Table 5.

Summary of studies on behavioral and sensory adaptation techniques for managing dental disorders in children with autism spectrum disorder using the PICO framework

Ref.	Population	Intervention	Comparison	Outcome	Study design	Key findings	Study quality rating
Marion et al[42], 2016	Children with ASD (n = 40)	Use of dental stories to prepare for dental visits	No preparatory aids	64% of caregivers found dental stories useful for their child’s preparation	Survey-based study	Caregivers preferred individualized story formats to match child’s comprehension level	High quality
Star et al[43], 2023	Children with ASD (n = 52)	Dental desensitization program (task analysis approach)	Standard preventive visits	Increased comfort and step completion in dental visits	Prospective cohort study	Children with expressive and receptive language skills benefited most	Moderate quality
Cai et al[44], 2022	Parents of children with ASD (n = 13)	Parent-reported effectiveness of desensitization	No structured desensitization	Reduced anxiety and improved treatment acceptance	Qualitative study	Barriers include financial burden and frequent appointments	Low quality
Yost et al[45], 2019	Children with ASD (n = 138)	Two-year follow-up on desensitization treatment	Initial exam acceptance only	92% retained examination skills, 83% accepted toothbrush prophylaxis	Retrospective case series	Sensory-invasive skills (radiographs) were acquired less frequently	Moderate quality
Myhren et al[46], 2023	Children with ASD (n = 17)	Individualized dental habituation program	Standard dental exams	82% completed dental exams, increased compliance with mirror and probe	Mixed-methods study	Collaboration with school personnel improved outcomes	Moderate quality
Junnarkar et al[47], 2022	Occupational & speech therapists	Role of therapists in dental care	No therapist involvement	Identified barriers to oral care and potential solutions	Qualitative study	Therapists play a key role in early intervention and pre-visit preparation	Moderate quality
Luscre and Center[48], 1996	Children with ASD (n = 3)	Desensitization with anxiety-reducing stimuli	No desensitization	Increased step completion in a clinical setting	Experimental study	Systematic desensitization reduces dental fear	Moderate quality
Mah and Tsang[34], 2016	Children with ASD (n = 14)	Visual schedule system during dental visits	Tell-show-do method	Faster task completion, reduced distress	RCT	Visual schedules enhanced cooperation and reduced anxiety	High quality
Hernandez and Ikkanda[49], 2011	Children with ASD	ABA in dental care	Standard behavior management	Improved cooperation with dental procedures	Literature review	ABA principles effectively modify problematic dental behaviors	Low quality
Uliana et al[42], 2024	Children with ASD (n = 61)	Impact of behavioral factors on caries prevalence	Cooperative children	Higher support needs linked to increased caries rates	Cross-sectional study	Poor mealtime behavior and dental noncompliance increased caries risk	Low quality

ABA Applied behavior analysis; ASD: Autism spectrum disorder; RCT: Randomized controlled trial.