Parent Training for Dental Care in Underserved Children With Autism: An RCT

OBJECTIVES Children with autism spectrum disorder (ASD) have difficulty participating in dental care and experience significant unmet dental needs. We examined the efficacy of parent training (PT) for improving oral hygiene and oral health in underserved children with ASD. METHODS Families of Medicaid-eligible children with ASD (ages 3 to 13; 85% male, 62% with intellectual disability) reporting difficulty with dental care participated in a 6-month randomized controlled trial comparing PT (n = 60) to a psychoeducational Toolkit (n = 59). Primary outcomes were parent-reported frequency of twice-daily tooth brushing and dentist-rated visual plaque. Secondary outcomes included parent-reported child behavior problems during home oral hygiene and dentist-rated caries. Dentists were blind to intervention assignment. Analyses were intent-to-treat. RESULTS Retention was high at post-treatment (3 months; 93%) and at 6-month follow-up (90%). Compared to the Toolkit, PT increased twice-daily tooth brushing at 3 months (78% PT vs. 55% Toolkit, P<.001) and 6 months (78% PT vs. 62% Toolkit, P=.002), and reduced plaque at 3 months (-0.19, 95% CI, -0.36 to -0.02, P=.03). PT decreased child problem behaviors at 3 (-0.90, 95% CI, -1.52 to -0.28, P=.005) and 6 months (-0.77, 95% CI, -1.39 to -0.14, P=.02) relative to the Toolkit. Children receiving PT also developed comparatively fewer caries over 3 months (ratio of rate ratios = 0.73, 95% CI, 0.54 to 0.99, P=.04). CONCLUSIONS Parent training represents a promising approach for improving oral hygiene and oral health in underserved children with ASD at risk for dental problems.