Autism Spectrum Disorder (ASD, Dental Health, Oral Hygiene, Oral Health, Pediatric Nursing
Conditions
Keywords
Autism Spectrum Disorder (ASD), video modeling, peer video modeling, oral health, tooth brushing
Brief summary
This study was conducted to improve the oral hygiene habits of children with Autism Spectrum Disorder (ASD) and to compare the effects of peer video modeling and three-dimensional (3D) jaw model simulation methods. The research was carried out at Istanbul Hamit Ibrahimiye Special Education Practice School with a randomized controlled experimental design, involving 120 children aged 6-12 years. The participants were divided into three groups: peer video modeling, 3D jaw model simulation, and control. Data collection tools included a sociodemographic information form, oral and dental health knowledge form, plaque index, gingival index and tooth brushing evaluation forms. The study was evaluated based on assessments conducted at baseline, 1st month, 3rd month, and 6th month. The findings of the study revealed that the peer video modeling method significantly reduced the plaque index (p \< 0.05) and led to a notable improvement in tooth brushing skills. The improvement observed in the 3D jaw model simulation group was more limited. In terms of long-term effects, peer video modeling was found to have a lasting impact on children's oral hygiene habits (p \< 0.01). These results indicate that peer video modeling is particularly more effective in promoting tooth brushing habits among children with ASD. In conclusion, peer video modeling appears to be a more effective method for oral and dental health education in children with ASD. Future studies should examine its long-term effects in more detail across different age groups. In addition, developing guideline materials for parents and educators may be beneficial.
Interventions
OTHERPeer video modeling
After obtaining written parental consent and demographic data, the study protocol is implemented. Oral examinations are conducted in the school infirmary by a pediatric dentist, under the researcher's supervision, using disposable materials. The number of teeth, caries and fillings, plaque index scores, and gingival health are recorded. Children and their parents then watch a 14-step toothbrushing instructional video in a separate classroom, in which a healthy 12-year-old boy demonstrates proper brushing behaviors with verbal instructions. Following the video, children practice brushing using a mirror and materials provided by the researcher. Performance is assessed using a 14-step tool scored from 0 to 3, and parents receive individualized feedback. For the peer video modeling group, a WhatsApp group is created, and parents are instructed to show the video daily before brushing. Assessments are conducted at baseline and at 1, 3, and 6 months using plaque and gingival indices.
OTHER3D jaw video modeling
After obtaining written parental consent and demographic data, the study protocol is implemented. Oral examinations are conducted in the school infirmary by a pediatric dentist under researcher supervision using disposable materials. The number of teeth, caries and fillings, plaque index scores, and gingival health are recorded. Children and their parents then watch a 14-step toothbrushing instructional video in a separate classroom, in which a 3D jaw model demonstrates proper brushing behaviors with verbal instructions. Following the video, children practice brushing using a mirror and materials provided by the researcher. Performance is assessed using a 14-step tool scored from 0 to 3, and parents receive individualized feedback. For the peer video modeling group, a WhatsApp group is created, and parents are instructed to show the video daily before brushing. Assessments are conducted at baseline and at 1, 3, and 6 months using plaque and gingival indices.
Sponsors
Ministry of Health, Turkey
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
DOUBLE (Caregiver, Outcomes Assessor)
Masking description
The pediatric dentist who conducted the examinations, the special education teacher who assigned the groups, and the statistician were all blind to the study.
Eligibility
Sex/Gender
ALL
Age
6 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
* The child responds to their name when called. * The child maintains eye contact for at least 2-5 minutes. * The child follows simple instructions (e.g., come, sit, open-close mouth). * The child can use at. least one reward (food, toy, or verbal). * No sensory hypersensitivity. * No antibiotic use in the last month. * No additional plaque control application in the last 5 months. * At least 20 teeth present. * Not undergoing orthodontic treatment. * No systemic diseases affecting oral health (e.g., Down syndrome, diabetes). * Average intelligence level comparable to peers. * Able to brush teeth independently.
Exclusion criteria
* Inability to sit in a specific place for 10 minutes. * Refusal of physical contact (mouth, face, body). * Severe autism (Grade 3). * Mental retardation. * Lack of parental consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Modified silness-löe plaque ındex (mPLI) | Baseline, 1.,3., and 6. months | Dental plaque accumulation was assessed using the Modified Silness-Löe Plaque Index (mPLI), a widely used tool for evaluating plaque presence on tooth surfaces, particularly suitable for pediatric and special needs populations. In accordance with the FDI tooth numbering system and expert consultation, six index teeth (3 buccal, 8 buccal, 14 buccal, 19 lingual, 24 buccal, and 30 lingual) were selected. Both buccal and lingual surfaces were examined. Each surface was scored on a 4-point scale (0 = no plaque; 1 = plaque detectable by probe; 2 = visible plaque; 3 = abundant plaque). The individual plaque score was calculated by dividing the total score by the number of surfaces examined. Scores were categorized as no (\<0.1), mild (0.1-1.0), moderate (1.1-2.0), or severe (2.1-3.0) plaque accumulation. |
| Gingival Index (GI) | Baseline, 1., 3., and 6. months | Gingival health was assessed using the Silness-Löe Gingival Index, a validated tool used to evaluate gingival inflammation and overall periodontal health. Gingival inflammation was measured by gently probing four gingival surfaces of each selected tooth with a WHO periodontal probe, applying a force not exceeding 20 g. Each surface was scored on a 4-point scale (0-3). The individual gingival index score was calculated by dividing the total score by the number of surfaces examined. Scores were classified as no (\<0.1), mild (0.1-1.0), moderate (1.1-2.0), or severe (2.1-3.0) inflammation. |
| Toothbrushing assessment form | Baseline, 1., 3., and 6.months | Toothbrushing performance was assessed using a structured 14-step protocol designed to evaluate toothbrushing skills and independence in oral hygiene practices, based on national guidelines and relevant literature. Each step was scored on a 4-point scale (0 = not completed, 1 = completed with caregiver assistance, 2 = completed with verbal guidance, 3 = completed independently). The overall score was calculated by dividing the total score by 14. The protocol includes essential brushing steps, such as cleaning anterior teeth and right and left posterior teeth in both jaws. This tool enables the systematic assessment of brushing accuracy, skill acquisition, and level of independence in children. |
Countries
Turkey (Türkiye)
Outcome results
None listed