Disparity in the dental care of children and adolescents with autism spectrum disorder in Korea: a national population-based cross-sectional study

Individuals with autism spectrum disorders (ASD) have difficulty accessing dental care. We aim to verify whether individuals with ASD are properly managed by checking the frequency of dental visits, cost and severity of dental treatment compared with those without ASD. This cross-sectional study used the Korean Health Insurance Database to analyze the frequency, cost and severity of dental treatment in 209,780 people under the age of 19 with or without ASD in 2020. The average frequency of dental visits for individuals without ASD was 2.98 times, which was significantly higher (p < 0.001) than the 2.89 times for those with ASD. However, the average dental cost for individuals with ASD was USD 132.63, which was significantly higher (p < 0.001) than USD 116.57 for those without ASD. Additionally, the average number of times that individuals without ASD received severe dental treatment was 1.23 times, significantly higher than the 1.15 times for those with ASD. Further, per 10,000 people, we found that trauma treatment was recorded for an average of 21.90 individuals with ASD, significantly higher than the 7.75 recorded for those without ASD (p < 0.001). Individuals with ASD encounter significant disparities in accessing dental care, as evidenced by their relatively infrequent dental visits. This discrepancy can be attributed to various barriers including the financial burden compared with those without ASD.

Autistic spectrum disorder; Dentistry; National health insurance; Cross-sectional study; Oral hygiene

[1] Alshihri AA, Al-Askar MH, Aldossary MS. Barriers to professional dental care among children with autism spectrum disorder. Journal of Autism and Developmental Disorders. 2021; 51: 2988–2994.

[2] Junnarkar VS, Tong HJ, Hanna KMB, Aishworiya R, Duggal M. Qualitative study on barriers and coping strategies for dental care in autistic children: parents’ perspective. International Journal of Paediatric Dentistry. 2023; 33: 203–215.

[3] Shi B, Wu W, Dai M, Zeng J, Luo J, Cai L, et al. Cognitive, language, and behavioral outcomes in children with autism spectrum disorders exposed to early comprehensive treatment models: a meta-analysis and meta-regression. Frontiers in Psychiatry. 2021; 12: 691148.

[4] Dean JA. McDonald and Avery’s dentistry for the child and adolescent-E-Book. 11th edn. Elsevier Health Sciences: Amsterdam. 2015.

[5] American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5™. 5th edn. American Psychiatric Publishing Inc: Arlington. 2013.

[6] Bernath B, Kanji Z. Exploring barriers to oral health care experienced by individuals living with autism spectrum disorder. Canadian Journal of Dental Hygiene. 2021; 55: 160–166.

[7] Pi X, Liu C, Li Z, Guo H, Jiang H, Du M. A meta-analysis of oral health status of children with autism. Journal of Clinical Pediatric Dentistry. 2020; 44: 1–7.

[8] Ferrazzano GF, Salerno C, Bravaccio C, Ingenito A, Sangianantoni G, Cantile T. Autism spectrum disorders and oral health status: review of the literature. European Journal of Paediatric Dentistry. 2020; 21: 9–12.

[9] Lam PPY, Zhou N, Wong HM, Yiu CKY. Oral health status of children and adolescents living with HIV undergoing antiretroviral therapy: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 2022; 19: 12864.

[10] Obeidat R, Noureldin A, Bitouni A, Abdellatif H, Lewis-Miranda S, Liu S, et al. Oral health needs of U.S. children with developmental disorders: a population-based study. BMC Public Health. 2022; 22: 861.

[11] Xu S, Wang HL, Xia C, Lv J, Zhang G. Associations between poor oral hygiene and risk of pancreatic cancer. Pancreas. 2022; 51: 985–994.

[12] Chang Y, Woo HG, Lee JS, Song TJ. Better oral hygiene is associated with lower risk of stroke. Journal of Periodontology. 2021; 92: 87–94.

[13] Tuganbaev T, Yoshida K, Honda K. The effects of oral microbiota on health. Science. 2022; 376: 934–936.

[14] Nakamura T, Zou K, Shibuya Y, Michikawa M. Oral dysfunctions and cognitive impairment/dementia. Journal of Neuroscience Research. 2021; 99: 518–528.

[15] Simpson TC, Clarkson JE, Worthington HV, MacDonald L, Weldon JC, Needleman I, et al. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database Systematic Reviews. 2022; 4: CD004714.

[16] Kitamoto S, Nagao-Kitamoto H, Hein R, Schmidt TM, Kamada N. The bacterial connection between the oral cavity and the gut diseases. Journal of Dental Research. 2020; 99: 1021–1029.

[17] Kleinstein SE, Nelson KE, Freire M. Inflammatory networks linking oral microbiome with systemic health and disease. Journal of Dental Research. 2020; 99: 1131–1139.

[18] Tonelli A, Lumngwena EN, Ntusi NAB. The oral microbiome in the pathophysiology of cardiovascular disease. Nature Reviews Cardiology. 2023; 20: 386–403.

[19] Lee J, Chang J. Oral health issues of young adults with severe intellectual and developmental disabilities and caregiver burdens: a qualitative study. BMC Oral Health. 2021; 21: 538.

[20] Zablotsky B, Black LI, Maenner MJ, Schieve LA, Blumberg SJ. Estimated prevalence of autism and other developmental disabilities following questionnaire changes in the 2014 National Health interview survey. National Health Statistics Report. 2015: 1–20.

[21] Solmi M, Song M, Yon DK, Lee SW, Fombonne E, Kim MS, et al. Incidence, prevalence, and global burden of autism spectrum disorder from 1990 to 2019 across 204 countries. Molecular Psychiatry. 2022; 27: 4172–4180.

[22] Hong M, Lee SM, Park S, Yoon SJ, Kim YE, Oh IH. Prevalence and economic burden of autism spectrum disorder in South Korea using National Health insurance data from 2008 to 2015. Journal of Autism and Developmental Disorders. 2020; 50: 333–339.

[23] National Health Insurance Service (NHIS). National health screening statistical yearbook. National Health Insurance Service. 2019.

[24] Bachmann CJ, Gerste B, Hoffmann F. Diagnoses of autism spectrum disorders in Germany: time trends in administrative prevalence and diagnostic stability. Autism. 2018; 22: 283–290.

[25] Hwang YIJ, Srasuebkul P, Foley K, Arnold S, Trollor JN. Mortality and cause of death of Australians on the autism spectrum. Autism Research. 2019; 12: 806–815.

[26] Health Insurance Review and Assessment Service. 2020. Available at: https://www.hira.or.kr/main.do (Accessed: date)

[27] Kopycka-Kedzierawski DT, Auinger P. Dental needs and status of autistic children: results from the National Survey of Children’s Health. Pediatric Dentistry Journal. 2008; 30: 54–58.

[28] DeMattei R, Cuvo A, Maurizio S. Oral assessment of children with an autism spectrum disorder. Journal of Dental Hygiene. 2007; 81: 65.

[29] Marshall J, Sheller B, Mancl L. Caries-risk assessment and caries status of children with autism. Pediatric Dentistry Journal. 2010; 32: 69–75.

[30] Onol S, Kırzıoğlu Z. Evaluation of oral health status and influential factors in children with autism. Nigerian Journal of Clinical Practice. 2018; 21: 429–435.

[31] de Almeida JS, Fernandes RF, Andrade ÁCB, Almeida BDC, Amorim ANDS, Lustosa JHDCM, et al. Impact of dental treatment on the oral health-related quality of life of children and adolescents with Autism Spectrum Disorder. Special Care in Dentistry. 2021; 41: 658–669.

[32] Fakroon S, Arheiam A, Omar S. Dental caries experience and periodontal treatment needs of children with autistic spectrum disorder. European Archives of Paediatric Dentistry. 2015; 16: 205–209.

[33] Fenning RM, Steinberg-Epstein R, Butter EM, Chan J, McKinnon-Bermingham K, Hammersmith KJ, et al. Access to dental visits and correlates of preventive dental care in children with autism spectrum disorder. Journal of Autism and Developmental Disorders. 2020; 50: 3739–3747.

[34] Korean Academy of Pediatric Dentistry. Textbook of Pediatric Dentistry. 5th edn. Yenang Inc: Seoul. 2014.

[35] Lee JY, Yun J. What else is needed in the Korean government’s master plan for people with developmental disabilities? Journal of Preventive Medicine and Public Health. 2019; 52: 200–204.