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Original Research

Open Access

Green light exposure in children with autism spectrum disorder: a pilot study

  • Caroline M. Sawicki1,*,
  • Paz Duran2,3
  • Sara Hestehave4
  • Rajesh Khanna2,3,5
  • Spencer D. Wade6,7

1Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC 27517, USA

2Pain Research Center, New York University, New York, NY 10010, USA

3Department of Molecular Pathobiology, New York University, New York, NY 10010, USA

4Department of Experimental Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark

5Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL 32610, USA

6Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York, NY 10010, USA

7Oral Health Center for People with Disabilities, College of Dentistry, New York University, New York, NY 10010, USA

DOI: 10.22514/jocpd.2024.083 Vol.48,Issue 4,July 2024 pp.99-107

Submitted: 11 January 2024 Accepted: 20 March 2024

Published: 03 July 2024

*Corresponding Author(s): Caroline M. Sawicki E-mail:


Children with autism spectrum disorder (ASD) are frequently afflicted with sensory processing difficulties, which often impact their ability to cooperate with dental treatment. The objective of this pilot study was to determine the effects of green light exposure on behavior, pain, distress and anxiety in pediatric patients with ASD undergoing a dental prophylaxis. Twelve children diagnosed with ASD, aged 6–17 years, requiring a dental prophylaxis participated in this study. Participants completed two dental prophylaxes, three months apart, one in a standard white light-exposed dental operatory and one in a green light-exposed dental operatory. Behavioral cooperation, pain intensity, physiological stress and anxiety were assessed in all patients. The Wilcoxon matched-pairs signed rank test was used to estimate differences in measured outcomes according to the experimental condition. There was a trend towards reduced uncooperative behavior when children received a dental prophylaxis in the green light-exposed operatory (p = 0.06). Similar levels of heart rate variability (p = 0.41), salivary alpha amylase (p = 0.19), and salivary cortisol (p = 0.67) were observed at the start and end of each visit in both conditions. Green light exposure had no significant effect on pain intensity (p = 0.17) or behavioral anxiety (p = 0.31). These findings suggest a preliminary positive benefit of green light exposure on behavioral outcomes in pediatric patients with ASD and warrants a further, large-scale clinical trial.


Autism spectrum disorder; Green light; Anxiety; Pain; Stress

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Caroline M. Sawicki,Paz Duran,Sara Hestehave,Rajesh Khanna,Spencer D. Wade. Green light exposure in children with autism spectrum disorder: a pilot study. Journal of Clinical Pediatric Dentistry. 2024. 48(4);99-107.


[1] Casamassimo PS, Seale NS, Ruehs K. General dentists’ perceptions of educational and treatment issues affecting access to care for children with special health care needs. Journal of Dental Education. 2004; 68: 23–28.

[2] Alghafis B, Alharbi A, Al-Haj Ali S, Alsineedi F, Alsudairi O. Dental treatment characteristics of autistic children and differences in dental procedures under general anesthesia relative to healthy counterparts. Children. 2023; 10: 466.

[3] Tang SJ, Wei HL, Li CY, Huang MN. Management strategies of dental anxiety and uncooperative behaviors in children with autism spectrum disorder. BMC Pediatrics. 2023; 23: 612.

[4] Loo CY, Graham RM, Hughes CV. Behaviour guidance in dental treatment of patients with autism spectrum disorder. International Journal of Paediatric Dentistry. 2009; 19: 390–398.

[5] Ben-Sasson A, Hen L, Fluss R, Cermak SA, Engel-Yeger B, Gal E. A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders. 2009; 39: 1–11.

[6] Bogdanova OV, Bogdanov VB, Pizano A, Bouvard M, Cazalets JR, Mellen N, et al. The current view on the paradox of pain in autism spectrum disorders. Frontiers in Psychiatry. 2022; 13: 910824.

[7] Cermak SA, Stein Duker LI, Williams ME, Dawson ME, Lane CJ, Polido JC. Sensory adapted dental environments to enhance oral care for children with autism spectrum disorders: a randomized controlled pilot study. Journal of Autism and Developmental Disorders. 2015; 45: 2876–2888.

[8] Tao L, Jiang R, Zhang K, Qian Z, Chen P, Lv Y, et al. Light therapy in non-seasonal depression: an update meta-analysis. Psychiatry Research. 2020; 291: 113247.

[9] Jiang L, Zhang S, Wang Y, So K, Ren C, Tao Q. Efficacy of light therapy for a college student sample with non-seasonal subthreshold depression: an RCT study. Journal of Affective Disorders. 2020; 277: 443–449.

[10] Yao L, Zhang Z, Lam LT. The effect of light therapy on sleep quality in cancer patients: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Psychiatry. 2023; 14: 1211561.

[11] Cibeira N, Maseda A, Lorenzo-López L, Rodríguez-Villamil JL, López-López R, Millán-Calenti JC. Application of light therapy in older adults with cognitive impairment: a systematic review. Geriatric Nursing. 2020; 41: 970–983.

[12] Martin L, Porreca F, Mata EI, Salloum M, Goel V, Gunnala P, et al. Green light exposure improves pain and quality of life in fibromyalgia patients: a preliminary one-way crossover clinical trial. Pain Medicine. 2021; 22: 118–130.

[13] Martin LF, Patwardhan AM, Jain SV, Salloum MM, Freeman J, Khanna R, et al. Evaluation of green light exposure on headache frequency and quality of life in migraine patients: a preliminary one-way cross-over clinical trial. Cephalalgia. 2021; 41: 135–147.

[14] Takemura Y, Kido K, Kawana H, Yamamoto T, Sanuki T, Mukai Y. Effects of green color exposure on stress, anxiety, and pain during peripheral intravenous cannulation in dental patients requiring sedation. International Journal of Environmental Research and Public Health. 2021; 18: 5939.

[15] Cleymaet AM, Berezin CT, Vigh J. Endogenous opioid signaling in the mouse retina modulates pupillary light reflex. International Journal of Molecular Sciences. 2021; 22: 554.

[16] Ibrahim MM, Patwardhan A, Gilbraith KB, Moutal A, Yang X, Chew LA, et al. Long-lasting antinociceptive effects of green light in acute and chronic pain in rats. Pain. 2017; 158: 347–360.

[17] Aditya PVA, Prasad MG, Nagaradhakrishna A, Raju NS, Babu DN. Comparison of effectiveness of three distraction techniques to allay dental anxiety during inferior alveolar nerve block in children: a randomized controlled clinical trial. Heliyon. 2021; 7: e08092.

[18] Yelderman M, New W. Evaluation of pulse oximetry. Anesthesiology. 1983; 59: 349–351.

[19] Takai N, Yamaguchi M, Aragaki T, Eto K, Uchihashi K, Nishikawa Y. Effect of psychological stress on the salivary cortisol and amylase levels in healthy young adults. Archives of Oral Biology. 2004; 49: 963–968.

[20] Anesiadou S, Makris G, Michou M, Bali P, Papassotiriou I, Apostolakou F, et al. Salivary cortisol and alpha‐amylase daily profiles and stress responses to an academic performance test and a moral cognition task in children with neurodevelopmental disorders. Stress and Health. 2021; 37: 45–59.

[21] Frankl S, FR S, HR F. Should the parent remain in the operatory? Journal of Dentistry for Children. 1962; 2: 150–163.

[22] Venham LL, Gaulin-Kremer E, Munster E, Bengston-Audia D, Cohan J. Interval rating scales for children’s dental anxiety and uncooperative behavior. Pediatric Dentistry Journal. 1980; 2: 195–202.

[23] Venham LL, Goldstein M, Gaulin-Kremer E, Peteros K, Cohan J, Fairbanks J. Effectiveness of a distraction technique in managing young dental patients. Pediatric Dentistry Journal. 1981; 3: 7–11.

[24] Marshall J, Sheller B, Williams BJ, Mancl L, Cowan C. Cooperation predictors for dental patients with autism. Pediatric Dentistry Journal. 2007; 29: 369–376.

[25] Isong IA, Rao SR, Holifield C, Iannuzzi D, Hanson E, Ware J, et al. Addressing dental fear in children with autism spectrum disorders. Clinical Pediatrics. 2014; 53: 230–237.

[26] Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B. The faces pain scale—revised: toward a common metric in pediatric pain measurement. Pain. 2001; 93: 173–183.

[27] Berberich FR, Landman Z. Reducing immunization discomfort in 4- to 6-year-old children: a randomized clinical trial. Pediatrics. 2009; 124: e203–e209.

[28] Malviya S, Voepel‐lewis T, Burke C, Merkel S, Tait AR. The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment. Pediatric Anesthesia. 2006; 16: 258–265.

[29] Maenner MJ, Warren Z, Williams AR, Amoakohene E, Bakian AV, Bilder DA, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring Network, 11 Sites, United States, 2020. MMWR Surveillance Summaries. 2023; 72: 1–14.

[30] Maenner MJ, Warren Z, Williams AR, Amoakohene E, Bakian AV, Bilder DA, et al. Prevalence of oral disease and treatment types proposed to children affected by autistic spectrum disorder in pediatric dentistry: a systematic review. Clinical Therapeutics. 2020; 171: e275–e282.

[31] 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.

[32] American Academy of Pediatric Dentistry. Behavior guidance for the pediatric dental patient. The Reference Manual of Pediatric Dentistry. American Academy of Pediatric Dentistry: Chicago, Ill. 2023; 359–377.

[33] Owens AP, Mathias CJ, Iodice V. Autonomic dysfunction in autism spectrum disorder. Frontiers in Integrative Neuroscience. 2021; 15: 787037.

[34] Makris G, Agorastos A, Chrousos GP, Pervanidou P. Stress system activation in children and adolescents with autism spectrum disorder. Frontiers in Neuroscience. 2021; 15: 756628.

[35] Gomez IN, Flores JG. Diverse patterns of autonomic nervous system response to sensory stimuli among children with autism. Current Developmental Disorders Reports. 2020; 7: 249–257.

[36] Stein Duker LI, Como DH, Jolette C, Vigen C, Gong CL, Williams ME, et al. Sensory adaptations to improve physiological and behavioral distress during dental visits in autistic children. JAMA Network Open. 2023; 6: e2316346.

[37] Rais M, Binder DK, Razak KA, Ethell IM. Sensory processing phenotypes in fragile X syndrome. ASN Neuro. 2018; 10: 175909141880109.

[38] Delgado-Lobete L, Pértega-Díaz S, Santos-del-Riego S, Montes-Montes R. Sensory processing patterns in developmental coordination disorder, attention deficit hyperactivity disorder and typical development. Research in Developmental Disabilities. 2020; 100: 103608.

[39] Allen S, Casey J. Developmental coordination disorders and sensory processing and integration: incidence, associations and co-morbidities. British Journal of Occupational Therapy. 2017; 80: 549–557.

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