Effectiveness of a tooth-brushing programme using the picture exchange communication system (PECS) on gingival health of children with autism spectrum disorders

  • O. B. Al-BataynehEmail author
  • T. S. Nazer
  • Y. S. Khader
  • A. I. Owais
Original Scientific Article



The Picture Exchange Communication System (PECS) is a communication system for children with autism spectrum disorders (ASD). The aim of this study was to assess the effect of a PECS-based tooth-brushing programme on gingival health in children with ASD and assess parents’ perception of PECS.


This was a prospective interventional study. Using PECS as a pictures/cards series showing a structured tooth-brushing method, 37 children with ASD (31 males, 6 females) (average age 9.49 ± 4.10, 4–16 years) and their parents/caregivers were trained on tooth-brushing twice, 2 weeks apart. Data collected after examinations (baseline, 3, 6-months) included gingival and plaque indices (GI, PI) and two questionnaires (baseline, 6-months) for demographic data and parents’ perception of PECS including difficulty rating (easy, hard, very hard) and PECS usefulness.


Most children with ASD had language abilities (64.9%) and prior PECS use (67.6%). Both GI and PI significantly dropped between baseline and both re-evaluations, (P < 0.001). Age, among studied factors, significantly affected PI only at all stages (P < 0.001). Most parents/caregivers (75.7%) rated PECS as hard, but useful (100%). Age and PECS prior use significantly affected PECS difficulty rating (P  = 0.000 and 0.031, respectively), while sex did not (P  > 0.05).


PECS though rated as hard was useful in improving gingival health in children with ASD.


Autism spectrum disorder Picture exchange communication system (PECS) Tooth-brushing programme Gingival index Plaque index 



This work was supported by the Deanship of Research, at Jordan University of Science and Technology, Irbid 22110, Jordan (Grant # 20110011).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© European Academy of Paediatric Dentistry 2019

Authors and Affiliations

  1. 1.Pediatric Dentistry Division, Preventive Dentistry DepartmentJordan University of Science and TechnologyIrbidJordan
  2. 2.Department of Community Medicine, Public Health and Family MedicineJordan University of Science and TechnologyIrbidJordan

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