ACE.D triptych

Oral Health and Autism Spectrum Disorder

Autism spectrum disorder (ASD) is an intellectual developmental disorder characterized by a range of disabilities in communication, social interaction, language, and abstract concepts. Persons with ASD have difficulty verbalizing their needs and often express themselves with behaviors that are not understood.

Malocclusions, such as tooth crowding, open bite, poor tongue coordination, and a tendency to pouch food inside the mouth instead of swallowing, are common and can lead to poor oral health. Persons with ASD often have negative oral habits like nocturnal bruxism, lip biting, and tongue thrusting. In addition, they are often sensitive to the taste of toothpaste and have a lack of coordination for brushing.

Persons with ASD may be challenged by dental treatment due to their hypersensitivity to sensations, lack of ability to communicate, and difficulty managing their emotions. Therefore, it is often a challenge to locate dental settings equipped to provide an appropriate clinical environment. This paucity of resources increases the risk for oral health disparities, which can lead to significant oral health problems. Health professionals caring for patients with autism need to be aware of these concerns, provide a calm, consistent environment, and prioritize anticipatory guidance for caregivers on the importance of offering behavioral guidance techniques for oral hygiene care and promoting oral health at home. The goals of behavioral guidance techniques in the dental setting are to develop rapport, lessen anxiety, and provide quality dental treatments while building a trusting and positive relationship for a lifetime between the professional and patient.

Oral Health and Autism Spectrum Disorder

Learning Objectives

Students will:

  1. Describe oral health needs of patient with ASD.
  2. Describe barriers to oral care for patients with ASD.
  3. Describe four questions to ask parent about child’s oral hygiene practice.
  4. Demonstrate techniques for behavior management of child with ASD in dental office.

Learner Prework

  1. Chandrashekhar, S., & Bommangoudar, S. J. (2018). Management of autistic patients in dental office: A clinical update. International Journal of Clinical Pediatric Dentistry,11(3), 219-227. doi: 10.5005/jp-journals-10005-1515
  2. Narzisi, A., Bondioli, M., Pardossi F., et al. (2020). "Mom let's go to the dentist!": Preliminary feasibility of a tailored dental intervention for children with autism spectrum disorder in the Italian public health service. Brain Science, 10(7), 444. Doi: 10.3390/brainsci10070444. P.11

Suggested Learning Activities

  1. Have each student role play an interview with a parent of a child with ASD using the questionnaire (p. 11) from the MyDentist project (Narzisi et al., 2020).
  2. Based on the article by Chandrashekhar and Bommangoudar, have students use the Oral Health and Autism Spectrum Disorder Interventions Based on Behavioral Guidance Techniques chart to choose one behavioral guidance technique and describe an intervention for a patient with ASD in the dental office. 

Suggested Reading

Como, D.H., Stein Duker, L.I., Polido, J.C., & Cermak, S.A. (2020). Oral health and autism spectrum disorders: A unique collaboration between dentistry and occupational therapy. International Journal of Environmental Research and Public Health, 18(1), 135. doi: 10.3390/ijerph18010135

Ferrazzano, G.F., Salerno, C., Bravaccio, C., Ingenito, A., Sangianantoni, G., & Cantile, T. (2020). Autism spectrum disorders and oral health status: Review of the literature. European Journal of Paediatric Dentistry, 21(1), 9-12. doi: 10.23804/ejpd.2020.21.01.02 

US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research. (2012). Dental care every day: A caregiver’s guide.

Author Information

Erin Hartnett, DNP, PPCNP-BC, CPNP, FAAN
Former Program Director
Oral Health Nursing Education and Practice (OHNEP)
NYU Rory Meyers College of Nursing

Judith Haber, PhD, APRN, FAAN
The Ursula Springer Leadership Professor in Nursing
Executive Director, Oral Health Nursing Education and Practice (OHNEP)
NYU Rory Meyers College of Nursing

Jessamin Elizabeth Cipollina, MA
Program Manager
Oral Health Nursing Education and Practice (OHNEP)
NYU Rory Meyers College of Nursing