# Oral Health Status of Children with Autism in Central Italy
###### Abstract  
Children with autism spectrum disorder (ASD) have significantly higher prevalence and caries severity compared to the average population. Knowledge about the oral health indices of children with this mental disorder is key to designing efficient plans of intervention. This paper reports the results of a study on the oral health status of children with ASD in central Italy. This is the first study of this type in Italy. The sample consists of 229 autistic children aged between 5 and 14 years, attending the Unit of Special Needs Policlinico Umberto I in Rome. Each patient received an intraoral examination to investigate decayed, missing, and filled teeth as well as periodontal status. Information on demographic attributes, dietary habits, medical history, and child's cooperativeness at the first visit was also recorded. Of the participants, 79.26% presented signs of gingivitis and about 90% of them had plaque. Caries prevalence was 66.38%. The average of the total number of decayed, missing, and filled teeth in the permanent and primary dentition was 2.91. Among the factors considered, only dietary habits and the periodontal indices showed statistically significant association with caries prevalence and caries severity. Despite the selection bias, that prevents us to interpret the results presented as epidemiological evidence, our study suggests that children with ASD in central Italy represent a population at risk. Keywords: autism spectrum disorder; caries prevalence; oral prevention; special need patients +
Footnote †: journal: MedicalThe reported ASD prevalence varies substantially across studies with values ranging from 1.9/10,000 to 169/10,000 for USA, Europe, Canada, Asia, and Australia populations [6; 7; 8; 9]. This variability may be due to the complexity of diagnosis in relation to the various clinical situations [10] and various methodological factors, such as differences in the diagnostic method, in the size of the sample examined, and in the age groups considered [11]. As far as Italy is concerned, prevalence rates estimated from local surveys on patients attended to by the National Health System (NHS) in Emilia-Romagna, Piemonte, and Toscana regions range from 15/10,000 to 80/10,000 [12]. Despite the differences in the reported prevalence, all these studies clearly indicate that ASD is a pathology with a strong social impact and important public health implications. In this respect, oral health problems represent a key component. Normal daily activities, such as tooth brushing as well as understanding the behavior of other individuals, constitute a constant challenge for children affected by ASD [13; 14; 15; 16; 17; 18]. Several studies indicate that, due to these difficulties in maintaining good oral hygiene and being periodically examined and eventually treated, children with ASD have significantly more untreated caries and a higher prevalence of periodontitis and gingivitis as well as higher values of the total number of decayed, missing, and filled teeth in the primary dentition and in the permanent dentition (denoted by DMFT/dmft) compared to the average population [19; 20; 21; 22; 23; 24; 25; 26; 27]. In addition, dental care, for patients with moderate or slight intellectual disorders, requires special procedures and adaptations [28]. Autistic children, compared to other patients with psychiatric disorders, have an additional difficulty with which to deal, namely anxiety. A dental office is full of potentially frightful stimuli, due to the peculiar environment and equipment used. Evidence-based psychosocial interventions, such as behavioral treatment and parenting skills training programs, can reduce difficulties in communication and social behavior, with a positive impact on well-being and quality of life for persons with ASD and their interaction with caregivers [13; 16; 28].