Non-Cochrane · intervention · PM41457771
Oral Health Interventions in Children With Autism Spectrum Disorder: A Systematic Review and Meta-Analysis of Interventional Studies.
Rajaei Iman, Babaei Azadeh, Djalalinia Shirin, et al. · Clinical and experimental dental research · 2025 · PubMed · doi:10.1002/cre2.70258
Findings
9 findings
| Population | ||||
|---|---|---|---|---|
| Children and adolescents under 20 years with autism spectrum disorder | Oral health interventions (educational visual, verbal, booklet and procedural approaches; child and/or caregiver directed) | Control or comparator interventions (e.g., conventional education, manual toothbrush, social story, passive video) | Plaque index (PI) Last post-intervention measurement · Not specified · Overall | SMD -0.73 [-1.02, -0.44] Low 9 studies · 754 participants |
| Children and adolescents under 20 years with autism spectrum disorder | Oral health interventions (educational visual, verbal, booklet and procedural approaches; child and/or caregiver directed) | Control or comparator interventions (e.g., conventional education, manual toothbrush, social story, passive video) | Plaque indices combined (PI and OHI-S) Last post-intervention measurement · Not specified · Sensitivity: nonrandomized studies only | SMD -0.11 [-0.39, 0.18] Low 2 studies · 197 participants |
| Children and adolescents (under 20 years) with autism spectrum disorder | Oral health interventions (educational visual, verbal, booklet/leaflet; procedural) | Control or comparator (conventional education, other modes, or standard care) | Plaque indices combined (PI and OHI-S) Not specified · Sensitivity: randomized studies only | SMD -1.12 [-1.58, -0.65] Low 11 studies · 794 participants |
| Children and adolescents under 20 years with autism spectrum disorder | Oral health interventions (educational visual, verbal, booklet and procedural approaches; child and/or caregiver directed) | Control or comparator interventions (e.g., conventional education, manual toothbrush, social story, passive video) | Plaque indices combined (PI and OHI-S) Last post-intervention measurement · Not specified · Overall | SMD -0.95 [-1.39, -0.52] Low 12 studies · 991 participants |
| Children and adolescents under 20 years with autism spectrum disorder | Oral health interventions (educational visual, verbal, booklet and procedural approaches; child and/or caregiver directed) | Control or comparator interventions (e.g., conventional education, manual toothbrush, social story, passive video) | Simplified Oral Hygiene Index (OHI-S) Last post-intervention measurement · Not specified · Trim-and-fill adjusted (5 imputed studies) | SMD -1.386 [-1.843, -0.929] Low Studies not reported |
| Children and adolescents under 20 years with autism spectrum disorder | Oral health interventions (educational visual, verbal, booklet and procedural approaches; child and/or caregiver directed) | Control or comparator interventions (e.g., conventional education, manual toothbrush, social story, passive video) | Gingival index (GI) Last post-intervention measurement · Not specified · All studies | SMD -0.74 [-1.34, -0.14] Low 6 studies · 563 participants |
| Children and adolescents under 20 years with autism spectrum disorder | Oral health interventions (educational visual, verbal, booklet and procedural approaches; child and/or caregiver directed) | Control or comparator interventions (e.g., conventional education, manual toothbrush, social story, passive video) | Gingival index (GI) Last post-intervention measurement · Not specified · Sensitivity: excluding nonrandomized study | SMD -0.92 [-1.52, -0.32] Low 5 studies · 503 participants |
| Children and adolescents under 20 years with autism spectrum disorder | Oral health interventions (educational visual, verbal, booklet and procedural approaches; child and/or caregiver directed) | Control or comparator interventions (e.g., conventional education, manual toothbrush, social story, passive video) | Simplified Oral Hygiene Index (OHI-S) Last post-intervention measurement · Not specified · Overall | SMD -1.44 [-2.79, -0.08] Low 4 studies · 287 participants |
| Children and adolescents under 20 years with autism spectrum disorder | Video-based (video modeling) oral health interventions | Other modes of intervention (pictures, verbal, other) | Plaque index (PI) Last post-intervention measurement · Not specified · Video-based interventions | SMD -0.69 [-1.2, -0.14] Low 5 studies · 288 participants |
Included primary studies 27
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Mah 2023 Studies on the regulatory properties of chloroplast fructose-1,6-bisphosphatase. PMID:202319 | 1978 | 1 other review | not stated | not extracted yet |
| Pai Khot 2023 Evaluation of a "Picture Assisted Illustration Reinforcement" (PAIR) System for Oral Hygiene in Children with Autism: A Double-Blind… PMID:36832499 | 2023 | 1 other review | Plaque index (PI); Simplified Oral Hygiene Index (OHI-S); Gingival index (GI) | not extracted yet |
| Al-Batayneh 2020 Effectiveness of a tooth-brushing programme using the picture exchange communication system (PECS) on gingival health of children with… PMID:31628661 | 2020 | this review only | not stated | not extracted yet |
| Aljubour 2022 Effect of Culturally Adapted Dental Visual Aids on Oral Hygiene Status during Dental Visits in Children with Autism Spectrum Disorder: A… PMID:35626843 | 2022 | this review only | Plaque indices combined (PI and OHI-S); Plaque index (PI) | not extracted yet |
| Carli 2022 Oral Health Preventive Program in Patients with Autism Spectrum Disorder. PMID:35455579 | 2022 | this review only | not stated | not extracted yet |
| Chawla 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Doichinova 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Du 2021 Evaluation of visual pedagogy in improving plaque control and gingival inflammation among preschool children with autism spectrum… PMID:32621656 | 2021 | this review only | not stated | not extracted yet |
| Du 2022b Developing a Toothbrushing Visual Pedagogy (TBVP) for Preschool Children with Autism Spectrum Disorder. PMID:33689090 | 2022 | this review only | not stated | not extracted yet |
| Fenning 2022 Parent Training for Dental Care in Underserved Children With Autism: A Randomized Controlled Trial. PMID:35211746 | 2022 | this review only | Plaque indices combined (PI and OHI-S); Plaque index (PI) | not extracted yet |
| Gandhi 2024 A comparative evaluation of video modeling and social stories for improving oral hygiene in children with autism spectrum disorder: A… PMID:37646912 | 2024 | this review only | Plaque indices combined (PI and OHI-S); Plaque index (PI); Gingival index (GI) | not extracted yet |
| Ibrahim 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Krishnan 2021 Effectiveness of two sensory-based health education methods on oral hygiene of adolescent with autism spectrum disorders: An… PMID:34050975 | 2021 | this review only | Plaque indices combined (PI and OHI-S); Plaque index (PI); Gingival index (GI) | not extracted yet |
| Lefer 2018 [Teaching tooth brushing to children with autistic spectrum disorder : A tablet-based training programme.]. PMID:30541258 | 2018 | this review only | not stated | not extracted yet |
| Lopez Cazaux 2019 Toothbrushing training programme using an iPad® for children and adolescents with autism. PMID:30879261 | 2019 | this review only | not stated | not extracted yet |
| Mahajan 2023 Evaluation of visual pedagogy teaching method for improving oral hygiene practice in children with Autism: An interventional study. PMID:37727414 | 2023 | this review only | not stated | not extracted yet |
| Pawar 2022 Manual and Powered Toothbrushing Effectiveness on Autistic Children's Oral Hygiene Status. PMID:36110675 | 2022 | this review only | Plaque index (PI); Simplified Oral Hygiene Index (OHI-S) | not extracted yet |
| Pilebro 2005 Teaching oral hygiene to children with autism. PMID:15663439 | 2005 | this review only | not stated | not extracted yet |
| Piraneh 2023 Social Story Based Toothbrushing Education Versus Video-Modeling Based Toothbrushing Training on Oral Hygiene Status Among Male Students… PMID:35871424 | 2023 | this review only | Plaque index (PI); Simplified Oral Hygiene Index (OHI-S) | not extracted yet |
| Popple 2016 Brief Report: Remotely Delivered Video Modeling for Improving Oral Hygiene in Children with ASD: A Pilot Study. PMID:27106570 | 2016 | this review only | Plaque indices combined (PI and OHI-S); Plaque index (PI) | not extracted yet |
| Ramassamy 2019 Yoga therapy as an adjunct to traditional tooth brushing training methods in children with autism spectrum disorder. PMID:31664728 | 2019 | this review only | Plaque indices combined (PI and OHI-S); Plaque index (PI); Gingival index (GI) | not extracted yet |
| Renuka 2022 Picture exchange communication system as a behavior modification technique for oral health assessment in autistic children. PMID:36624899 | 2022 | this review only | not stated | not extracted yet |
| Sallam 2013 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Shalabi 2022 Picture Examination Communication System Versus Video Modelling in Improving Oral Hygiene of Children with Autism Spectrum Disorder: A… PMID:35232533 | 2022 | this review only | Plaque indices combined (PI and OHI-S); Plaque index (PI); Simplified Oral Hygiene Index (OHI-S) | not extracted yet |
| Smutkeeree 2020 The Effectiveness of Visual Pedagogy for Toothbrushing in Children with Autism Spectrum Disorder. PMID:33042882 | 2020 | this review only | not stated | not extracted yet |
| Vajawat 2015 A clinicomicrobiological study to evaluate the efficacy of manual and powered toothbrushes among autistic patients. PMID:26681855 | 2015 | this review only | Plaque indices combined (PI and OHI-S); Plaque index (PI); Gingival index (GI) | not extracted yet |
| Zhou 2020 Social story-based oral health promotion for preschool children with special healthcare needs: A 24-month randomized controlled trial. PMID:32578261 | 2020 | this review only | Plaque indices combined (PI and OHI-S); Plaque index (PI); Gingival index (GI) | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adolescents under 20 years with a definitive diagnosis of autism spectrum disorder | Children with ASD aged 2 to 19 years (n=1918) |
| Intervention | Oral health interventions aimed at children, parents/caregivers/teachers or both (training, preventive techniques, procedures, behavior modules; video, pictures, verbal, booklets, apps) | Educational (visual, verbal, booklet/leaflet) and procedural interventions; for children (16 studies), caregivers/parents/teachers (5), or both (6) |
| Comparison | With or without comparator arms | Conventional education, other modes (social story, pictures, passive video), manual toothbrush, or no control (single-arm) |
| Outcomes | DMFT/dmft, OHI-S, PI, GI and others; mixed-method indicators (feasibility, acceptability, QALY, autonomy) | OHI-S, PI, GI pooled; DMFT/dmft, behavior and knowledge outcomes narrative |
| Study designs | Randomized/nonrandomized clinical trials and quasi-experimental studies; no language or time restriction | 12 RCTs, 2 non-randomized studies, 13 quasi-experimental studies (n=27) |
| Timing | Not specified | Not specified |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | No | no |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: No · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |