Dental awareness of the parents, dietary habits and oral hygiene of autistic children at Prince Mohammed Bin Salman Autistic Center in King Fahad Armed Forces Hospital Jeddah, Kingdom of Saudi Arabia (observational study)

Background: Dental health care is very challenging for autistic children and their families. The study aims to report baseline information about the dental awareness of the parents and dental health of a group of autistic children in King Fahad Armed Forces Hospital, Jeddah. This information proved essential for enhancing the quality of care provided at the hospital. It facilitated the development of impactful educational initiatives tailored for autistic children and their families, to enhance their overall well-being and oral health. Methods: Consent forms were dispersed among the parents or legal guardians of autistic children, while the questionnaires, written in simple Arabic, encompassed socio-demographic details, the child’s daily dietary and oral hygiene practices and the parents’ dental knowledge. The chi-square test was employed to explore relationships between categorical variables, assuming a normal distribution. Significance was determined using the conventional p-value of < 0.05 to reject the null hypothesis. Results: The total of 72 samples showed that 86% were male autistic patients and 13.9% were females. Their ages range from 6–8 years old. Most of the parents had a high school education. The frequent use of sweet food as a reward scored 73.6%. At the same time, a soft diet was favored by 68% of the participants, and 81.9% of the children demonstrated a preference for snacking between meals. In terms of tooth brushing habits, most mothers assisted their children with brushing (80.6%), while 55.6% of the children brushed their teeth independently. Furthermore, 79% of the participants indicated a dislike for the taste of toothpaste. When asked about seeking dental care for their child when experiencing dental pain, 72.2% of parents responded positively, however, they showed reluctance towards conducting regular dental check-ups at home. Conclusions: Most parents knew about oral hygiene, but their attitudes and practices needed to reflect the same knowledge.

Autistic children; Oral care; Dietary habits; Dental awareness of parents

[1] Zhuang H, Liang Z, Ma G, Qureshi A, Ran X, Feng C, et al. Autism spectrum disorder: pathogenesis, biomarker, and intervention therapy. MedComm. 2024; 5: e497.

[2] Kanner L. Autistic disturbances of affective contact. Nervous Child. 1943; 2: 217–250.

[3] Waizbard-Bartov E, Fein D, Lord C, Amaral DG. Autism severity and its relationship to disability. Autism Research. 2023; 16: 685–696.

[4] Quetsch LB, Brown C, Onovbiona H, Bradley R, Aloia L, Kanne S. Understanding aggression in autism across childhood: comparisons with a non-autistic sample. Autism Research. 2023; 16: 1185–1198.

[5] Huang C, Chen K, Lee K, Lin C, Chen K. Different autism measures targeting different severity levels in children with autism spectrum disorder. European Archives of Psychiatry and Clinical Neuroscience. 2024; 274: 27–33.

[6] Wang S, Sun Z, Martinez-Tejada LA, Yoshimura N. Comparison of autism spectrum disorder subtypes based on functional and structural factors. Frontiers in Neuroscience. 2024; 18: 1440222.

[7] Thom RP, Friedman ND, Nasir R, Politte LC, Nowinski LA, McDougle CJ. Neurodevelopmental Disorders: Autism Spectrum Disorder. In Tasman A, Riba MB, Alarcón RD, Alfonso CA, Kanba S, Lecic-Tosevski D, et al. (eds.) Tasman’s Psychiatry (pp. 1561–s1614). 5th edn. Springer International Publishing: Cham. 2024.

[8] Gordon RA, Dimitropoulos A. Autism spectrum disorder: a lifespan overview. In Valdovinos MG (ed.) Intellectual and developmental disabilities: a dynamic systems approach (pp. 327–358). 1st edn. Springer: Switzerland. 2024.

[9] Machado Cruz T. Clinical profiles in autism spectrum disorder: enhancing diagnosis, treatment, and overall health outcomes. Medicine Advances. 2024; 2: 384–401.

[10] George SS, Elenjickal MG, Naik S, Thomas NG, Vellappally S, Varghese N, et al. Oral health status and dental treatment needs in children with autism spectrum disorder. Heliyon. 2024; 10: e37728.

[11] Ram A, Han H, Chu JT. Dental caries experiences among children with congenital disabilities and the barriers to dental care: a narrative review. Australian & New Zealand Journal of Dental and Oral Health Therapy. 2024; 12: 5.

[12] Martignon S, Guarnizo-Herreño CC, Franco-Cortés AM, García-Zapata LM, Ochoa-Acosta EM, Restrepo-Pérez LF, et al. Socioeconomic inequalities in early childhood caries: evidence from vulnerable populations in Colombia. Brazilian Oral Research. 2024; 38: e126.

[13] Hariyani N, Shoaib LA, Rohani MM, Hanna KM, Lee H. Caregivers’ perceptions, beliefs and behavior influence dental caries experience in children with autism spectrum disorder: a qualitative study. The Saudi Dental Journal. 2024; 36: 1533–1538.

[14] Dimopoulou M, Antoniadou M, Amargianitakis M, Gortzi O, Androutsos O, Varzakas T. Nutritional factors associated with dental caries across the lifespan: a review. Applied Sciences. 2023; 13: 13254.

[15] Alsajer MA, Assaf AS, Tannous SM. Nutritional behaviors among children and adolescents with autism spectrum disorder. Damanhour Scientific Nursing Journal. 2023; 1: 1–12.

[16] Uliana JC, Del’Agnese CC, Antoniazzi RP, Kantorski KZ. Autistic individuals have worse oral status than neurotypical controls: a systematic review and meta-analysis of observational studies. Clinical Oral Investigations. 2024; 28: 137.

[17] Sarangi S, Raj RR, Rawat A, Salam S, Tripathi S, Aggarwal D, et al. Oral health care concerns among autism patients: a. Bioinformation. 2024; 20: 1017–1021.

[18] Jones J, Roberts E, Cockrell D, Higgins D, Sharma D. Barriers to oral health care for autistic individuals—a scoping review. Healthcare. 2024; 12: 103.

[19] Chen RJ, Lai KH, Lee CH, Lin HY, Lin CC, Chen CH, et al. Exploring the link between xerostomia and oral health in mental illness: insights from autism spectrum disorder, depression, bipolar disorder, and schizophrenia. Healthcare. 2024; 12: 2018.

[20] Kaushik M. A systematic review of parents’ knowledge of children’s oral health. Cureus. 2023; 15: e41485.

[21] Minervini G, Franco R, Marrapodi MM, Di Blasio M, Ronsivalle V, Cicciù M. Children oral health and parents education status: a cross sectional study. BMC Oral Health. 2023; 23: 787.

[22] Ehsan H, Ahmadzai N, Orfani Z, Rezayee BM, Wally M, Daftani S. Oral health knowledge, attitude, and behavior among health professions’ students at Kabul University of medical sciences. Clinical, Cosmetic and Investigational Dentistry. 2023; 31: 349–358.

[23] Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. The Lancet. 2007; 370: 1453–1457.

[24] Zeidan J, Fombonne E, Scorah J, Ibrahim A, Durkin MS, Saxena S, et al. Global prevalence of autism: a systematic review update. Autism Research. 2022; 15: 778–790.

[25] Qin L, Wang H, Ning W, Cui M, Wang Q. New advances in the diagnosis and treatment of autism spectrum disorders. European Journal of Medical Research. 2024; 29: 322.

[26] Barbosa MA, Lotito MC, Masterson D, Pastura G, de Souza IP, Tavares-Silva CM, et al. Autistic spectrum disorder children and adolescents’ oral health characteristics—scoping review. International Journal of Developmental Disabilities. 2024; 70: 329–342.

[27] Kaskova LF, Sadovski MO, Murtazaev S, Novikova SC, Amosova LI, Ulasevych LP, et al. The importance of parental involvement in the oral hygiene of children aged 3–5 years. The Medical and Ecological Problems. 2024; 28: 21–26.

[28] Sauer AK, Stanton J, Hans S, Grabrucker A. Autism spectrum disorders: etiology and pathology. In Grabrucker AM (ed.) Autism spectrum disorders (pp. 1–5). Exon Publications: Brisbane. 2021.

[29] da Silva AC, Barbosa TD, Gavião MB. Parental perception of the oral health-related quality of life of children and adolescents with autism spectrum disorder (ASD). International Journal of Environmental Research and Public Health. 2023; 20: 1151.

[30] Bagattoni S, Lardani L, D’Alessandro G, Piana G. Oral health status of Italian children with autism spectrum disorder. European Journal of Paediatric Dentistry. 2021; 22: 243–247.

[31] Nadeem NJ, Afzal S, Dogar IA, Smith JG, Shah T, Noreen M, et al. The impact of having an autisTic child on parental mental health and wellbeing in pakistan. Research in Autism Spectrum Disorders. 2024; 115: 102423.

[32] Kurtz PF, Strohmeier CW, Becraft JL, Chin MD. Collateral effects of behavioral treatment for problem behavior on caregiver stress. Journal of Autism and Developmental Disorders. 2021; 51: 2852–2865.

[33] Kurzrok J, McBride E, Grossman RB. Autism-specific parenting self-efficacy: an examination of the role of parent-reported intervention involvement, satisfaction with intervention-related training, and caregiver burden. Autism. 2021; 25: 1395–1408.

[34] Shetty AA, Fernandes DY, Hegde AM. Autism spectrum disorder in a dental office—a review. Journal of Evolution of Medical and Dental Sciences. 2021; 10: 1931–1940.

[35] Alwadi MA, AlJameel AH, Baker SR, Owens J. Facilitating oral healthcare for children with disabilities in the Kingdom of Saudi Arabia: a qualitative exploration of the perceptions of parents and professionals. BMC Oral Health. 2024; 24: 1526.

[36] Al-Hussyeen A, Al-Sadhan SA. Oral hygiene practices and dietary habits among children with Down’s syndrome in Riyadh, Saudi Arabia. The Saudi Dental Journal. 2006; 18: 141–148.

[37] Mohammed Al-Dahan H, Ali Ismael S. Early childhood caries: parents’ knowledge, attitude and practice towards its prevention in refugee camps in Erbil, Iraq. BMC Oral Health. 2023; 23: 792.

[38] Aiuto R, Dioguardi M, Caruso S, Lipani E, Re D, Gatto R, et al. What do mothers (or caregivers) know about their children’s oral Hygiene? An update of the current evidence. Children. 2022; 9: 1215.

[39] Kumar N, Nabi AT, Kavita K, Choudhary P, Huda I, Dubey SK. Familial oral hygiene practices and its influence among rural youths-exploring primary preventive measures. Journal of Family Medicine and Primary Care. 2020; 9: 4353–4357.

[40] Singh R, Kisku A, Kungumaraj H, Nagaraj V, Pal A, Kumar S, et al. Autism spectrum disorders: a recent update on targeting inflammatory pathways with natural anti-inflammatory agents. Biomedicines. 2023; 11: 115.

[41] Castilho AR, Mialhe FL, Barbosa Tde S, Puppin-Rontani RM. Influence of family environment on children’s oral health: a systematic review. The Journal of Pediatrics. 2013; 89: 116–123.

[42] Barranca-Enríquez A, Romo-González T. Your health is in your mouth: a comprehensive view to promote general wellness. Frontiers in Oral Health. 2022; 3: 971223.

[43] Entezami S, Peres KG, Li H, Hijazi M, Ahmed KE. Tooth wear and socioeconomic status in childhood and adulthood: findings from a systematic review and meta-analysis of observational studies. Journal of Dentistry. 2021; 115: 103827.