Assessment of the Educational Sensory Based Approach for dental treatment of children with autism in central Italy

Denise Corridore¹Mario Trottini^2*GIANNI DI GIORGIO^3*Giulia Zumbo³Ida Carmen Corvino³Alessandro Salucci³Matteo Nagni⁴Iole Vozza³Maurizio Bossu³

• ¹Department of Life Science, Health, and Health Professions, Link Campus University, Rome, Italy
• ²Department of Mathematics, University of Alicante, Alicante, Spain
• ³Department of Oral and Maxillofacial Sciences,, Universita degli Studi di Roma La Sapienza, Rome, Italy
• ⁴Dental School, IRCCS San Raffaele Hospital, Universita Vita Salute San Raffaele, Milan, Italy

Background: For some children with Autism Spectrum Disorder (ASD) over-responsivity to sensor stimuli in dental office environment and communication barriers could results in uncooperative behaviour and forces to resort, in extreme cases, to general anesthesia. Taylored educational approaches are a promising tool to address these issues. Objective: To assess the effectiveness of an existing educational approach called Educational Sensory Based Approach (ESBA) aimed to improve cooperation in dental care treatment of children with ASD. The relevant research questions are whether children improve their cooperation during the phases of ESBA and how such an improvement depends on the variables in the study. According to our definition: an initially uncooperative child (Frankl scale at first visit negative or definitely negative) improved by the end of a certain phase if his/her Frankl scale rating at the end of the phase is positive or definitely positive; while an initially cooperative child (Frankl scale at first visit positive) improved by the end of a certain phase if his/her Frankl scale rating at the end of the phase is definitely positive. Methods: A retrospective repeated measurement design was used. The final sample comprises 45 initially uncooperative and 40 initially cooperative children with ASD that completed the ESBA program between 2013 and 2020. Data include demographic, and clinical examinations variables, medical history, and children behaviour and cooperation. Statistical analysis was performed by fitting 3328 cumulative logit models to address the relevant research questions. Results. A statistically significant improvement through the different phases of ESBA program was found independent of the other explanatory variables in the study. The 95% confidence intervals for the predicted probability that an initially uncooperative child would have improved by the end of ESBA program is [0.71, 0.88] and “drops” to [0.04, 0.20] for an initially cooperative child. Conclusions: ESBA represents a promising tool for managing dental care in children with ASD. It facilitates cooperation and limits reliance on general anesthesia. Findings from this study can inform clinical practice in pediatric dentistry, particularly in managing patients with ASD, and provide a starting point for other medical teams to implant and implement alternative educational approaches