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Autism is an intellectual developmental disorder characterized by insidious disability in communication, social interaction, and using language and abstract concepts. This organic disorder is known to have deformities in brain, i.e., cerebellum and limbic system, showing wide spectrum of systemic and behavioral symptoms. The oral health care of suc...
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... It is important to main- tain good, ongoing communication throughout the visits and even after that. The ability to follow directions, learn new things, and articulate wants and needs may be diffi- cult for some patients with autism. Some require assistive communicative devices, such as a Smart/Scan 32 pro, an augmentative communication device (Fig. 1), or a Picture Exchange Communication System (PECS) (Fig. 2). For autistic patients, PECS is an alternative communica- tion technique with no or little verbal ...
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El Síndrome de Asperger es una enfermedad del neurodesarrollo caracterizado por deficiencias en la interacción social y la comunicación,sin retraso en el desarrollo cognitivo y del lenguaje, considerado dentro de los Trastornos Generalizados del Desarrollo y de las Condiciones del Espectro Autista. Debido a las características de este síndrome esto...
Citations
... ASD has a heterogeneous etiology, with numerous recognized genetic, environmental, and immunological factors, as well as epigenetic mechanisms (4). The diagnosis relies on analyzing an individual's behavior, along with psychosomatic tests and parental history, as there are currently no specific tests or biomarkers available for this condition (5). ...
... The purpose of managing patients with ASD is to optimize the patient's performance, promote the maintenance of their health safely, nurture constant care, and focus on family support, in an empathetic and effective way. For a treatment plan to be successful, it is important to have interdisciplinary work and that each professional recognizes their role and performs it satisfactorily and creatively (5,13). Thus, dentistry professionals must have a scientific basis to conduct practical, efficient, and comfortable consultations for this population. ...
S U M M A R Y Introduction/Aim. Evaluating dental students' grasp on managing dental care for patients with autism spectrum disorder (ASD) is paramount for effective treatment. The aim of the paper was to assess the understanding of dental students at a public university in northeastern Brazil about managing dental care for patients with ASD. Methods. In this cross-sectional study, two meticulously designed questionnaires were utilized, targeting students from the fifth to the tenth period. The first questionnaire explored sociodemographic details, while the second assessed knowledge about the subject. The second questionnaire was divided into two sections: the first focused on the definition, diagnosis, and related comorbidities of ASD, and the second examined its impact on oral health, dental management, and oral manifestations. Statistical analysis involved the Kruskal-Wallis and Mann-Whitney tests, maintaining a 5% significance level. The analysis was conducted using SPSS statistical software, version 20. Results. Ninety-eight questionnaires were analyzed, revealing an average age of students of 22.68 years (SD ± 3.03). The majority were female (69.4%) and identified as white (46.9%). The majority of participants (53.1%) attended public high schools before enrolling in university, and the majority (60.2%) had no prior exposure to the topic. No significant differences were observed between the course periods in relation to general knowledge about dental management for autistic patients (p = 0.952). Public high school students were more likely to correctly answer questions related to priority treatment routines (p = 0.014), while those familiar with the topic before university had a higher likelihood of answering questions concerning pharmacological methods for managing patients with ASD (p = 0.039). Conclusion. This study revealed a satisfactory level of knowledge among dentistry students at a university center in northeastern Brazil regarding the management of patients with ASD.
... As a result, they may struggle to express their needs, discomfort, or pain to the dentist, making it difficult for the dentist to understand and address their concerns. Children and youth with ASD also struggle with managing emotions and may exhibit stereotyped movements, low frustration tolerance, aggression, and hyperactivity, which can impede successful behavior during dental appointments, interfere with the dental examination, or make it challenging for the dentist to perform procedures (Chandrashekhar & Bommangoudar, 2018). They also often respond to routine and predictability. ...
Oral health care is a significant unmet need among children, including those with developmental disabilities such as autism spectrum disorder (ASD). Children with ASD face notable challenges during dental procedures, resulting in fewer routine dental visits and increased oral disease risks. Furthermore, children with intellectual and developmental disabilities such as ASD encounter difficulties in accessing dental care due to the lack of skills and training among dentists to address their specific needs. This paper highlights the common challenges faced by children with ASD that hinder successful dental visits. While sedation is commonly used as a treatment approach for individuals with ASD, we propose the adoption of research-informed strategies as effective and safer alternatives to facilitate dental treatment. Early childhood teachers play a vital role not only in implementing dental care education for young children as part of their instruction, but also for collaborating and sharing practical strategies with families to provide caregiver education on oral hygiene practices, ultimately improving oral health outcomes in all children, including those with ASD.
... Autism or autistic spectrum disorder (ASD) is defined as a severe developmental disorder characterized by the classic triad of impaired communication, socialization, and repetitive and restricted patterns of behavior [4]. Disabled children are usually uncooperative with dentists to fulfill consultation, examination, and treatment owing to their congenital intelligence retardation and language development deficits [5]. ...
Crowns have been recommended to treat decayed teeth and rebuild teeth function. The dental management of children with autism is a tremendous challenge for pediatric dentists due to the impaired behaviors and communication disorders. In this context, a 5-year-old boy with autism was treated to solve carious lesions under the assistance of general anesthesia. The posterior occlusal function was restored, and the crossbite existing in the primary anterior teeth was approached merely by NuSmile® zirconia crowns (ZCs) rather than orthodontic intervention. We conducted an 18-month period. Throughout the long-term follow-up, the boy’s masticatory efficiency was remarkably improved and the anterior teeth had transferred into the correct position with adequate overbite to maintain the new relationship, thus ameliorating the appearance of tissue on the labial surface and enhancing his quality of life and oral health.
... isso é importante que a criança desde o diagnóstico seja incluída na sociedade para que se desenvolva com facilidade(Viana et al., 2021).Já na estabilização protetora é possível enxergar a limitação de liberdade dessas crianças, seja de movimentos ou até mesmo de autorização, e é isso que buscam, a liberdade de controlar ou eliminar manobras existentes. O intuito é reduzir o risco de lesões na equipe odontológica ou até mesmo no paciente, pois só assim será executado com eficiência o atendimento é feito o procedimento desejado de forma segura e eficiente(Chandrashekhar;Bommangoudar, 2018). Essas manobras são indicadas quando as demais técnicas não foi o suficiente para evitar o comportamento indesejado da criança, e há necessidade de diagnóstico ou tratamento urgente, pelas manobras involuntárias e impulsivas que o paciente apresenta, existe risco de proteção para o paciente, equipe médica e seus responsáveis no decorrer da consulta. ...
... isso é importante que a criança desde o diagnóstico seja incluída na sociedade para que se desenvolva com facilidade(Viana et al., 2021).Já na estabilização protetora é possível enxergar a limitação de liberdade dessas crianças, seja de movimentos ou até mesmo de autorização, e é isso que buscam, a liberdade de controlar ou eliminar manobras existentes. O intuito é reduzir o risco de lesões na equipe odontológica ou até mesmo no paciente, pois só assim será executado com eficiência o atendimento é feito o procedimento desejado de forma segura e eficiente(Chandrashekhar;Bommangoudar, 2018). Essas manobras são indicadas quando as demais técnicas não foi o suficiente para evitar o comportamento indesejado da criança, e há necessidade de diagnóstico ou tratamento urgente, pelas manobras involuntárias e impulsivas que o paciente apresenta, existe risco de proteção para o paciente, equipe médica e seus responsáveis no decorrer da consulta. ...
O transtorno do espectro autista (TEA) é um distúrbio do neurodesenvolvimento definido por desenvolvimento atípico, manifestações comportamentais, deficiência na comunicação e na interação social, padrões de comportamento repetitivos. Esse estudo consiste em uma revisão de literatura narrativa e foi desenvolvido a partir de uma análise documental da produção bibliográfica obtida através das bases de dados Pubmed e Scielo. Os critérios para inclusão dos estudos foram: artigos publicados entre os anos de 2012 a 2023; escritos nas línguas portuguesa e inglesa. Artigos publicados em inglês foram traduzidos para a avaliação posterior. O medo e os traumas serão sempre um obstáculo para a interferência odontológica presente no tratamento de crianças e adultos, com ou sem necessidades especiais, o que dificulta ainda mais o dentista a colocar em prática suas habilidades. Técnicas de condicionamento ou até mesmo abordagem multidisciplinar em crianças portadoras do TEA, o padrão a ser seguido é sempre o acolhimento, envolvimento da família, condicionamento comportamental e psicológico. Desta forma, foi possível entender que o tratamento odontológico para pacientes com TEA, é fundamental e possível desde que o profissional esteja devidamente capacitado, tendo uma abordagem adequada e diferenciada para cada um.
... Adapting the clinical experience to the individual patient's needs and developing familiarity with a consistent experience, promoted cooperation. Collectively, the ways to improve oral health for Autistic individuals are multifaceted and involve modifications by dental practitioners [20,21] and parents or carers [22], as well as service delivery and environmental modifications [7,11,23,24]. Further research in this space is needed to understand the barriers interfering with improved oral health and access to adequate dental care, and the need for a multidisciplinary approach to oral health care [25]. ...
Background:
Challenges in providing adequate dental care for individuals with Autism Spectrum Disorder (ASD) are recognised by parents, caregivers, and dental practitioners, leading to a higher prevalence of unaddressed dental needs. This scoping review aims to explore existing research on the obstacles to oral health care as perceived by individuals with ASD, as reported by their parents, caregivers, and dental professionals.
Methods:
Systematic searches were conducted in DOSS, Medline, and PubMed databases using relevant keywords to identify relevant studies. Barriers identified within these studies were then categorised based on themes identified.
Results:
The initial search yielded a total of 254 studies. Following the removal of duplicates and screening of titles and abstracts, 47 studies were further assessed against predetermined criteria, ultimately resulting in the inclusion of 16 articles in this scoping review. The identified barriers were grouped into five overarching themes: challenges in accessing appropriate care (n = 8), negative past experiences (n = 5), parental perceptions of the impact of ASD (n = 8), clinician bias (n = 2), and clinician education (n = 7).
Conclusions:
The findings of this review highlight the obstacles faced by individuals with ASD in obtaining routine oral health care. These results underscore the imperative for the development, testing, and implementation of tailored interventions focused on autism, as well as their integration into educational curricula for dental practitioners at various educational levels. This approach aims to enhance the delivery of equitable oral health care to individuals with ASD, starting from undergraduate through to postgraduate dental education.
... When ASD is evaluated in terms of dentistry, due to various drugs (antipsychotic, antidepressant, anticonvulsant, etc.) used in the treatment, these individuals experience an increase in dry mouth, caries, and perio dontal diseases [5]. In addition, behavioral disorders, such as bruxism, lip biting, dysfunctional chewing, self-mutilation and tantrums, nutritional problems, inadequacy in motor skills, and orthodontic problems, are all common in individuals with ASD [6]. ...
... Essa alteração pode ser evidenciada antes dos 3 anos de idade, com maior prevalência no sexo masculino do que no feminino. Por outro lado, as mulheres tendem a ser mais suscetível ao comprometimento cognitivo grave (Chandrashekhar, Bommangoudar, 2018;Da Silva et al, 2019 ...
Introdução: O autismo ou Transtorno do Espectro Autista (TEA), é considerado uma síndrome comportamental de neurodesenvolvimento. Caracteriza-se por alterações que afeta o comportamento, a comunicação e a interação social. O atendimento odontológico para pacientes com TEA é desafiador devido aos padrões comportamentais repetitivos, dificuldades de comunicação e recusa em seguir comandos. Objetivo: Foi revisar na literatura a importância do acesso ao tratamento odontológico para pacientes com TEA no Brasil e os desafios enfrentados pelos profissionais. Metodologia: Foram realizadas pesquisas bibliográficas no LILACS e PUBMED durante março e abril de 2023. Com os critérios de inclusão, artigos clássicos e portarias que expressão correlação ao tema, nos idiomas inglês e português. Sendo excluídas publicações que não contemplaram a proposta metodológica, bem como trabalhos de conclusão de curso, dissertações e teses. Resultado: 84 estudos foram selecionados, eliminando-se 74 artigos que não se enquadravam no tema da revisão, totalizando 10 artigos para o estudo. Conclusão: Pacientes com TEA, precisam ser acompanhados por uma equipe multidisciplinar. Os pais e responsáveis têm um papel essencial no apoio a uma criança autista, eles podem ajudar a garantir o acesso à saúde e educação. O tratamento odontológico em pacientes com TEA é considerado desafiador para o cirurgião-dentista, devido às dificuldades associadas.
... Autistic patients constitute a percentage of the special child population, and they require unique management because of their behavioral characteristics. Oral checkups and treatments are a challenge because of the reduced ability of autistic kids to communicate and manage their emotions, repetitive body movements, and hyperactivity associated with attention deficiency [22]. Prakash et al. confirmed that autism is a neurodevelopmental disorder that mainly affects the cognitive functions and patterns dependent upon these [23]. ...
Introduction
Oral health significantly influences functions such as chewing, swallowing, and overall well-being. Children with neuropsychiatric disorders (NPD) often experience compromised oral functions, escalating their risk of malnutrition.
Materials and methods
Our study, conducted in Varna, Bulgaria, from April to October 2017, aimed to evaluate some components of the oral health of 49 children with NPD and its relation to their motor impairments. In the studied cohort, participants were categorized based on their Gross Motor Function Classification System (GMFCS) scores into two groups: minor limitations (ML), encompassing GMFCS levels 1-3, and gross limitations (GL), which included GMFCS levels 4-5. Comprehensive oral examinations were conducted by a trained dentist. Data analysis utilized the JAMOVI v.2.2.2.0 software with a 0.05 significance threshold.
Results
Preliminary findings indicate that children with more pronounced motor limitations have poorer oral health compared to their mildly impaired counterparts. A mere 14.3% (n=7) of the children with NPD had recorded dental visits. The data show that 18.2% (n=6) of ML children had at least an annual dental consultation, while only a single child (6.2%) from the GL group had a dental visit, leaving a staggering 93.8% (n=15) without any.
Statistical analyses indicate a significant relationship between motor activity (MA) and toothbrushing frequency (r=0.529, p=0.0001), suggesting that children with better MA have improved chances of maintaining oral hygiene. A significant correlation was observed between dental visits and toothbrushing frequency (r=0.371, p=0.0007).
Conclusion
Given their challenges, children with NPD require increased attention to dental care, emphasizing regular checkups and preventive oral health measures. This study prompts a reevaluation of these care standards.
... O conceito de autismo emerge como um rótulo para características comportamentais e foi inicialmente introduzido por Bleuler em 1911. (Chandrashekhar et al, 2018) É amplamente conhecido que existem obstáculos que afetam a acessibilidade aos cuidados odontológicos para pessoas no transtorno do espectro autista e suas famílias. Estes obstáculos abarcam preocupações vinculadas à interação social, complexidades comportamentais e sensibilidades sensoriais, além disso, é importante notar que condições coexistentes, como ansiedade, desafios de aprendizado, epilepsia e TDAH, podem impactar negativamente tanto a saúde bucal quanto a experiência de receber cuidados odontológicos. ...
... Além disso, as questões sensoriais também desempenham um papel relevante, abarcando pistas visuais, auditivas, olfativas, gustativas e táteis. (Chandrashekhar et al, 2018) O reforço positivo, especialmente com crianças, envolve recompensas pequenas ou elogios verbais para incentivar cooperação e comportamento adequado. É eficaz no atendimento odontológico infantil e baseia-se em princípios psicológicos comprovados. ...
... É crucial evitar movimentos abruptos de objetos próximos e compreender que a visão periférica é usada para obter informações confiáveis, aspectos fundamentais que devem ser levados em consideração. (Chandrashekhar et al, 2018) Após programa de dessensibilização individualizada, muitos pacientes colaboram, mas alguns mostram comportamento inapropriado, como agressão ou desobediência a comandos. Compreender a função desses comportamentos é essencial, evitando reforçá-los e desenvolvendo novos comportamentos apropriados. ...
This paper addresses Autism Spectrum Disorder (ASD), a neurological condition that encompasses challenges in language, communication, and social interaction. The term “autism” originates from Greek and reflects the concept of internal absorption. The research highlights obstacles in dental care for individuals with ASD due to behavioral complexities, sensory sensitivities, and coexisting conditions such as anxiety. A study conducted by Castaño Novoa et al. suggests that a collaborative desensitization approach involving dentists and therapists can facilitate dental procedures in autistic adults, reducing the need for pharmacological interventions. Effective communication is essential, emphasizing mutual understanding and the use of the “tell-show-do” technique. The treatment of children with ASD faces challenges in communication, emotional regulation, and sensory sensitivity. Strategies of positive reinforcement and anxiety management are employed to encourage cooperation. The dental team must be prepared to deal with unconventional sensory responses, especially due to sensitive peripheral vision in autistic children. The research underscores the importance of understanding inappropriate behaviors post-desensitization and addresses the differentiation between inappropriate behaviors and stereotypes, emphasizing communication with parents, therapists, and doctors. Globally, the study highlights the significance of adaptation, effective communication, and understanding the intricacies of ASD in dental care, aiming to enhance the treatment experience and oral health of affected individuals.
... Following the proposed methodology, 32 articles were selected (see Figure 1). The selected studies discussed (see Table 1): oral health conditions of ASD people (AlHammad et al., 2020;Blomqvist et al., 2014;Chandrashekhar & Bommangoudar, 2018;Corridore et al., 2020;David Amaral et al., 2016;Ferrazzano et al., 2020;Hage et al., 2020;Mansoor et al., 2018;McKinney et al., 2014;Onol & Kırzıoğlu, 2018;Orellana et al., 2019;Radović et al., 2018), dental treatment strategies for this group (AlHammad et al., 2020;Cermak et al., 2015;Corridore et al., 2020;Delli et al., 2013;Duker et al., 2019;Ferrazzano et al., 2020;Hage et al., 2020;Onol & Kırzıoğlu, 2018;Widyagarini & Suharsini, 2017), understanding and practices of parents and/or guardians in oral health care (AlHammad et al., 2020;Blomqvist et al., 2014Blomqvist et al., , 2015Cagetti et al., 2015;David Amaral et al., 2016;Floríndez et al., 2019;Hage et al., 2020;Mansoor et al., 2018;Thomas et al., 2017;Widyagarini & Suharsini, 2017), oral health management of these individuals (Alshatrat et al., 2020; Autism 00(0) Blomqvist et al., 2015;Chandrashekhar & Bommangoudar, 2018;Corridore et al., 2020;David Amaral et al., 2016;Duker et al., 2019;Hage et al., 2020;Mansoor et al., 2018;Udhya et al., 2014;Widyagarini & Suharsini, 2017;Wiener et al., 2016), barriers and challenges faced by parents/caregivers in seeking dental care (Chandrashekhar & Bommangoudar, 2018;Corridore et al., 2020;David Amaral et al., 2016;Duker et al., 2017;Floríndez et al., 2019;Hage et al., 2020;Mansoor et al., 2018;Morrissette & Boman, 2020;Murshid, 2015;Onol & Kırzıoğlu, 2018;Radović et al., 2018), and use of technological resources as support in the health care of these subjects (Cagetti et al., 2015;Lai et al., 2019;Narzisi et al., 2020;Popple et al., 2016). ...
... Following the proposed methodology, 32 articles were selected (see Figure 1). The selected studies discussed (see Table 1): oral health conditions of ASD people (AlHammad et al., 2020;Blomqvist et al., 2014;Chandrashekhar & Bommangoudar, 2018;Corridore et al., 2020;David Amaral et al., 2016;Ferrazzano et al., 2020;Hage et al., 2020;Mansoor et al., 2018;McKinney et al., 2014;Onol & Kırzıoğlu, 2018;Orellana et al., 2019;Radović et al., 2018), dental treatment strategies for this group (AlHammad et al., 2020;Cermak et al., 2015;Corridore et al., 2020;Delli et al., 2013;Duker et al., 2019;Ferrazzano et al., 2020;Hage et al., 2020;Onol & Kırzıoğlu, 2018;Widyagarini & Suharsini, 2017), understanding and practices of parents and/or guardians in oral health care (AlHammad et al., 2020;Blomqvist et al., 2014Blomqvist et al., , 2015Cagetti et al., 2015;David Amaral et al., 2016;Floríndez et al., 2019;Hage et al., 2020;Mansoor et al., 2018;Thomas et al., 2017;Widyagarini & Suharsini, 2017), oral health management of these individuals (Alshatrat et al., 2020; Autism 00(0) Blomqvist et al., 2015;Chandrashekhar & Bommangoudar, 2018;Corridore et al., 2020;David Amaral et al., 2016;Duker et al., 2019;Hage et al., 2020;Mansoor et al., 2018;Udhya et al., 2014;Widyagarini & Suharsini, 2017;Wiener et al., 2016), barriers and challenges faced by parents/caregivers in seeking dental care (Chandrashekhar & Bommangoudar, 2018;Corridore et al., 2020;David Amaral et al., 2016;Duker et al., 2017;Floríndez et al., 2019;Hage et al., 2020;Mansoor et al., 2018;Morrissette & Boman, 2020;Murshid, 2015;Onol & Kırzıoğlu, 2018;Radović et al., 2018), and use of technological resources as support in the health care of these subjects (Cagetti et al., 2015;Lai et al., 2019;Narzisi et al., 2020;Popple et al., 2016). ...
... Following the proposed methodology, 32 articles were selected (see Figure 1). The selected studies discussed (see Table 1): oral health conditions of ASD people (AlHammad et al., 2020;Blomqvist et al., 2014;Chandrashekhar & Bommangoudar, 2018;Corridore et al., 2020;David Amaral et al., 2016;Ferrazzano et al., 2020;Hage et al., 2020;Mansoor et al., 2018;McKinney et al., 2014;Onol & Kırzıoğlu, 2018;Orellana et al., 2019;Radović et al., 2018), dental treatment strategies for this group (AlHammad et al., 2020;Cermak et al., 2015;Corridore et al., 2020;Delli et al., 2013;Duker et al., 2019;Ferrazzano et al., 2020;Hage et al., 2020;Onol & Kırzıoğlu, 2018;Widyagarini & Suharsini, 2017), understanding and practices of parents and/or guardians in oral health care (AlHammad et al., 2020;Blomqvist et al., 2014Blomqvist et al., , 2015Cagetti et al., 2015;David Amaral et al., 2016;Floríndez et al., 2019;Hage et al., 2020;Mansoor et al., 2018;Thomas et al., 2017;Widyagarini & Suharsini, 2017), oral health management of these individuals (Alshatrat et al., 2020; Autism 00(0) Blomqvist et al., 2015;Chandrashekhar & Bommangoudar, 2018;Corridore et al., 2020;David Amaral et al., 2016;Duker et al., 2019;Hage et al., 2020;Mansoor et al., 2018;Udhya et al., 2014;Widyagarini & Suharsini, 2017;Wiener et al., 2016), barriers and challenges faced by parents/caregivers in seeking dental care (Chandrashekhar & Bommangoudar, 2018;Corridore et al., 2020;David Amaral et al., 2016;Duker et al., 2017;Floríndez et al., 2019;Hage et al., 2020;Mansoor et al., 2018;Morrissette & Boman, 2020;Murshid, 2015;Onol & Kırzıoğlu, 2018;Radović et al., 2018), and use of technological resources as support in the health care of these subjects (Cagetti et al., 2015;Lai et al., 2019;Narzisi et al., 2020;Popple et al., 2016). ...
Autism spectrum disorder requires a careful approach from professionals and a favorable clinical environment for dental care and assistance. This article aims To perform a literature review about oral health among people with autism spectrum disorder and dental management strategies for this group. An integrative literature review was carried out in three databases, associating the descriptors: (autism or autism spectrum disorder) with (oral health or oral diseases) and (dental care or dental services). After identification and screening steps, 32 articles were included in the study. The most prevalent subjects were oral health conditions, parents’ understanding and practical attitudes about oral health, treatment and management strategies, and the use of technology. The principal barriers to dental care were the scarcity of specialized professionals, unpreparedness in the referral system, poor accessibility of the clinics, and lack of specific care protocols. The world literature on the subject is scarce, and there is still a need for investment and scientific production due to the incidence of autism in the world population and the maintenance of difficulties and barriers in offering quality health care to this group.
Lay abstract
Autism spectrum disorder requires a more careful approach from oral health professionals and a favorable clinical environment related to dental care and assistance. This article has the objective to perform a literature review about the oral health-care knowledge and practices in people with autism spectrum disorder, as well as the characteristics of dental care for this group. It was carried out in three articles databases, associating descriptors such as autism or autism spectrum disorder; oral health or oral diseases; dental care or dental services. We identified 32 articles. The most prevalent subjects were oral health conditions, treatment strategies, parents’ understanding and practical attitudes about oral health, management, and use of technology to improve oral health care. The principal barriers to people with autism spectrum disorder to access dental care were the scarcity of specialized professionals, unpreparedness in the referral system, poor accessibility of the clinics, and lack of specific care protocols. The world literature on the subject is scarce, and there is still a need for investment and scientific production due to the incidence of autism in the world population and the maintenance of difficulties and barriers in offering quality health care to this group.
