Oral health care guidance to enhance parent confidence and ability to improve toothbrushing performance for autistic children
Research type
Research Study
Full title
Oral health care guidance to enhance parent confidence and ability to improve toothbrushing performance for autistic children.
IRAS ID
331171
Contact name
Jennifer Parry
Contact email
Sponsor organisation
Sussex Community NHS Foundation Trust
Clinicaltrials.gov Identifier
Duration of Study in the UK
0 years, 11 months, 1 days
Research summary
Parents of autistic children have reported a lack of understanding by oral health care staff around delivery of oral health preventive habits for their children.
This study aims to investigate if oral healthcare training utilising the Mini Mouth Care Matters (MCM) programme designed for Special Education Settings (SES) enhances parent confidence in their ability to influence their child’s oral health, increases toothbrushing episodes and reduces challenging toothbrushing behaviour of autistic children.
The participants of this study will be parents of children who have a confirmed professional diagnosis of Autistic Spectrum Disorder. Parents will be recruited via healthcare professionals who provide oral health promotion within SES.
Special Education Settings will be randomised into one of two groups. Group one will receive 'delivering better oral health' advice. Group two will receive the MCM user intervention guide for oral healthcare.
A maximum of 30 parents will be recruited into each intervention arm. A maximum of 60 parents will be recruited to the study.
Lay summary of study results: Study Title: Oral health care guidance to enhance parent confidence and ability to improve toothbrushing performance for autistic children.
This study was carried out by staff working for the Special Care Dental Service of Sussex Community NHS Foundation Trust. The sponsor for this study was the Research Manager of Sussex Community NHS Foundation Trust. Funding for this study was obtained from the Oral and Dental Research Trust - Colgate Robin Davis Award 2023.
The Kent, Surrey and Sussex Young People’s Advisory Group (YPAG) was involved at the study planning stage. The YPAG suggestions were:
1.Dentists and dental teams should listen to parents and carers of autistic young people about dental fears and dental issues.
2. Parents and carers of autistic young people are likely to be in the best position to understand the dental health support needed by their autistic children.
The study took place in schools in West Sussex and Brighton and Hove (England). The research was needed because many parents of autistic children say that toothbrushing can be a major source of stress for autistic children and their families. Parents of autistic children often say that dentists and dental teams do not recognise the stress and challenges of toothbrushing and do not provide useful advice.
The main study questions were:
1. Is toothbrushing advice with strategies to help children cope with the sensations and challenges of toothbrushing better that traditional toothbrushing advice for families of autistic children?
2. What are the attitudes of parents of autistic children towards toothbrushing, sugar snacking and dental cavities?Twelve schools took part in the project. Fifty-two parents participated. Each participant represented one autistic child. The age range of children was from 3-years to 15-years. Sixteen children were female and 36 were male. Fifteen children were described by their parents as having a complex learning disability in addition to autism.
Schools taking part in the study were randomly divided into two groups.
School group 1 parents attended a study workshop and were given traditional toothbrushing advice (parents or carers should brush their children’s teeth twice a day, last thing at night / before bedtime and on one other occasion with a toothpaste containing appropriate fluoride level. Thorough cleaning may take at least 2 minutes).
School group 2 parents attended a study workshop which concentrated on tips and strategies to help children cope with sensations and challenges of toothbrushing.
Both groups were given a Tooth Care Pack with toothbrushes and toothpaste listed as useful in The Clinical Standard for oral healthcare for autistic children and young people and/or those with a learning disability in special educational settings published by NHS England in 2023.
Parents in both groups completed questionnaires about their attitudes towards toothbrushing, sugar snacking and dental cavities, and how their child coped with toothbrushing.Fifty-one parents provided information about pre-study toothbrushing habits for their child. Forty-eight parents used a toothbrush, two parents used their finger, and one parent reported that nothing was possible. Forty-six parents reported using toothpaste. Seventeen (33%) parents selected a non-mint toothpaste for their child. Twenty-seven parents (52%) reported brushing their child’s teeth twice daily.
The results were examined to look for the influence of the workshops in bringing about changes in twice-a-day toothbrushing and duration of toothbrushing.
Pre-study parental attitude scores towards toothbrushing, sugar snacking and dental cavities were examined.
The number of parents toothbrushing twice-a-day in Group 1 (traditional advice) did not change after attending workshops. The number of parents toothbrushing twice-a-day in Group 2 (tips to cope with sensations) increased post-study. The change in number of parents toothbrushing twice-a-day in Group 2 was not statistically significant.
Pre-study daily brushing time was approximately half the traditionally recommended 4 minutes (2 minutes twice daily). Post-study there was evidence of increased mean daily toothbrushing time in group 2 (tips to cope with sensations) and slight decrease in mean toothbrushing time group 1 (traditional advice). Mean toothbrushing time post-study remained below two minutes twice daily in both groups.
Parental attitude scores to toothbrushing, sugar snacking and dental cavities suggested that parents considered that having dental cavities was a serious problem for children. High scores were associated with parents aiming to brush teeth and control sugars in food and drink. Moderate scores were recorded for parental belief in their ability to carry out their planned aims of toothbrushing and sugar control.
Parent feedback gathered during the study emphasised the need to recognise difference and provide choice to tackle toothbrushing challenges for autistic children and young people.
This study has been submitted and accepted for publication in the Journal of the British Society of Special Care Dentistry. The anticipated publication date is April 2026.REC name
East Midlands - Leicester Central Research Ethics Committee
REC reference
23/EM/0277
Date of REC Opinion
3 Jan 2024
REC opinion
Further Information Favourable Opinion