Introduction
Methods
The project of research
The PICO strategy
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P: Population of interest (autistic children between 3 and 19 years old)
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I: Interventions (management techniques in the dental treatment and the cooperation rate of children)
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C: Control (TD children and ASD group in different dental environment)
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O: Outcome (the improvement of dental anxiety in the behavior scale)
Literature search
Search strategy |
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Search Databases: PubMed, Embase, Cochrane Library |
Date: As of Jan 3, 2023 |
Search term: ((((((dental fear) OR (dental anxiety)) OR (dental anxieties)) OR (dental phobia)) OR (Dentophobia)) OR (Odontophobia)) AND (((((Autistic Disorder) OR (autism)) OR (Asperger syndrome)) OR (Autism Spectrum Disorder)) OR (ASD)) |
Inclusion and exclusion criteria
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1) Articles in English;
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2) Controlled trials, interventional study and studies with comparative groups in full text;
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3) Children population suffering from ASD;
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4) Interventions for behavior scales or cooperation rate;
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1) Absence of English language;
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2) Meta-analyses, reviews and case reports;
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3) Children population with other diagnoses or ASD adults;
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4) Duplicate studies.
Data extraction
Quality assessment
Study | Selection | Comparability | Outcome | Scores | |||||
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Representa-tiveness of exposure | Selection of the non- exposure | Ascertainment of exposure | Demonstration that outcome was not present at start | Cohorts on the basis of the design or analysis | Assessment | Long follow-up for outcomes to occur | Adequacy of follow up | ||
Isong, 2014 [15] | ★ | ★ | ★ | ★ | ★ ★ | ★ | ★ | ★ | 9 |
Stein, 2014 [7] | ☆ | ★ | ★ | ★ | ★ ★ | ★ | ★ | ★ | 8 |
Cermak,2015 [16] | ★ | ★ | ★ | ★ | ★ ★ | ★ | ★ | ★ | 9 |
G.Lefer,2018 [13] | ★ | ★ | ★ | ★ | ★ ★ | ☆ | ★ | ★ | 8 |
YePark, 2022 [22] | ★ | ★ | ★ | ★ | ★ ★ | ☆ | ★ | ★ | 8 |
Fallea, 2022 [29] | ☆ | ★ | ★ | ★ | ★ ★ | ☆ | ★ | ★ | 7 |
Result
Study selection
Descriptive characteristics
First Author (Year of Publication) | Study Design | Study Participants | Participants’ Medical Status | Dependent variables | Dental Procedure | Results | NOS |
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Isong, 2014 [15] | RCT | 80(7-17 years old) | Four groups with ASD Group A: control group; group B: only video peer modeling ; group C: only video goggles/DVD ; group D: B+C | Venham Anxiety and Behavior Scores | oral examination, radiographs, scaling (if needed), prophylaxis, application of fluoride | The average anxiety and behavioral scores of group C subjects decreased significantly by 0.9 points, while the average anxiety and behavioral scores of group D subjects decreased by 0.8 points in visit 1 and visit 2, respectively. There were no significant changes in the average anxiety and behavioral scores of subjects in Group A and Group B. | 9 |
Stein, 2014 [7] | CCT | 44(6-12 years old) | One group with ASD One group with TD | A & C scale, Children’s Dental Behavior Rating Scale(CDBRS) | oral examination, prophylaxis (cleaning), application of fluoride. | Children with ASD had more difficulties in sensory processing, general anxiety, and dental anxiety than children with TD Children with ASD demonstrated greater resistance and uncooperative behavior at the time of dental healthcare, compared to the TD group | 8 |
Cermak,2015 [16] | RCT | 44(6-12 years old) | One group with ASD in RED One group with ASD in SADE One group with TD in RED One group with TD in SADE | CDBRS scaled, A & C scale, Frankl scale, Pain intensity | Oral examination, prophylaxis(cleaning), fluoride application | The Anxiety and Cooperation scale Showed that SADE conditions could improve the relaxation and cooperation rate of the ASD group (46 % RDE to 59 % SADE) and most TD children exhibited positive dental cooperative behavior in both environmental conditions (91 and 95 % for RDE and SADE, respectively). | 9 |
G.Lefer,2018 [13] | prospective | 52(3-19 years old) | All Children with ASD(dental exam at the beginning baseline of the study (T0) and every two months thereafter (T1, T2, T3, and T4) | Scores of achievement (SAch), Scores of anxiety (SAnx) | Progressive dental exam: Sitting→Light shining→mouth opening→Placing a mirror into the mouth→Placing an explorer on the teeth→Placing both the mirror and explorer into the mouth | SAch scores increased significantly between T0 and T1, between T2 and T3, and between T0 and T4. For SAnx, the differences between T0 and T1 and between T0 and T4 are significant. The study sample made progress in all steps of achievement, and individuals became less anxious. | 8 |
YePark, 2022 [22] | SM | 76(7-13 years old) | All Children with ASD | Abeer Children Dental Anxiety Scale (ACDAS) | The most common feeling of dental anxiety in this sample, include: "pinching" of the gums, "tooth extraction", "wearing a gas mask is necessary," and "strange taste in the mouth." | there were no significant associations between the ACDAS and any hypothetical variables in all children with ASD. | 8 |
Fallea, 2022 [29] | CCT | 50(9-10 years old) | All Children with ASD(Oral therapy of each participant in RED and SADE) | Treatment success rate | Treat decayed permanent tooth | The treatment success rate of SADE group is higher than that of RDE group. | 7 |
Study | Dependent variables | TD Mean ± SD | ASD Mean ± SD | Effect size | |||
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Stein, 2014 | CDBRS scale | 34.69 (12.47) | 47.31 (8.61) | 1.1∗ | |||
A & C scale | 0.45 ± 1.06 | 2.07 ± 1.59 | 1.3∗ | ||||
Cermak, 2015 | CDBRS scale | TD | ASD | Effect size | |||
RDE | SADE | RDE | SADE | TD | ASD | ||
A & C scale | Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | |||
34.7 ± 12.5 | 30.8 ± 14.6 | 47.3 ± 8.6 | 44.9 ± 11.8 | 0.29 | 0.23 | ||
0.5 ± 1.1 | 0.4 ± 1.1 | 2.1 ± 1.6 | 1.8 ± 2.0 | 0.06 | 0.13 |