Management strategies of dental anxiety and uncooperative behaviors in children with Autism spectrum disorder

The evidence remains scattered across intervention types, settings, and outcome measures, with substantial heterogeneity in how studies define and assess success.

“Although the number of publications is increasing, the evidence remains scattered across intervention types, settings, and outcome measures. Recent syntheses have highlighted substantial heterogeneity in how studies define and assess success. Outcomes range from cooperation ratings and procedural tolerance to behavioral distress and physiological markers.2”

Preparation-focused strategies such as systematic desensitization, modeling, and stepwise rehearsal are frequently described as practical methods to increase acceptance of dental examinations and procedures.

“Preparation-focused strategies, such as systematic desensitization, modeling, and stepwise rehearsal, are frequently described as practical methods to increase acceptance of dental examinations and procedures.1,2”

Children with neurodevelopmental disorders, especially autism spectrum disorder, commonly have sensory over-responsivity, communication differences, and difficulty tolerating changes in routine.

“These conditions are commonly associated with sensory over-responsivity, communication differences, and difficulty tolerating changes in routine.”

Sensory, communication, and routine-tolerance features in children with neurodevelopmental disorders can amplify dental anxiety and distress, reduce cooperation, and contribute to delayed or incomplete care.

“Such features can amplify dental anxiety and distress in the operatory, reduce cooperation, and contribute to delayed or incomplete care.1–3”

These chairside factors may lead to avoidance, resistance to change, behavioral escalation, increased appointment duration, reduced procedural quality, and safety concerns for the child and dental team.

“These factors may lead to avoidance, resistance to change, or behavioral escalation. They may also increase appointment duration, reduce procedural quality, and raise safety concerns for both the child and the dental team.1–3”

The literature continues to be dominated by autism spectrum disorder, with limited mapping of non-autism neurodevelopmental disorder profiles and fewer studies emphasizing standardized, child-centered outcomes.

“In addition, the literature continues to be dominated by ASD, with limited mapping of non-ASD NDD profiles and fewer studies emphasizing standardized, child-centered outcomes.2,4”

Behavioral challenges in autism spectrum disorder and other neurodevelopmental disorders at chairside are often triggered by predictable aspects of dental care (bright lights, sounds, smells, physical proximity, intraoral touch) and by difficulties understanding unfamiliar instructions or coping with uncertainty.

“At chairside, behavioral challenges in ASD and other NDD profiles are often triggered by predictable aspects of dental care. These include bright lights, sounds from suction or handpieces, unfamiliar smells, physical proximity, and intraoral touch. Difficulties in understanding unfamiliar instructions or coping with uncertainty can further increase distress.1–3”

It remains difficult to determine which approach is best suited for a particular child profile or what constitutes clinically meaningful improvement in routine care completion.

“For example, it remains difficult to determine which approach is best suited for a particular child profile or what constitutes clinically meaningful improvement in routine care completion.2”

Preparation-based strategies may be especially important in autism spectrum disorder because sensory unpredictability and unfamiliar routines can lead to avoidance and agitation during dental treatment.

“Preparation-based strategies may be especially important in ASD because sensory unpredictability and unfamiliar routines can lead to avoidance and agitation during dental treatment.2,4”

The available evidence suggests that non-pharmacological chairside management in neurodevelopmental disorders may be most useful when implemented as a stepwise, patient-centered approach.

“The available evidence suggests that non-pharmacological chairside management in NDD may be most useful when implemented as a stepwise, patient-centered approach.2,4–7”

Within the recent evidence base, the literature was limited, predominantly focused on autism spectrum disorder, and highly heterogeneous in interventions and outcome measures.

“Within this recent evidence base, the literature was limited, predominantly focused on ASD, and highly heterogeneous in terms of interventions and outcome measures.2,4–7”

Outcome heterogeneity was identified as a major challenge because it limits comparability and slows translation into standardized chairside protocols.

“Outcome heterogeneity was identified as a major challenge because it limits comparability and slows translation into standardized chairside protocols.2”

This review highlights an autism spectrum disorder-dominant evidence base, with limited representation of other neurodevelopmental disorder profiles such as tic disorders, dyslexia, and speech-language delay.

“This review also highlights an ASD-dominant evidence based, with limited representation of other NDD profiles, such as tic disorders, dyslexia, and speech-language delay, in recent chairside management research.2,4,5,7,9”

Across the included evidence, graded exposure, desensitization, and modeling were described as approaches that may reduce novelty and increase procedural tolerance.

“Across the included evidence, graded exposure, desensitization, and modeling were described as approaches that may reduce novelty and increase procedural tolerance.2,4,7”

Earlier foundational studies and caregiver/provider acceptability literature that may inform feasibility and ethics may not have been captured.

“Therefore, earlier foundational studies and caregiver/provider acceptability literature that may inform feasibility and ethics may not have been captured.2,3”

The systematic review by Tang et al emphasized that studies used different tools to assess anxiety, cooperation, and uncooperative behaviors, and many studies focused on sensory-adapted environments as a strategy to increase cooperation during procedural and preventive examinations.

“The systematic review by Tang et al emphasized that studies used different tools to assess anxiety, cooperation, and uncooperative behaviors. Many studies also focused on sensory-adapted environments as a strategy to increase cooperation during procedural and preventive examinations.2”

This review provides a systematic overview of recent chairside approach clusters, highlights measurement gaps, and identifies priorities for future work.

“Nevertheless, this review provides a systematic overview of recent chairside approach clusters, highlights measurement gaps, and identifies priorities for future work.1–5,7”

The supporting evidence was heterogeneous in design and outcome measures, making quantitative synthesis impossible.

“Furthermore, the supporting evidence was heterogeneous in design and outcome measures, making quantitative synthesis impossible.2,5”

Protective stabilization was discussed or employed in selected circumstances during treatment.

“Protective stabilization was also discussed or employed in selected circumstances during treatment.2,4–7”