The challenges of dentists in the care of children with Autism Spectrum Disorder: integrative reviewABSTRACT
Objective: The aim of this study was to exemplify the dental management of dentists as an indispensable role in the management and treatment of pediatric patients with Autism Spectrum Disorder.
Methods: This study is an integrative review, with a search in the Virtual Health Library and PubMed databases. Studies from 2015 to 2025, in Portuguese and English, with full and free text were included.
Results: After screening, nine articles met the eligibility criteria and made up the final sample, in which observational and descriptive studies predominated, which addressed behavioral, sensory, and interaction difficulties, in addition to management techniques, use of sedation, and the impact of oral diseases on the quality of life of these patients.
Conclusion: Therefore, the main difficulties in dental care for children with Autism Spectrum Disorder involve limitations in communication and social interaction, compromising the success of treatment and oral health. The importance of trained professionals, the use of behavioral management techniques, and the adequacy of the clinical environment are highlighted. In addition, the lack of knowledge of parents about oral care and retention techniques reinforces the need for educational actions and effective communication to improve the experience and results of care.
Indexing terms
Autistic disorder; Dental care; Pediatric dentistry
RESUMO
Objetivo: Objetivou-se exemplificar o manejo odontológico dos cirurgiões-dentistas como um papel imprescindível na conduta e tratamento de pacientes infantis com Transtorno do Espectro Autista.
Métodos: Este estudo trata-se de uma revisão integrativa, com busca nas bases de dados Biblioteca Virtual em Saúde e PubMed. Foram incluídos estudos de 2015 a 2025, em português e inglês, com texto completo e gratuito.
Resultados: Após a triagem, nove artigos atenderam aos critérios de elegibilidade e compuseram a amostra final, no qual predominaram estudos de caráter observacional e descritivo, os quais abordaram dificuldades comportamentais, sensoriais e de interação, além de técnicas de manejo, uso de sedação e impacto das doenças bucais na qualidade de vida desses pacientes.
Conclusão: Sendo assim, as principais dificuldades no atendimento odontológico de crianças com Transtorno do Espectro Autista envolvem limitações na comunicação e na interação social, comprometendo o sucesso do tratamento e a saúde bucal. Destaca-se a importância de profissionais capacitados, o uso de técnicas de manejo comportamental e a adequação do ambiente clínico. Além disso, a falta de conhecimento dos pais sobre cuidados bucais e técnicas de contenção reforçam a necessidade de ações educativas e a comunicação eficaz para melhorar a experiência e os resultados do atendimento.
Termos de indexação
Transtorno do Espectro Autista; Assistência odontológica; Odontopediatria
INTRODUCTION
Autism Spectrum Disorder (ASD) is characterized, according to the Diagnostic and Statistical Manual of Mental Disorders, as a range of variations in social interaction, presenting diverse symptoms that impact development to varying degrees of severity. These situations reflect premature difficulties in social and communicative interaction, corroborating patterns of restricted and repetitive behavior and interests [1].
According to DSM-5 data, ASD is usually noticed during the second year of life (12 to 24 months), although it can be perceived earlier. Thus, the first symptoms observed reflect the extent of gradual or relatively rapid development in social behaviors or language use. Furthermore, with the development of a child with ASD, some symptoms are persistent, such as: repetitive motor movements, insistence on routine or ritualized patterns of verbal or nonverbal behavior, fixed and highly restricted interests that are abnormal in intensity or focus, and hyper- or hyporeactivity to sensory stimuli or unusual interest in sensory aspects of the environment [1].
In the early 1990s, there were approximately 1 in 1,500 individuals diagnosed with ASD [2]. However, more recent studies reveal an estimated percentage of children with ASD at 1 in 160 globally; consequently, it is also highlighted that research conducted in the last 50 years points to a significant increase in this statistic with an expected trend of continuous growth, according to the Pan American Health Organization [3].
From this perspective, children with ASD often exhibit atypical behavior in the dental field, which makes adequate clinical care and investigation difficult. This difficulty is often linked to strange lights, sounds, tastes, and smells routinely encountered in a dental health service [4,5]. Thus, due to poor oral hygiene, linked to few or no preventive instructions, early dental caries develops, as well as the emergence of possible periodontal diseases [6].
Furthermore, it is important to emphasize that autistic children generally exhibit uncooperative behaviors, such as crying or physical aggression, during visits to the dentist, in addition to demonstrating fear due to new visual and auditory stimuli that can contribute to developing anxiety. Because of this, parents choose not to take their children for routine checkups due to the behavior they exhibit and to protect them from behavioral situations [7,8].
Therefore, during the care of children with ASD, it is necessary to develop more adapted and specific strategies to increase the success rate of dental care [9]. To this end, it is important to have different behavioral interventions, including child-centered play, systematic desensitization and cognitive-behavioral therapy, modeling, relaxation, techniques derived from pediatric dentistry, for example, desensitization, positive-negative reinforcement, and tell-show-do. These strategies aim to improve the ability of children with ASD to receive dental treatment and oral health care [10,11].
Dental care and oral health for children with ASD were areas that required special procedures and adaptations due to poor oral hygiene and severe dental diseases in this population [12].
Furthermore, with inadequate communication, children with ASD often have difficulty reporting discomfort or pain caused by dental diseases. For this reason, it is difficult for the patient to understand verbal messages that prioritize calming and reassuring them, as well as those that aim to demonstrate what will happen during dental procedures. Finally, with compromised communication, inadequate communication strategies are generated that can turn into behavioral problems [13].
Therefore, this research is justified by the aim of understanding the challenges and difficulties that the dentist faces with patients with ASD, due to treatment aversion because of behavioral, sensory factors, interaction difficulties, and anxiety depending on the degree of the disorder. As a consequence, oral health complications arise, such as caries lesions and periodontal diseases, impacting well-being.
Therefore, in order to clarify the topic, the following research question was developed: How should dentists act when treating children with ASD? Given the above, this study aimed to exemplify the dental management of dentists as an essential role in the conduct and treatment of pediatric patients with ASD. Furthermore, it is possible to understand the characteristics and main limitations, alongside the techniques and resources used, denoting a viable alternative and contributing to the success of the treatment.
METHODS
To conduct and systematize the literature review, it will be necessary to go through some distinct steps: identification of the theme, establishment of eligibility criteria for studies, systematized search in various sources of information, data collection, analysis, discussion and synthesis of knowledge [14].
The bibliographic collection search was carried out in the following databases: Virtual Health Bibliography (VHL), Medical Literature Analysis and Retrieval System Online (MedLine) via (PubMed). The following descriptors will be used, based on the Terminologies in Health Sciences (DeCS Health) in the languages Portuguese and English, namely: Pediatric Dentistry, Childhood Autism and Dental Care. In this way, the Descritores em Ciência da Saúde (DeCS, Health Sciences Descriptors) terms will be joined in the terminology “AND” for the purpose of relating the studies analyzed.
The inclusion and exclusion criteria were the second step in planning and choosing a search alternative, which aimed to establish coherence with the previously established research problem [15].
Thus, the inclusion criteria defined for the selection of articles were: articles published in Portuguese and English, full texts and free access available in electronic collections, published in the last ten years (2015-2025).
These studies could be literature reviews, case studies, experience reports, descriptive observational or randomized studies, as long as they addressed the theme related to the review.
Furthermore, the exclusion criteria were based on incomplete articles, abstracts, paid articles, articles published more than ten years ago, and those that do not fit the thematic axis of the review. Thus, tables were created to facilitate the reader’s visualization, containing relevant information from the articles, such as year, title, authors, and main findings to aid in the reader’s visualization.
The initial search yielded 93 articles, among them 63 that were outside the thematic scope, leaving 30 manuscripts, of which, based on the application of methodological criteria, 21 manuscripts were excluded because they were not freely available, including 1 due to duplication, and did not address the proposed theme, leaving only 9 works (figure 1).
RESULTS
The chart 1 shows the number of articles selected from the databases after applying the proposed methodology.
This literature review analyzed nine studies published between 2015 and 2025 that investigate the challenges faced by dentists in treating children with Most studies were cross-sectional (n=4), followed by one observational study (n=1), one quantitative study (n=1), and one clinical case study (n=1), highlighting the predominance of observational and descriptive research in this area. Only two studies were classified as literature reviews (n=2). The selected articles primarily address obstacles related to behavioral and sensory factors, interaction difficulties, and high levels of anxiety that hinder dental treatment. Furthermore, they discuss management and sedation techniques, parents’ level of knowledge about oral health, and the most frequent consequences, such as caries and periodontal diseases, that negatively impact the quality of life of children with ASD.
DISCUSSION
As studies in the field have pointed out, the performance of dentists when treating children with ASD requires an understanding of multiple factors. Among these, the behavioral characteristics and limitations inherent to the disorder, the oral hygiene care performed in the home environment, the level of knowledge of parents and/or guardians, as well as the professional themselves, and the conduct adopted during dental care stand out. In this context, clinical management, specific techniques, and adapted resources become fundamental to promoting effective, safe, and humanized care.
It is unanimous among the authors that providing oral care, both at home and in dental settings, for individuals with ASD represents a major challenge. Several sensory factors act as irritants and can generate aversion to treatment, such as loud sounds (including tone of voice), bright lights, characteristic odors of the office, closed environments, noise from instruments, and the presence of many people in the place [16,17].
Furthermore, frequent communication deficits and heightened sensory sensitivities in children with ASD impose significant obstacles on parents, in addition to poor manual dexterity and cooperation, making it difficult to perform adequate oral hygiene to remove bacterial plaque [18]. Another factor that contributes to the higher prevalence of caries and periodontal diseases in this group is the dietary preference for soft and sugary foods as positive reinforcement, coupled with the habit of keeping food in the mouth for long periods and limitations in the oral hygiene routine, such as resistance and aversion to the sensation of toothpaste and toothbrush in the mouth [16,17].
In parallel, one of the studies analyzed the dental histories of children with ASD and identified that most parents reported difficulties in supervising their children’s oral hygiene, in calming them before dental appointments, and frequently sought professional care only when complaining of pain. These factors end up contributing to increased anxiety in the child and hinder the success of dental treatment [18,19]. As a result, it was observed that children with ASD had higher rates of tooth extractions, followed by restorations and consultations, in contrast to children without the disorder, in whom restorative and preventive procedures were more prevalent [17].
In this context, the importance of the dentist in preventing oral diseases is observed, providing guidance on diet, proper hygiene, and restoring oral health for children with ASD. However, a large proportion of professionals considered their level of knowledge about the dental approach insufficient for this group, with a significant portion being newly graduated [20]. Therefore, proper management by the dentist is essential, along with techniques to reduce anxiety and improve acceptance during treatment [21].
According to the literature, several techniques have proven effective in reducing anxiety and increasing the cooperativeness of children with ASD during dental care. Conventional management strategies include the “tell-show-do” method, voice control, nonverbal communication, and positive reinforcement. However, considering the limitations in expressive communication typical of this group, new approaches have been suggested to promote more cooperative and predictable behavior. Among them, the use of visual resources, behavioral training and modeling, image display, story reading, and desensitization techniques stand out [21].
Autism Spectrum Disorder (ASD) in a Sensory Adapted Office, compared to the conventional environment. In the visual domain, all fluorescent lights and the dental reflector were turned off, and a directional light, attached to glasses, was used to avoid direct incidence on the eyes. Slow-motion images, such as bubbles or aquatic scenes chosen by the child or parents, were projected onto the ceiling in order to promote a more comfortable and less stressful environment. Additionally, parents read a personalized social story to their children over 15 days in order to familiarize them with the upcoming dental appointment. As a result, the adapted office showed a lower frequency and duration of behaviors indicative of distress, being a potential technique to support care and improve successful experiences for this population [21,22].
Furthermore, it is important to highlight advanced techniques in response to the lack of success in the aforementioned techniques, including protective stabilization, conscious sedation, and deep sedation [23]. Thus, conscious sedation options can be used as a complement in the dental treatment of autistic children, the main ones being nitrous oxide (N2O) inhalation, anxiolytic medications (Midazolam, Diazepam), and, in severe cases, the use of general anesthesia [24].
From this perspective, parental interest in dental management techniques in children with ASD can generate controversy due to a lack of adequate understanding, which can result in delays in starting treatment and additional harm to the care of these children [18]. Moreover, a significant lack of knowledge and acceptance on the part of parents regarding advanced restraint and sedation techniques was observed, especially among those who have children with ASD. These data highlight the need for greater awareness and parental education, with the aim of expanding therapeutic possibilities and promoting greater cooperation during dental care [23].
CONCLUSION
We concluded that the main difficulties faced in providing dental treatment to children with ASD were limitations in communication and challenges in social interaction between dentist and patient, hindering the construction of an effective relationship and negatively impacting the success of the treatment, which can significantly compromise oral health, favoring the development of dental caries and periodontal diseases.
The scientific evidence from this review highlights the importance of specific dental care for children with ASD, performed by professionals trained in behavioral management techniques and special education. Strategies such as the “tell-show-do” method, nonverbal communication, voice control, positive reinforcement, and distraction techniques are fundamental desensitization techniques. In necessary cases, physical restraint, medication, or general anesthesia may be used. In addition, it is essential that dental offices are adequately equipped to offer safe and humane care.
Furthermore, the study highlights a significant lack of knowledge among parents regarding oral health care for children with ASD, specifically concerning brushing, cariogenic diet, and difficulty accepting certain restraint or sedation techniques. This finding indicates the need for targeted educational efforts to improve parents’ understanding of these techniques, promoting open communication and shared decision-making, which can lead to better dental care experiences for children with ASD.
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How to cite this article
Oliveira AA, Sousa FPL, Leal ES, Barbosa IMA. The challenges of dentists in the care of children with Autism Spectrum Disorder: integrative review. RGO, Rev Gaúch Odontol. 2026;74:e20260011. http://dx.doi.org/10.1590/1981-86372026001120250054
Data Availability
The research data are available in the body of the document.
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Edited by
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Assistant editor
Luciana Butini Oliveira
Note: BVS: Biblioteca Virtual em Saúde. Source: Elaborated by the authors (2025).