Abstract
Purpose
This study aimed to characterize oral health status, oral hygiene practices, and caregiver-reported dental care experiences among children with autism spectrum disorder (ASD) in Almaty, Kazakhstan, and to describe caregiver awareness and practices related to oral care.
Methods
This descriptive cross-sectional pilot study included 53 children aged 3-18 years with a confirmed ASD diagnosis recruited from the “Autism Pobedim” rehabilitation center in Almaty. Clinical examinations assessed caries using the DMFT/dmft and CAST indices and oral hygiene using the OHI-S index. A study-specific 36-item caregiver questionnaire collected information on home oral hygiene, dental care experiences, and selected developmental characteristics.
Results
Only 24.5% of children brushed their teeth twice daily, and most required parental assistance. Overall, 30.2% had never visited a dentist, while 58.5% of caregivers reported major difficulties during dental visits. Reported management approaches in the sample included physical restraint, sedation, and general anesthesia. Overall, 39.6% of children had received completed dental treatment. In addition, 71.7% consumed sweets between meals and only 17.0% rinsed their mouths after eating. Although 75.5% of caregivers reported checking toothpaste composition, professional guidance on oral hygiene was limited.
Conclusion
In this single-center sample, children with ASD had a substantial burden of dental caries, suboptimal home oral hygiene, limited independent oral care, and caregiver-reported challenges during dental treatment. These exploratory findings support larger multicenter studies and further evaluation of tailored preventive, caregiver-education, and behavior-support strategies for children with ASD in Kazakhstan.
Keywords: autism spectrum disorder, children, dental behavior management, dental care, Kazakhstan, oral health
Introduction
The health and well-being of children and adolescents are closely linked to oral health, which influences eating, communication, social interaction, and quality of life (1–3). Children with developmental conditions such as autism spectrum disorder (ASD) may require adapted preventive and dental care approaches because of differences in communication, sensory processing, behavior, and daily self-care.
ASD is a neurodevelopmental condition characterized by persistent differences in social communication and interaction together with restricted or repetitive patterns of behavior or interests. Clinical presentation and support needs vary substantially among individuals. The World Health Organization has estimated that approximately one in 100 children is affected by ASD (4).
ASD is not associated with a single specific oral pathology; however, sensory sensitivities, communication difficulties, resistance to changes in routine, motor coordination limitations, and selective eating may complicate home oral hygiene and dental attendance (5–14). Studies from several countries have reported poor oral hygiene, considerable caries experience, frequent need for caregiver assistance with tooth brushing, and difficulties with cooperation during dental care among children with ASD, although comparisons with neurotypical children have been heterogeneous (2, 3, 5, 15–17).
Evidence from Central Asia remains limited, and there are few clinical data describing the oral health status and dental care experiences of children with ASD in Kazakhstan. Context-specific information is needed to characterize oral health needs and to guide the design of future preventive and service-delivery research.
Accordingly, this study aimed to describe the clinical oral health status and oral hygiene of children with ASD in Almaty using standardized dental indices and to characterize caregiver-reported home oral hygiene practices, dental care experiences, and perceived barriers to care. The study was designed as an exploratory descriptive investigation and did not aim to establish causal relationships or to evaluate the effect of ASD severity on oral health or treatment outcomes.
To our knowledge, this is among the first studies to report clinical oral health data for children with ASD in Kazakhstan, thereby providing preliminary evidence from an underrepresented geographical setting.
Methods
Study design and participants
This descriptive cross-sectional pilot study was conducted among children attending the “Autism Pobedim” rehabilitation center in Almaty, Kazakhstan. Children aged 3-18 years with a verified diagnosis of ASD in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), were eligible for inclusion. Children with systemic comorbidities that could independently affect oral health (e.g., cerebral palsy, syndromic disorders, severe epilepsy) were excluded to reduce potential confounding.
ASD severity was not assessed or stratified because standardized instruments such as CARS-2 or ADOS were not routinely available in the participating institutions at the time of data collection. Therefore, no analyses concerning the relationship between ASD severity and oral health or dental treatment outcomes were performed.
Given the exploratory pilot nature of the study, a formal a priori power calculation was not performed. Age-related variation in oral hygiene was described by age-based dentition groups: primary dentition (3-5 years), mixed dentition (6-11 years), and permanent dentition (12-18 years).
The study was approved by the Local Ethics Committee of S.D. Asfendiyarov Kazakh National Medical University [Approval No. 8(114), dated 30.06.2021]. All procedures involving human participants were conducted in accordance with institutional and national ethical standards and the Declaration of Helsinki. Written informed consent was obtained from the parents or legal guardians of all participating children before inclusion.
Clinical measures
Dental examinations were performed at the rehabilitation center in the presence of a parent or caregiver. Disposable colored plastic mirrors and probes were used. Oral status was assessed using the Decayed, Missing and Filled Teeth indices for primary and permanent dentitions (dmft/DMFT) and the Caries Assessment Spectrum and Treatment (CAST) index. Oral hygiene was evaluated using the Simplified Oral Hygiene Index (OHI-S; Greene and Vermillion), and dental plaque was additionally visualized using the Qscan Plus device (AIOBIO, South Korea).
CAST was used to record the spectrum of caries from sound or restored teeth through enamel and dentinal lesions to advanced disease and tooth loss due to caries. Scoring followed the published CAST methodology (18); detailed diagnostic codes are therefore not repeated here.
Caregiver questionnaire
Caregivers completed a structured 36-item questionnaire in Google Forms. The questionnaire was developed specifically for this study and had not been previously published. It collected sociodemographic information and caregiver-reported data on tooth-brushing frequency and assistance, toothpaste and toothbrush practices, sources of oral-health information, dental attendance and treatment experiences, difficulties during dental visits, dietary habits, and selected developmental characteristics, including age at ASD diagnosis (Supplementary File S1).
The questionnaire was intended as a descriptive data-collection instrument rather than a psychometric scale. Formal assessment of construct validity, test-retest reliability, or internal consistency was not performed. Accordingly, questionnaire-derived findings were interpreted as exploratory caregiver-reported data.
Statistical analysis
Data were processed using Microsoft Excel and IBM SPSS Statistics version 26.0. Descriptive statistics were used to summarize demographic, clinical, and questionnaire data. Categorical variables are presented as absolute frequencies (n) and percentages (%), while quantitative variables are summarized using means, standard deviations, medians, and ranges where appropriate.
OHI-S values were summarized by the three age-based dentition groups. Because of the small sample and sparse cell counts, inferential analyses were limited. For one exploratory comparison, tooth-brushing frequency was dichotomized as daily (once or twice daily) vs. less than daily, and its association with history of dental attendance (visited a dentist vs. never visited) was assessed using Fisher's exact test. A two-sided p-value < 0.05 was considered statistically significant. All other questionnaire analyses were descriptive.
Missing or incomplete responses were excluded from the relevant item-level analysis while the overall sample size was retained for reporting.
Results
This study included 53 children diagnosed with ASD, aged 3–18 years (mean age 8.26 ± 3.68 years), who attended a rehabilitation center in Almaty, Kazakhstan. Of the participants, 84.9% (n = 45) were male and 15.1% (n = 8) were female.
The mean number of decayed teeth was 3.85 ± 1.60 (range 1-8), the mean number of missing teeth was 0.38 ± 0.63 (range 0-2), and the mean number of filled teeth was 0.91 ± 1.20 (range 0–4). The mean DMFT/dmft index was 5.13 ± 2.05, with a median of 5 and a range of 2-10.
CAST assessment showed lesions across several stages. Mean values were 1.53 ± 0.72 for CAST code 3, 1.55 ± 1.03 for CAST code 4, and 0.68 ± 0.78 for CAST code 5; other CAST categories were less frequent.
All three age-based dentition groups had poor or very poor OHI-S values: 4.20 ± 0.15 in the primary dentition group, 3.95 ± 0.13 in the mixed dentition group, and 4.15 ± 0.14 in the permanent dentition group (Table 1). Values were comparably high across groups, with no monotonic age-related pattern apparent in these descriptive data. No inferential comparisons between dentition groups were performed.
Table 1.
OHI-S by age-based dentition group.
| Parameter | Primary dentition (3–5 years) | Mixed dentition (6–11 years) | Permanent dentition (12–18 years) |
|---|---|---|---|
| Mean OHI-S | 4.20 | 3.95 | 4.15 |
| Standard deviation | ±0.15 | ±0.13 | ±0.14 |
| Hygiene level | Poor | Poor | Very poor |
Mean index values, standard deviations, and hygiene-level classifications across primary, mixed, and permanent dentition groups in children with ASD.
Caregiver responses indicated inconsistent home oral hygiene practices. Only 24.5% (n = 13) of children brushed twice daily, 41.5% (n = 22) brushed once daily, 22.6% (n = 12) brushed several times per week or occasionally, and 11.3% (n = 6) rarely or never brushed. Regarding assistance, 56.6% (n = 30) brushed with parental assistance, 28.3% (n = 15) were brushed solely by parents, only 3.8% (n = 2) brushed independently, and 11.3% (n = 6) did not brush their teeth.
Most children (64.2%, n = 34) used children's toothpaste, while 24.5% (n = 13) used adult toothpaste. Natural-based products were used by 3.8% (n = 2), both children's and adult toothpaste by 3.8% (n = 2), and no toothpaste by 3.8% (n = 2). A total of 75.5% (n = 40) of caregivers reported checking toothpaste composition. Toothbrushes were replaced every three months by 52.8% (n = 28), every six months by 37.7% (n = 20), annually by 3.8% (n = 2), and monthly by 5.7% (n = 3). Only one child (1.9%) used an electric toothbrush.
Information about oral hygiene was obtained primarily from the internet or social networks (49.1%, n = 26), followed by dental visits (22.6%, n = 12). However, 15.1% (n = 8) of caregivers reported having no information on how to properly brush their child's teeth. Overall, 69.8% (n = 37) of children had been examined or treated by a dentist, whereas 30.2% (n = 16) had never visited one. The most common reported reasons for dental attendance were caries or plaque (37.7%, n = 20) and acute dental pain (24.5%, n = 13); only 7.5% (n = 4) reported routine check-ups.
Regarding the timing of the most recent dental visit, 22.6% (n = 12) had last visited more than one year earlier and 20.8% (n = 11) approximately six months earlier. Major difficulties during dental visits were reported by 58.5% (n = 31) of caregivers, including fear and restlessness. Overall, 39.6% (n = 21) of children had received completed dental treatment. Reported behavior-management or treatment approaches included physical restraint (n = 7), general anesthesia (n = 5), and sedation (n = 6). In addition, 20.8% (n = 11) had previously undergone a dental procedure under general anesthesia.
Dental treatment had been provided in state clinics for 41.5% (n = 22) of the sample and in private clinics for 28.3% (n = 15); 30.2% (n = 16) had not received treatment. Caregivers reported recognizing possible dental problems through behaviors or signs such as putting fingers in the mouth or touching the cheeks (28.3%, n = 15), visible cavities (15.1%, n = 8), and complaints of pain (15.1%, n = 8). A smaller number reported swelling or eating difficulties, while 9.4% (n = 5) reported no dental problems.
Only 17.0% (n = 9) of children rinsed their mouths after meals, and 71.7% (n = 38) consumed sweets between meals; 24.5% (n = 13) consumed sweets daily or more often. Oral care was initiated at age three in 28.3% (n = 15), at age two in 17.0% (n = 9), and at age one in 15.1% (n = 8), while 9.4% (n = 5) had never started routine oral care.
When asked what could improve dental care, caregivers most frequently identified treatment under anesthesia or sedation (18.9%, n = 10), a more individualized approach (13.2%, n = 7), improved access or financial support (11.3%, n = 6), and better training for dental professionals (7.5%, n = 4). These responses represent caregiver perceptions and were not used as measures of healthcare-system performance.
Figure 1 summarizes selected oral hygiene and dental care utilization indicators. Figure 2 presents the distribution of dental attendance according to tooth-brushing frequency. In the exploratory dichotomized analysis, 25 of 35 children who brushed daily had visited a dentist compared with 12 of 18 children who brushed less than daily. Fisher's exact test did not show a statistically significant association between daily tooth brushing and history of dental attendance (p = 0.759).
Figure 1.
Oral hygiene practices and dental care utilization among children with ASD (n = 53): (A) tooth brushing frequency; (B) who brushes teeth; (C) toothpaste type; (D) toothbrush replacement; (E) place of treatment; and (F) reasons for visiting the dentist. Bars represent the number of children (n).
Figure 2.
Distribution of dental attendance according to tooth-brushing frequency among children with ASD (n = 53).
Discussion
This study provides preliminary clinical and caregiver-reported data on oral health among children with ASD in Almaty, Kazakhstan. The principal findings were a substantial caries burden, poor or very poor OHI-S values across all age-based dentition groups, low prevalence of twice-daily tooth brushing and independent oral care, frequent intermeal consumption of sweets, limited routine dental attendance, and caregiver-reported difficulties during dental visits. Because the study was descriptive and cross-sectional, these findings should be interpreted as co-occurring characteristics of this sample rather than evidence of causal relationships.
The mean DMFT/dmft value of 5.13 ± 2.05 was higher than values reported by Bagattoni et al. in an Italian ASD cohort (3.00 ± 1.2 in primary dentition and 2.3 ± 1.8 in permanent dentition) (3) and slightly higher than the mean value of 4.75 ± 3.66 reported by Oda et al. in Turkey (19). In the present sample, OHI-S values exceeded 3.9 in all dentition groups, and CAST assessment showed both superficial and deeper lesions. These observations are broadly consistent with previous reviews and observational studies describing poor oral hygiene and a considerable burden of dental disease among children with ASD (16, 17). Differences among studies may reflect variation in age, diagnostic criteria, oral-health measures, sampling, healthcare access, and local preventive practices.
Home oral hygiene was strongly dependent on caregiver involvement in this cohort: most children required assistance or complete parental brushing, whereas only two children brushed independently. Similar dependence on caregiver assistance has been reported in other ASD populations, including the study by Suhaib et al. (20). At the same time, nearly half of caregivers in our sample obtained oral-health information from the internet or social networks, and 15.1% reported receiving no guidance on how to brush their child's teeth. These findings identify caregiver education and practical home-based support as relevant areas for future intervention research; however, the present study did not test whether caregiver knowledge or brushing assistance caused differences in clinical oral-health outcomes.
Behavioral and sensory challenges during dental care were prominent in caregiver reports. Major difficulties during dental visits were reported for 58.5% of the sample, and caregivers described use of physical restraint, sedation, and general anesthesia in some children. Previous research has similarly identified cooperation, sensory responsiveness, and communication as important considerations in dental care for children with ASD (5, 15, 21). Importantly, recent studies have examined structured alternatives intended to improve treatment acceptance. Corridore et al. evaluated an educational sensory-based approach in children with ASD and reported improvement in cooperation across program phases, particularly among initially uncooperative children (22). Di Giorgio et al. also reported improved Frankl cooperation scores during orthodontic care delivered within a specialized supportive framework (23). In addition, the systematic review by Corridore et al. summarized the variability of oral disease burden and the treatment approaches used in pediatric dental care for children with ASD, including the role of general anesthesia in selected cases (24). These studies support further evaluation of individualized sensory adaptation, visual preparation, gradual desensitization, structured visits, and caregiver participation; these approaches were not tested in the current study.
Dietary and dental-attendance findings also warrant cautious interpretation. More than 70% of children consumed sweets between meals and only 17% rinsed after meals. These behaviors are clinically relevant to caries prevention, but the present design cannot determine their causal contribution to the observed caries burden. Similarly, 30.2% of children had never visited a dentist and only 7.5% of the total sample attended for routine check-ups. The exploratory analysis did not identify a statistically significant association between daily tooth brushing and history of dental attendance (p = 0.759), suggesting that these aspects of care should be considered separately rather than interpreted as directly linked within this dataset.
The broad age range is another important consideration. OHI-S was described by age-based dentition group, and all three groups had high mean values; however, the data did not show a monotonic age-related trend, and the sample was too small for detailed age-stratified analyses of caries, dietary behavior, dental attendance, or cooperation. Likewise, ASD severity was not measured using a standardized instrument. Although previous studies have explored developmental profiles and cooperation with oral-health procedures (21, 25–35), the present dataset cannot determine whether ASD severity influenced oral-health status, behavior during dental care, or treatment completion.
Clinical implications and future directions
The caregiver-reported priorities in this study—including individualized care, improved access or financial support, and better professional training—may inform hypotheses for future service-development research. They should not, however, be interpreted as direct evidence that specific healthcare policies or service models will improve outcomes.
Future multicenter studies in Kazakhstan should recruit larger samples, include age- and, where feasible, ASD-severity stratification, use validated caregiver-reported instruments, and include comparison groups when the research question requires them. Prospective studies could evaluate sensory-adapted environments, visual supports, preparatory or “acclimatization” visits, caregiver training, and other structured behavioral approaches using clinically meaningful outcomes such as cooperation, treatment completion, need for pharmacological behavior management, and oral-health indices. Such studies would provide a stronger evidence base for locally appropriate clinical pathways and public-health planning.
Limitations
This study has several limitations. First, the sample was small and recruited from a single rehabilitation center in Almaty; therefore, the findings may not be representative of all children with ASD in Almaty or Kazakhstan. The pilot design and absence of an a priori power calculation also limited the scope of inferential analyses.
Second, participants ranged from 3 to 18 years, spanning primary, mixed, and permanent dentitions and markedly different developmental stages. Only OHI-S was stratified by age-based dentition group, while most questionnaire and clinical findings were analyzed for the pooled sample. More detailed age-stratified analyses were not feasible because of small subgroup sizes.
Third, ASD severity was not assessed using standardized tools such as CARS-2 or ADOS; consequently, the relationship between ASD severity and oral health, cooperation, access to care, or treatment outcomes could not be evaluated. Fourth, the caregiver questionnaire was developed specifically for this study and did not undergo formal psychometric validation or reliability testing. Caregiver-reported findings may therefore be affected by recall, interpretation, or social-desirability bias.
Finally, the cross-sectional design does not permit causal inference, and the absence of a neurotypical or other disability comparison group limits comparative interpretation. Future studies should address these limitations using larger multicenter samples, validated instruments, prespecified age and ASD-severity strata, and longitudinal or comparative designs where appropriate.
Conclusion
In this single-center Almaty sample, children with ASD showed a substantial burden of dental caries, poor oral hygiene across age-based dentition groups, limited independent tooth brushing, frequent intermeal sweet consumption, and caregiver-reported difficulties during dental care. These findings describe unmet oral-health needs but do not establish causal relationships or the influence of ASD severity.
The study provides preliminary data from an underrepresented setting and supports further multicenter research in Kazakhstan. Future work should evaluate age- and severity-related differences and test tailored caregiver-education, preventive, sensory-adapted, and behavioral-support strategies using validated outcome measures.
Acknowledgments
The authors thank the Ministry of Science and Higher Education of the Republic of Kazakhstan.
Funding Statement
The author(s) declared that financial support was received for this work and/or its publication. This research has been funded by the Science Committee of the Ministry of Science and Higher Education of the Republic of Kazakhstan (Grant No. AP22686056).
Footnotes
Edited by: Iole Vozza, Sapienza University of Rome, Italy
Reviewed by: Kapil Paiwal, Daswani Dental College and Research Center, India
Ida Carmen Corvino, Sapienza University of Rome, Italy
Data availability statement
The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.
Ethics statement
The studies involving humans were approved by Local Ethics Committee of Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants' legal guardians/next of kin.
Author contributions
ZY: Data curation, Supervision, Investigation, Writing – original draft, Writing – review & editing, Software, Conceptualization, Methodology, Resources, Visualization, Funding acquisition, Project administration, Formal analysis, Validation. GY: Supervision, Conceptualization, Writing – review & editing. KS: Supervision, Writing – review & editing. SY: Supervision, Writing – review & editing, Methodology. YM: Funding acquisition, Resources, Investigation, Supervision, Software, Writing – original draft, Project administration, Validation, Data curation, Methodology, Visualization. KR: Resources, Investigation, Writing – original draft, Software, Visualization, Validation, Formal analysis, Methodology, Supervision. ZA: Methodology, Writing – original draft, Formal analysis, Conceptualization.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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The author(s) declared that generative AI was not used in the creation of this manuscript.
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Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fdmed.2026.1928744/full#supplementary-material
References
- 1.Qiao Y, Shi H, Wang H, Wang M, Chen F. Oral health status of Chinese children with autism spectrum disorders. Front Psychiatry. (2020) 11:398. 10.3389/fpsyt.2020.00398 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.El Khatib AA, El Tekeya MM, El Tantawi MA, Omar T. Oral health status and behaviours of children with autism spectrum disorder: a case-control study. Int J Paediatr Dent. (2014) 24(4):314–23. 10.1111/ipd.12067 [DOI] [PubMed] [Google Scholar]
- 3.Bagattoni S, Lardani L, D’Alessandro G, Piana G. Oral health status of Italian children with autism spectrum disorder. Eur J Paediatr Dent. (2021) 22(3):243–7. 10.23804/ejpd.2021.22.03.12 [DOI] [PubMed] [Google Scholar]
- 4.World Health Organization. Autism Spectrum Disorders & Other Developmental Disorders: From Raising Awareness to Building Capacity. Geneva: WHO; (2013). [Google Scholar]
- 5.Lam PP, Du R, Peng S, McGrath CP, Yiu CK. Oral health status of children and adolescents with autism spectrum disorder: a systematic review of case-control studies and meta-analysis. Autism. (2020) 24(5):1047–66. 10.1177/1362361319877337 [DOI] [PubMed] [Google Scholar]
- 6.Prynda M, Pawlik AA, Emich-Widera E, Kazek B, Mazur M, Niemczyk W, et al. Oral hygiene Status in children on the autism Spectrum disorder. J Clin Med. (2025) 14(6):1868. 10.3390/jcm14061868 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Jaber MA. Dental caries experience, oral health status and treatment needs of dental patients with autism. J Appl Oral Sci. (2011) 19(3):212–7. 10.1590/S1678-77572011000300006 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Alshatrat SM, Al-Bakri IA, Al-Omari WM, Al Mortadi NA. Oral health knowledge and dental behavior among individuals with autism in Jordan: a case-control study. BMC Oral Health. (2021) 21(1):62. 10.1186/s12903-021-01423-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Yerkibayeva Z, Yermukhanova G, Saduakasova K, Menchisheva Y, Rakhimov K, Abu Z, et al. Innovative oral hygiene strategies for children with autism spectrum disorder: a gamified app-based intervention. Eur Arch Paediatr Dent. (2026) 27(1):125–34. 10.1007/s40368-025-01115-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Jaber MA, Sayyab M, Abu Fanas SH. Oral health status and dental needs of autistic children and young adults. J Investig Clin Dent. (2011) 2(1):57–62. 10.1111/j.2041-1626.2010.00030.x [DOI] [PubMed] [Google Scholar]
- 11.Alshihri AA, Al-Askar MH, Aldossary MS. Barriers to professional dental care among children with autism spectrum disorder. J Autism Dev Disord. (2021) 51(8):2988–94. 10.1007/s10803-020-04759-y [DOI] [PubMed] [Google Scholar]
- 12.AlHumaid J, Gaffar B, AlYousef Y, Alshuraim F, Alhareky M, E Tantawi M. Oral health of children with autism: the influence of parental attitudes and willingness in providing care. ScientificWorldJournal. (2020) 2020:8329426. 10.1155/2020/8329426 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Pi X, Liu C, Li Z, Guo H, Jiang H, Du M. A meta-analysis of oral health status of children with autism. J Clin Pediatr Dent. (2020) 44(1):1–7. 10.17796/1053-4625-44.1.1 [DOI] [PubMed] [Google Scholar]
- 14.Onol S, Kirzioglu Z. Evaluation of oral health status and influential factors in children with autism. Niger J Clin Pract. (2018) 21(4):429–35. 10.4103/njcp.njcp_41_17 [DOI] [PubMed] [Google Scholar]
- 15.Loo CY, Graham RM, Hughes CV. The caries experience and behavior of dental patients with autism spectrum disorder. J Am Dent Assoc. (2008) 139(11):1518–24. 10.14219/jada.archive.2008.0078 [DOI] [PubMed] [Google Scholar]
- 16.Ferrazzano GF, Salerno C, Bravaccio C, Ingenito A, Sangianantoni G, Cantile T. Autism spectrum disorders and oral health status: review of the literature. Eur J Paediatr Dent. (2020) 21(1):9–12. 10.23804/ejpd.2020.21.01.02 [DOI] [PubMed] [Google Scholar]
- 17.Bossù M, Trottini M, Corridore D, Di Giorgio G, Sfasciotti GL, Palaia G, et al. Oral health status of children with autism in central Italy. Appl Sci. (2020) 10(7):2247. 10.3390/app10072247 [DOI] [Google Scholar]
- 18.Leal SC, Ribeiro APD, Frencken JE. Caries assessment Spectrum and treatment (CAST): a novel epidemiological instrument. Caries Res. (2017) 51(5):500–6. 10.1159/000479042 [DOI] [PubMed] [Google Scholar]
- 19.Oda G, Karayagmurlu A, Dagli I, Aren G, Soylu N. Oral health status in children with autism spectrum disorder: a cross sectional study from Turkey. Psychiatry Behav Sci. (2021) 11(3):186. 10.5455/PBS.20210321075312 [DOI] [Google Scholar]
- 20.Suhaib F, Saeed A, Gul H, Kaleem M. Oral assessment of children with autism spectrum disorder in Rawalpindi, Pakistan. Autism. (2019) 23(1):81–6. 10.1177/1362361317730299 [DOI] [PubMed] [Google Scholar]
- 21.Du RY, Yiu CCY, Wong VCN, McGrath CP. Autism developmental profiles and cooperation with oral health screening. J Autism Dev Disord. (2015) 45(9):2758–63. 10.1007/s10803-015-2416-7 [DOI] [PubMed] [Google Scholar]
- 22.Corridore D, Trottini M, Di Giorgio G, Zumbo G, Corvino IC, Salucci A, et al. Assessment of the educational sensory-based approach for dental treatment of children with autism in central Italy. Front Oral Health. (2026) 6:1731639. 10.3389/froh.2025.1731639 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Di Giorgio G, Corridore D, Corvino IC, Zumbo G, Pranno N, Vozza I, et al. Orthodontic treatment in pediatric patients with autism Spectrum disorder: compliance and satisfaction: pilot study. Appl Sci. (2023) 13(16):9189. 10.3390/app13169189 [DOI] [Google Scholar]
- 24.Corridore D, Zumbo G, Corvino I, Guaragna M, Bossù M, Polimeni A, et al. Prevalence of oral disease and treatment types proposed to children affected by autistic spectrum disorder in pediatric dentistry: a systematic review. Clin Ter. (2020) 171(3):e275–82. 10.7417/CT.2020.2226 [DOI] [PubMed] [Google Scholar]
- 25.Zhang Y, Lin L, Liu J, Shi L, Lu J. Dental caries status in autistic children: a meta-analysis. J Autism Dev Disord. (2020) 50(4):1249–57. 10.1007/s10803-019-04256-x [DOI] [PubMed] [Google Scholar]
- 26.Vishnu Rekha C, Arangannal P, Shahed H. Oral health status of children with autistic disorder in chennai. Eur Arch Paediatr Dent. (2012) 13(3):126–31. 10.1007/BF03262858 [DOI] [PubMed] [Google Scholar]
- 27.Shapira J, Mann J, Tamari I, Mester R, Knobler H, Yoeli Y, et al. Oral health status and dental needs of an autistic population of children and young adults. Spec Care Dentist. (1989) 9(2):38–41. 10.1111/j.1754-4505.1989.tb01022.x [DOI] [PubMed] [Google Scholar]
- 28.Ibragimova R, Yermukhanova G, Yessirkepov A, Xetayeva G, Yerkibayeva Z. Relationship between pathogenic factors and the prevalence of temporomandibular joint dysfunctions in children. Saudi Dent J. (2023) 35(1):103–9. 10.1016/j.sdentj.2022.12.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Da Silva GCB, Firmino RT, Nobrega WFS, d’Avila S. Oral habits, sociopsychological orthodontic needs, and sociodemographic factors perceived by caregivers impact oral health-related quality of life in children with and without autism. Int J Paediatr Dent. (2024) 34(5):593–607. 10.1111/ipd.13160 [DOI] [PubMed] [Google Scholar]
- 30.Zhou N, Wong HM, McGrath C. Social story-based oral health promotion for preschool children with special healthcare needs: a 24-month randomized controlled trial. Community Dent Oral Epidemiol. (2020) 48(5):415–22. 10.1111/cdoe.12554 [DOI] [PubMed] [Google Scholar]
- 31.Chauhan A, Leadbitter K, Gray-Burrows KA, Vinall-Collier K, Pickles N, Baker SR, et al. An “explosion in the mouth”: the oral health experiences of autistic children. Autism. (2025) 29(3):627–41. 10.1177/13623613241288628 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Como DH, Florindez-Cox LI, Stein Duker LI, Cermak SA. Oral health barriers for African American caregivers of autistic children. Int J Environ Res Public Health. (2022) 19(24):17067. 10.3390/ijerph192417067 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Makkar A, Indushekar KR, Saraf BG, Sardana D, Sheoran N. A cross sectional study to evaluate the oral health status of children with intellectual disabilities in the national capital region of India (Delhi-NCR). J Intellect Disabil Res. (2019) 63(1):31–9. 10.1111/jir.12553 [DOI] [PubMed] [Google Scholar]
- 34.Foros P, Oikonomou E, Koletsi D, Rahiotis C. Detection methods for early caries diagnosis: a systematic review and meta-analysis. Caries Res. (2021) 55(4):247–59. 10.1159/000516084 [DOI] [PubMed] [Google Scholar]
- 35.Gudipaneni RK, Alkuwaykibi AS, Ganji KK, Bandela V, Karobari MI, Hsiao CY, et al. Assessment of caries diagnostic thresholds of DMFT, ICDAS II and CAST in the estimation of caries prevalence rate in first permanent molars in early permanent dentition: a cross-sectional study. BMC Oral Health. (2022) 22(1):133. 10.1186/s12903-022-02134-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
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Data Availability Statement
The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.