Abstract
BACKGROUND: For some children with autism spectrum disorder (ASD), over-responsivity to sensory stimuli in a dental office environment and communication barriers can result in uncooperative behavior, in extreme cases necessitating the use of general anesthesia. Tailored educational approaches are a promising tool to address these issues. OBJECTIVE: This study assesses the effectiveness of an existing educational approach, called the educational sensory-based approach (ESBA), which aims to improve cooperation during dental care treatment of children with ASD. The relevant research questions are whether children improve their levels of cooperation during the implementation of the phases of the ESBA and how such improvement depends on study variables. According to our definition, an initially uncooperative child (Frankl scale at first visit rated negative or definitely negative) is considered to have improved by the end of a certain phase if their Frankl scale rating at the end of the phase is positive or definitely positive, while an initially cooperative child (Frankl scale at first visit rated positive) is considered to have improved by the end of a certain phase if their Frankl scale rating at the end of the phase is definitely positive. METHODS: In this study, a retrospective repeated-measures design was used. The final sample comprised 45 initially uncooperative and 40 initially cooperative children with ASD who completed the ESBA program between 2013 and 2020. Data included demographic and clinical examination variables, medical history, and child behavior and cooperation. A statistical analysis was performed using 3,328 cumulative logit models to address the relevant research questions. RESULTS: A statistically significant improvement across the different phases of the ESBA program was observed, independent of the other explanatory variables in the study. The 95% confidence intervals for the predicted probability that an initially uncooperative child would improve by the end of the ESBA program were [0.71 and 0.88], whereas the probabilities for an initially cooperative child improving were lower at [0.04 and 0.20]. CONCLUSIONS: The ESBA represents a promising tool for managing dental care in children with ASD. It facilitates cooperation and limits reliance on general anesthesia. The findings from this study can inform clinical practice in pediatric dentistry, particularly in managing patients with ASD, and provide a starting point for other medical teams to implant and implement alternative educational approaches.