUSSION From the above results, it is derived that the majority of the children brushes once in a day. From the study, it is understood that they do not use any special type of brush. They brush themselves. Many of them have complaints of bad breath. Most of the children consume only a balanced diet. Majority of the children consumes cool drinks and junk food. Most of the children use mouthwash and most of the children do not experience tooth discoloration. Most of the children visit the dentist only when needed. According to the parent s report, many children did not show any signs of dental pain or dental problems. Some were not aware of dental care or oral hygiene practices. In this study, the oral health status of autistic children was assessed. Oral problems may arise due to autismrelated behaviors such as improper communications, 2116

3 Figure 4: Whether the child brush himself/herself Figure 8: Whether the child visits the dentist Figure 5: Whether the child use any special type of brush Figure 9: Whether the child consumes junk food Figure 6: Whether the child have complaint of bad breath Figure 10: Whether the child consumes cool drinks Figure 7: What does the child normally eat? personal neglect, behavior that cause self-injury, dietary habits, effects of medications, lack of dental care, hyposensitivity to pain, and avoidance of social contact. [14] This study is useful in understanding oral hygiene in children with autism. Oral health may be affected due to a limited understanding on the importance of oral health management, difficulties in communicating oral health needs, and anticonvulsant medications that impact on gum health and a fear of oral health procedures. [15] Autistic children are most sensitive to taste and food consistency. [16,17] The children with autism may also have lower salivary secretion when compared with others. Poor oral hygiene is mostly associated with improper brushing habits, lack of dental education, and poor dental awareness. [16,18] The autistic children may be hypersensitive or hyposensitive; some may have special interests, some may have learning disabilities. [17] Although ASD was not associated with the prevalence, or severity of increased dental caries 2117

4 In most people, there is a high chance of tooth loss, dental caries, periodontal disease, xerostomia, and cancer. In addition, poor oral hygiene and poor general hygiene are often interrelated. Poor oral health can lead to difficulties in eating, speech impediments, oral pain, disturbances in sleep, and decreased self-esteem which results in a negative effect on health and quality of life. Health-related quality of life in young autistic patients has been studied extensively Figure 11: Whether the child use mouthwash Figure 12: Whether the child experience tooth discoloration whereas considerably less attention has been given to the oral health-related quality of life in young autistic patients. [17,19-22] Parents are the decision maker in a matter of health care for children with special health care needs; thus, they play an important role in achieving the best oral health outcomes for their children. Hence, this study suggests that oral health promotion programs should be introduced to special care to the children along with parental education. [9] When parents attend the clinic with their children, it is important they are educated on the need to reduce and as much as possible to substitute cariogenic snacks with fruits and vegetables. Since parents are responsible for almost all health issues related to their children, their role in modeling their children toward practicing preventive oral health throughout life is crucial. [14,23] Dental care should be viewed as an integral part of a comprehensive health-care program. [11] It is essential to practice good oral hygiene practices to maintain good oral health [Figure 13 and 14]. [24] The attitude and behavior toward oral health maintenance are very important to maintain good oral hygiene. Dental care can sometimes be a forgotten part of a healthy lifestyle. Hence, every parent should be made aware of ways to keep their autism affected children healthy. [25,26] CONCLUSION Figure 13: Oral hygiene practice Figure 14: Preventive measures dental professionals should emphasize the importance of regular preventive measures, such as using daily rinses and a good dietary habits. In the present study, we could see clearly that many of the parents were not aware of oral hygiene practices. The significance of oral hygiene should be made aware to all caretakers, parents, and hospital members so that the autistic child can lead a healthy and independent life as they mature. The results of this study show that most of the children preferred to consume a diet high in sugar and frequent snacks, which put them at higher risk of developing dental caries. Appropriate oral health encouragement and treatment programs should be established to create awareness among parents and students to prevent oral diseases. Frequent tooth brushing, regular dental visits are highly recommended for parents to follow as preventive measures. REFERENCES 1. Subramaniam P, Gupta M. Oral health status of autistic children in India. J Clin Pediatr Dent 2011;36: Murshid EZ. Diet, oral hygiene practices and dental health in autistic children in Riyadh, Saudi Arabia. Oral Health Dent 2118

5 Manag 2014;13: Patil A, Tamgond S, Sandhyarani B, Shigli A, Patil S, Gunda S. An update on dental outlook for autism. Autism Open Access 2016;6:3. 4. Vajawat M, Deepika PC. Comparative evaluation of oral hygiene practices and oral health status in autistic and normal individuals. J Int Soc Prev Community Dent 2012;2: Chan D, Chan S, So H, Li A, Ng RC, Tsang N. Dental health of preschool children with autism spectrum disorder in Hong Kong. HK J Paediatr (new series) 2014;19: Jaber MA. Dental caries experience, oral health status and treatment needs of dental patients with autism. J Appl Oral Sci 2011;19: Rada RE. Controversial issues in treating the dental patient with autism. J Am Dent Assoc 2010;141: Mohinderpal Chadha G, Kakodkar P, Chaugule V, Nimbalkar V. Dental survey of institutionalized children with autistic disorder. Int J Clin Pediatr Dent 2012;5: Al-Maweri SA, Halboub ES, Al-Soneidar WA, Al-Sufyani GA. Oral lesions and dental status of autistic children in Yemen: A casecontrol study. J Int Soc Prev Community Dent 2014;4:S Klein U, Nowak AJ. Autistic disorder: A review for the pediatric dentist. Pediatr Dent 1998;20: Delli K, Reichart PA, Bornstein MM, Livas C. Management of children with autism spectrum disorder in the dental setting: Concerns, behavioural approaches and recommendations. Med Oral Patol Oral Cir Bucal 2013;18:e Vishnu Rekha C, Arangannal P, Shahed H. Oral health status of children with autistic disorder in Chennai. Eur Arch Paediatr Dent 2012;13: Bhalla, J. Autism and dental management. Ontario Dent 2006;83: Al-Mamun A, Ahmad MS, Islam S, Begum S, Habib A, Rahman M. Oral health status of school children with autism disorder in Northern region of Bangladesh. RRJDS 2016;4: Altun C, Guven G, Akgun OM, Akkurt MD, Basak F, Akbulut E, et al. Oral health status of disabled individuals attending special schools. Eur J Dent 2010;4: Nonong YH, Setiawan A, Dewi FD, Navaneetha C. Oral health knowledge among parents of autistic child in Bandung- Indonesia. Dent J (Maj. Ked. Gigi) 2014;47: Gough N. Autism and asperger syndrome: Dental management. Vital 2012;9: Bejerot MB, Dahllöf G. A cross-sectional study on oral health and dental care in intellectually able adults with autism spectrum disorder. BMC Oral Health 2015;15: Kalyoncu IÖ, Tanboga I. Oral health status of children with autistic spectrum disorder compared with non-authentic peers. Iran J Public Health 2017;46: Stubbs C, Riordan PJ. Dental screening of older adults living in residential aged care facilities in Perth. Aust Dent J 2002;47: da Silva SR, Valsecki A Jr. Evaluation of oral health conditions among the elderly in a Brazilian city. Revista Panamericana de Salud P ublica 2000;8: Stein LI, Polido JC, Najera SO, Cermak SA. Oral care experiences and challenges in children with autism spectrum disorders. Pediatr Dent 2012;34: Magoo J, Shetty AK, Chandra P, Anandkrishna L, Kamath PS, Iyengar U. Knowledge, attitude and practice towards oral health care among parents of autism spectrum disorder children. J Adv Clin Res Insights 2015;1: Subashri A, Maheshwari TN. Knowledge and attitude of oral hygiene practice among dental students. Res J Pharm Tech 2016;9: Haripriya M, KumarMP. A survey on awarness of oral hygiene maintenance among dental undergraduate students. Int J Pharm Sci Rev Res 2017;44: Jaber MA, Sayyab M, Fanas SH. Oral health status and dental needs of autistic children and young adults. J Invest Clin Dent 2011;2: Source of support: Nil; Conflict of interest: None Declared 2119