Table 2.
Main characteristics of the included studies regarding the effectiveness of visual pedagogy in improving ASD children’s skills in oral hygiene.
| Author (Year) | N-Subjects M/F Age-Range | Intellectual Disability/Verbal Fluency | Study Length | Type of Tool | Visual Pedagogy Protocol | Adjunctive Tool | Study Design/Groups (Outcome) | Results Mean (SD) | Findings | |
|---|---|---|---|---|---|---|---|---|---|---|
| PECS | ||||||||||
| Al-Batayneh et al. (2020) [14] | 37 | Fluent, non-fluent and non-verbal | Six mo | PECS (paper) | Provided daily by parents/caregivers | - | Two groups: | G1 | G2 | PI and GI showed a statistically significant improvement at three-month and six-month evaluations in both groups (p < 0.01). No comparison between groups was performed |
| M/F | G1: 4–10 yy (n = 24) | Plaque Index (PI) | ||||||||
| 4–16 yy | G2: 10–16 yy (n = 13) | Baseline 1.88 (0.36) | Baseline 2.17 (0.26) | |||||||
| Three mo 1.47 (0.30) | Three mo 1.47 (0.26) | |||||||||
| GI and PI | Six mo 1.27 (0.34) | Six mo 1.38 (0.24) | ||||||||
| Gingival Index (GI) | ||||||||||
| Baseline 1.12 (0.22) | Baseline 1.26 (0.23) | |||||||||
| Three mo 0.89 (0.19) | Three mo 0.97 (0.28) | |||||||||
| Six mo 0.85 (0.17) | Six mo 0.95 (0.27) | |||||||||
| Doichinova et al. (2019) [16] | 30 | Non-verbal and non-fluent | 12 mo | PECS (paper) | Provided daily by parents/caregivers | Behavioral management; TSD | One group (n = 30) | Plaque Index (PI) | PI showed a statistically significant improvement at three-, six-, and 12-month evaluations (p < 0.05) | |
| - | Baseline 2.29 | |||||||||
| 6–11 yy | PI | Three mo 1.95 (0.36) | ||||||||
| Six mo 1.88 (0.35) | ||||||||||
| 12 mo 1.79 (0.36) | ||||||||||
| Doichinova & Peneva, (2012) [15] | 30 | Moderately severe | 12 mo | PECS (paper) | Provided daily by parents and for 15 min every two weeks by dental specialist | Behavioral management; TSD | One group (n = 30) | Plaque Index (PI) | PI improved but did not reach a statistical significance (p > 0.05) | |
| M/F | Baseline 2.49 (0.55) | |||||||||
| 4–11 yy | PI | Three mo 2.40 (0.15) | ||||||||
| Six mo 2.42 (0.21) | ||||||||||
| 12 mo 2.34 (0.21) | ||||||||||
| Different Kind of Images | ||||||||||
| Du, (2020) [17] | 122 | From mild to severe | Six mo | Photos (paper) | Provided daily by parents/caregiver | - | One group (n = 122) | Plaque Index (PI) | PI and GI showed a statistically significant improvement at three- and six-month evaluations (p < 0.01) | |
| M/F | Baseline 1.00 (0.32) | |||||||||
| 2.5–7 yy | GI and PI | Three mo 0.67 (0.27) | ||||||||
| Six mo 0.63 (0.25) | ||||||||||
| Gingival Index (GI) | ||||||||||
| Baseline 0.91 (0.26) | ||||||||||
| Three mo 0.58 (0.26) | ||||||||||
| Six mo 0.60 (0.26) | ||||||||||
| Zhou, (2020) [21] | 169 | From mild to severe | Six mo | Social Story (paper) | Provided daily by parents/caregivers | - | Two groups: | G1 | G2 | Tooth brushing performance, DI-S, and MGI showed a statistically significant improvement at the six-month evaluation in both groups (p < 0.01). Children with ASDs showed better oral hygiene status (p = 0.01) and gingival status (p < 0.01) than their peers with other disabilities. No significant difference in the tooth brushing performance between groups was found. |
| - | G1: ASD (n = 84) | Plaque Index (DI-S) | ||||||||
| <6 yy | G2: other disability (n = 85) | Baseline 1.63 (0.82) | Baseline 1.64 (0.77) | |||||||
| Six mo 0.68 (0.42) | Six mo 0.85 (0.44) | |||||||||
| Gingival Index (MGI) | ||||||||||
| Tooth brushing performance, DI-S, and MG | Baseline 1.02 (0.64) | Baseline 1.17 (0.56) | ||||||||
| Six mo 0.43 (0.42) | Six mo 0.69 (0.50) | |||||||||
| Tooth brushing performance, DI-S, and MGI | Tooth brushing performance (steps achieved) | |||||||||
| Baseline 6.69 (3.23) | Baseline 6.62 (2.69) | |||||||||
| Six mo 8.30 (3.36) | Six mo 8.07 (3.41) | |||||||||
| Lopez Cazaux et al. (2019) [19] | 52 | - | Eight mo | Pictograms and photos (digital) | Provided daily by parents/caregivers and weekly by dentist | - | One group (n = 52) | Tooth brushing performance * | Tooth brushing performance showed a statistically significant improvement at the eight-month evaluation at each step (p < 0.01) | |
| M/F | Put toothpaste on the brush | |||||||||
| 3–19 yy | Tooth brushing performance | Baseline 4.2 (0.8) | ||||||||
| Four mo 4.5 (0.7) | ||||||||||
| Eight mo 4.8 (0.5) | ||||||||||
| Brush occlusal surface | ||||||||||
| Baseline 3.1 (1.0) | ||||||||||
| Four mo 3.9 (1.0) | ||||||||||
| Eight mo 4.2 (0.7) | ||||||||||
| Brush buccal surface | ||||||||||
| Baseline 2.6 (1.2) | ||||||||||
| Four mo 3.5 (0.9) | ||||||||||
| Eight mo 3.8 (0.9) | ||||||||||
| Brush lingual surface | ||||||||||
| Baseline 2.1 (1.0) | ||||||||||
| Four mo 3.4 (1.0) | ||||||||||
| Eight mo 3.8 (0.9) | ||||||||||
| Spit and store the brush | ||||||||||
| Baseline 3.9 (0.9) | ||||||||||
| Four mo 4.2 (0.8) | ||||||||||
| Eight mo 4.3 (0.8) | ||||||||||
| Pilebro & Bäckman, (2005) [18] | 14 | Fluent and non-fluent | 18 mo | Photo (paper) | Provided daily by parents | - | One group (n = 14) | Plaque Index (PI) | PI showed improvement at eight- and 12-month evaluations (no statistical analysis available) | |
| M | Baseline 2.57 | |||||||||
| 5–13 yy | PI | Eight mo 1.64 | ||||||||
| 12 mo 1.92 | ||||||||||
| Videos or Videos Plus Images | ||||||||||
| Ramassamy et al. (2019) [22] | 67 | Moderate | Six mo | Pictures (paper) and video | Provided daily by parents or teacher | - | Two groups: | G1 | G2 | Children in G2 demonstrated better oral hygiene. PI and GI were statistically significantly different at two months (p = 0.04 and p = 0.01), three months (p = 0.01 and p = 0.01), and six months (p = 0.01 for both) between groups. |
| M/F | G1: visual pedagogy (n = 32) | Plaque Index (PI) | ||||||||
| 7–15 yy | G2: visual pedagogy + yoga therapy (n = 35) | Baseline 1.78 (0.14) | Baseline 1.75 (0.25) | |||||||
| Three mo 1.55 (0.21) | Three mo 1.22 (0.39) | |||||||||
| Six mo 1.35 (0.35) | Six mo 0.96 (0.34) | |||||||||
| PI and GI | Gingival Index (GI) | |||||||||
| Baseline 1.76 (0.14) | Baseline 1.72 (0.22) | |||||||||
| Three mo 1.59 (0.17) | Three mo 1.36 (0.36) | |||||||||
| Six mo 1.49 (0.18) | Six mo 1.09 (0.27) | |||||||||
| Popple et al. (2016) [20] | 18 | Moderate | Six wk | Video | Provided daily by parents | - | Two groups: | G1 | G2 | PI-PH showed a statistically significant improvement at three-week and six-week evaluations in both groups (p < 0.01); statistically significant differences between G1 and G2 at the six-week evaluation were found (d = 1.02) |
| M/F | G1: intervention video (n = 9) | Plaque Index (PI-PH) | ||||||||
| 5–14 yy | G2: control video (n = 9) | Baseline 1.78 (0.62) | Baseline 1.75 (0.83) | |||||||
| Three wk 0.92 (0.65) | Three wk 1.45 (0.91) | |||||||||
| PI-PH | Six wk 0.38 (0.43) | Six wk 1.20 (1.05) | ||||||||
yy: Years; mo: months; wk: weeks; M: male; F: female; PECS: Picture Exchange Communication System; TSD: tell-show-do; PI: Plaque Index (Löe and Silness Index); GI: Gingival Index (Silness and Löe Index); DI-S: Simplified Debris Index; MGI: Modified Gingival Index; PI-PH: Plaque Index (Podshadley and Haley); * results rounded to one decimal.