Dental News - Sensory-adapted dental clinic reduces stress in autistic children

Iveta Ramonaite, Dental Tribune International

Wed. 14. June 2023

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LOS ANGELES, US: Dental visits can be a source of great stress for patients, especially those who have autism. In a recent study, researchers at the University of Southern California (USC) in Los Angeles sought to examine the effect of a sensory-adapted dental environment (SADE) on the physiological stress of autistic children. They found that certain visual, auditory and tactile sensory adaptations help create a less distressing oral care experience for autistic children, thus enabling their dental care.

According to the World Health Organization, approximately one in 100 children worldwide have autism. Owing to sensory differences, autistic children often have poorer oral health and greater oral care challenges compared with children with typical neurological development, and researchers believe that it is crucial to improve their oral care experiences in order to address these concerns.

“We’ve shown that the combination of curated visual, auditory and tactile adaptations—all of which are easily implemented, relatively inexpensive and don’t require training to safely use—led to statistically significant decreases in autistic children’s behavioural and physiological distress during dental cleanings,” lead author Dr Leah Stein Duker, an assistant professor at the USC Chan Division of Occupational Science and Occupational Therapy, said in a press release.

The study included 162 autistic children. Each child received a professional tooth cleaning in both a standard clinic environment and an adapted one approximately six months apart. The SADE included modified visual, auditory and tactile stimuli, such as the use of blackout curtains, calming music and a lead apron placed on the child’s chest. The researchers then assessed the children’s electrodermal activity and observed the frequency and duration of distressed behaviours exhibited during the tooth cleaning, such as jerking away from the dentist, attempting to bite the dentist, crying and screaming.

The findings showed that children had significantly lower physiological stress during dental care in the SADE compared with the regular dental environment. Additionally, it was reported that having to make sensory adaptations did not disrupt logistics, total procedure time or scheduling for clinics.

“So many interventions try to change the person,” Dr Stein Duker commented. “Instead, this intervention sees children for who they are—it does not try to fix or change them—focusing the intervention to modify problematic environmental factors as a way to empower the child and family to engage successfully in occupation.”

A sensory-adapted dental environment research clinic at Children’s Hospital Los Angeles. (Image: Phil Channing)

Improving the overall clinic experience

The SADE research project at USC began in 2011. According to Dr Stein Duker, the intervention has been replicated in some pilot studies, but the current study is the first to have a large enough sample size to have full statistical power.

“Because it’s a fully powered study, we were able to identify some other very exciting findings,” she said. “For example, our data showed that children’s physiological stress dropped as soon as they entered the adapted dental cleaning room before the actual cleaning even began, and that level of physiological stress predicted behavioural distress during the cleaning.”

The researchers also noted that younger children and those with lower IQs and lower expressive communication levels experienced a greater reduction in stress in the study. They will now study the effectiveness of a modified SADE for typically developing children with dental fear and anxiety.

“Regardless of population, my advice to dental professionals and parents alike is to work together to find ways to improve the overall clinic experience,” Dr Stein Duker said. “There are weighted radiographic bibs in every single dental office that may help calm the child; they can wear sunglasses; they can wear a beanie hat covering the ears to muffle noises—all of these are completely free and easy adaptations that have the potential to improve the clinic experience for those with sensory sensitivities, without negatively impacting dentists’ ability to provide care,” she concluded.

The study, titled “Sensory adaptations to improve physiological and behavioral distress during dental visits in autistic children: A randomized crossover trial”, was published online on 2 June 2023 in JAMA Network Open.

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