# Oral Health Status of Children with Autism in Central Italy
## 4 Discussion  
To the best of our knowledge, this is the first study that provides information on the oral health status of children aged 5 to 14 years with ASD in central Italy (and more in general in Italy). The observed male/female ratio (which is approximately 4:1) is in agreement with values reported by the WHO based on which ASD is 3 to 4 times more frequent in males than in females [1]. The overall caries prevalence in our study is 66.4%, smaller than the one reported in similar studies in South Africa and United Arab Emirates [20; 27] (where a prevalence up to 85% was observed) but (more than 20%) larger than the prevalence that appears in other studies for Turkey and India [22]. In terms of caries severity, the average DMFT/dmft score for our sample (2.91) is substantially smaller than the one obtained in comparable studies conducted in Africa [24; 27] (where average values of DMFT/dmft of 4.79 and 7.23 have been found), slightly smaller than the one reported in a similar study in Turkey [36] and slightly larger than those obtained in studies on autism in Asian populations [20; 21; 36; 37; 38] (for which \begin{table}
\begin{tabular}{l c c c} \hline \hline  & **Variables** & **Mean DMFT/dmft** & \(p\)**-Value** \\ \hline Gender & & & \\  & Male & 2.988 & \\  & Female & 2.655 & 0.703 \\ Age & & & \\  & 5–7 & 3.014 & \\  & 8–10 & 3.258 & 0.121 \\  & 11–14 & 2.229 & \\ Medications & & & \\  & Yes & 2.559 & \\  & No & 3.101 & 0.170 \\
**Diet** & & & \\  & Free and varied diet & 1.384 & \\  & Free diet rich in sugars & 3.930 & **<0.001 \({}^{*}\)** \\  & Restriction for intolerances & 2.615 & \\ Natural birth & & & \\  & Yes & 2.731 & \\  & No & 3.000 & 0.375 \\ \hline \hline \end{tabular}
\end{table} 
Table 4: Caries severity in relation to background and behavioral variables. \(p\)-values \(<\) 0.05, corresponding to statistically significant differences, are marked with an asterisk and the corresponding variable is highlighted in bold. \begin{table}
\begin{tabular}{l c c} \hline \hline  & **Variables** & **Mean DMFT/dmft** & \(p\)**-Value** \\ \hline
**Gingival Index** & & \\  & Healthy & 1.467 & \\  & Bleeding & 2.986 & **<0.001 \({}^{*}\)** \\  & Tartar & 3.717 & \\ \hline
**Plaque Index** & & \\  & No plaque & 0.636 & \\  & Plaque detectable with the periodontal probe & 1.778 & \\  & Plaque visible to the naked eye at the gingival margin & 3.693 & **<0.001 \({}^{*}\)** \\  & Abundant accumulation of calculus beyond the margin & 4.875 & \\ \hline
**Frankl scale** & & \\  & Definitely Negative & 2.693 & \\  & Negative & 2.824 & \\  & Positive & 3.967 & \\  & Definitely positive & - & \\ \hline \hline \end{tabular}
\end{table} 
Table 5: Caries severity in relation to Gingival Index, plaque Index, and ASD severity (measured as the Frankl scale rating). \(p\)-values \(<\) 0.05, corresponding to statistically significant differences, are marked with an asterisk and the corresponding variable is highlighted in bold. an average value between 2.01 and 2.4 has been reported). We found that both caries prevalence and caries severity have a statistically significant association with the type of diet and the periodontal indices PI and GI of the autistic patient but, contrary to the findings of similar studies [12; 36; 37; 38], a not statistically significant association with age and gender was found. No statistical association between autism severity (as measured by the Frankl scale rating) was found. This may be due to the fact that the vast majority of children with ASD (87% in our case) are not cooperative and thus the Frankl rating exhibits little variation in our sample, and to the presence of potential confounding variables (the subgroups of children with different Frankl rating values may not be homogeneous with respect to factors, such as dietary habits, relevant for caries prevalence and caries severity).