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Can researchers enhance the dental experience for children with autism?

Record-setting grant will help USC division study sensory stimuli that lessen a child’s anxiety during oral care.

Kaleidoscopic lighting effects are projected onto the ceiling of a dental office. (Photo/John Hobbs)
Kaleidoscopic lighting effects are projected onto the ceiling of a dental office. (Photo/John Hobbs)

A five-year, $3.1 million National Institutes of Health research grant has been awarded to further study an intervention that adapts sensory stimuli inside a dental office to decrease children’s anxiety and negative responses during oral care. This is the largest-single research grant awarded in the history of the USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy.

Professor Sharon Cermak will be the principal investigator of the Sensory Adapted Dental Environments to Enhance Oral Care for Children, or “SADE-2” study, funded by the National Institute of Dental and Craniofacial Research (NIDCR). SADE-2 is a continuation of Cermak’s research that has been funded by an NIDCR planning grant since 2011.

The randomized controlled trial will enlist 220 children —110 of whom have autism spectrum disorder (ASD) — and measure both their physiological anxiety and uncooperative distressed behaviors during dental cleanings. These responses to a typical dental environment will be compared to those elicited in a sensory adapted dental environment providing visual, auditory and tactile stimulation during dental treatment.

Examples of sensory alterations include kaleidoscopic lighting effects projected onto the ceiling, rhythmic music played through speakers and a “butterfly wrap” which envelops the child’s body with a calming “hugging” pressure.

What works?

Cermak and her team want to better understand why the adapted dental setting works and for which children it will be the most effective.

“We want to look at if it’s more effective for younger children or older children — or is it more effective for children with sensory issues or anxiety issues,” Cermak said. “Or is it more effective for higher-functioning children or children who may be lower functioning — and does that make a difference?”

As many parents can testify, distressing experiences at the dentist are common. According to a 2010 survey of nearly 400 parents of children with autism, almost two-thirds reported “moderate to extreme” difficulty with oral cleaning at the dental office. A 2012 study conducted by a team of USC researchers found that 18 percent of parents of children with autism reported the use of restraint “often” or “almost always” during dental visits.

“A lot of kids are really afraid of going to the dentist,” Cermak said. “All of these factors are really uncomfortable for children, particularly those with autism,” who are more sensitive to stimuli.

If successful, the intervention has the potential to transform clinic-based dental care for the growing population of children with ASD, as well as for typically developing children with dental anxiety and/or sensory over-responsivity. Not only does it have potential to increase comfort for children during oral care, the researchers will also examine whether the sensory adapted environment might facilitate safer, more efficient and less costly dental treatments.

The SADE-2 study continues building upon Cermak’s previous pilot research conducted from 2011 to 2015, the preliminary positive results of which were published in the May/June issue of the American Journal of Occupational Therapy.

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Can researchers enhance the dental experience for children with autism?

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