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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

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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

Keywords

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

Notes

Acknowledgements

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.

References

  1. Al-Batayneh OB, Owais AI, Al-Saydali MO, Waldman HB. Traumatic dental injuries in children with special health care needs. Dent Traumatol. 2017;33:269–75.CrossRefGoogle Scholar
  2. Ashwood P, Wills S, Van de Water J. The immune response in autism: a new frontier for autism research. J Leukoc Biol. 2006;80:1–15.CrossRefGoogle Scholar
  3. Bondy A, Frost L. PECS: the picture exchange communication system training manual. Brighton: Pyramid Educational Consultants; 1994.Google Scholar
  4. Charlop-Christy MH, Carpenter M, Le L, LeBlanc LA, Kellet K. Using the picture exchange communication system (PECS) with children with autism: assessment of acquisition, speech, social communicative behavior and problem behavior. J Appl Behav Anal. 2002;35:213–31.CrossRefGoogle Scholar
  5. DeMattei R, Cuvo A, Maurizio S. Oral assessment of children with an autism spectrum disorder. J Dent Hyg. 2007;81:65.PubMedGoogle Scholar
  6. Eslami N, Movahed T, Asadi M. Parents’ perceptions of the oral health-related quality of life of their autistic children in Iran. J Clin Pediatr Dent. 2018;42(6):422–6.CrossRefGoogle Scholar
  7. Jaber MA. Dental caries experience, oral health status and treatment needs of dental patients with autism. J Appl Oral Sci. 2011;19:212–7.CrossRefGoogle Scholar
  8. Kasari C, Patterson S. Interventions addressing social impairment in autism. Curr Psychiatry Rep. 2012;14:713–25.CrossRefGoogle Scholar
  9. Kopycka-Kedzierawski DT, Auinger P. Dental needs and status of autistic children: results from the National Survey of Children’s Health. Pediatr Dent. 2008;30:54–8.PubMedGoogle Scholar
  10. Kravits TR, Kamps DM, Kemmerer K, Potucek J. Brief Report: increasing communication skills for an elementary-aged student with autism using picture exchange communication system. J Autism Dev Disord. 2002;32:225–30.CrossRefGoogle Scholar
  11. Lerna A, Esposito D, Conson M, Massagli A. Long-term effects of PECS on social-communicative skills of children with autism spectrum disorders: a follow-up study. Int J Lang Commun Disord. 2014;49:478–85.CrossRefGoogle Scholar
  12. Löe H, Silness J. The gingival index, the plaque index and retention index systems. J Periodontol. 1967;38:610–6.CrossRefGoogle Scholar
  13. Marshall J, Sheller B, Williams BJ, Mancl L, Cowan C. Cooperation predictors for dental patients with autism. Pediatr Dent. 2007;29:369–76.PubMedGoogle Scholar
  14. Mayer Johnson. B 150 PECS Book 4 autism ABA, speech therapy, ADHD, language & apraxia aspergers. 2010, USA.Google Scholar
  15. Mirenda P, Mathy-Laikko P. Augmentative and alternative communication applications for persons with severe congenital communication disorders: an introduction. Augment Altern Commun. 1989;5(1):3–13.CrossRefGoogle Scholar
  16. Morales-Chávez MC. Oral health assessment of a group of children with autism disorder. J Clin Pediatr Dent. 2017;41:147–9.CrossRefGoogle Scholar
  17. Murshid E. Oral health status, dental needs, habits and behavioral attitude towards dental treatment of a group of autistic children in Riyadh, Saudi Arabia. Saudi Dent J. 2005;17:133–9.Google Scholar
  18. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml. Accessed Sept 2018.
  19. Pawlaczyk-Kamieńska T, Torlińska-Walkowiak N, Borysewicz-Lewicka M. The relationship between oral hygiene level and gingivitis in children. Adv Clin Exp Med. 2018;27:1397–401.CrossRefGoogle Scholar
  20. Pilebro C, Backman B. Teaching oral hygiene to children with autism. Int J Paediatr Dent. 2005;15:1–9.CrossRefGoogle Scholar
  21. Quill KA. Teaching children with autism: strategies to enhance communication and socialization. Albany: Delmar Publishers Inc.; 1995.Google Scholar
  22. Sarnat H, Samuel E, Ashkenazi-Alfasi N, Peretz B. Oral health characteristics of preschool children with autistic syndrome disorder. J Clin Pediatr Dent. 2016;40:21–5.CrossRefGoogle Scholar
  23. Schwartz IS, Garfinkle AN, Bauer J. The picture exchange communication system: communicative outcome for children with autism. Topics Early Child Spec Educ. 1998;18:144–59.CrossRefGoogle Scholar
  24. Scottish Intercollegiate Guideline Network, Dental interventions to prevent caries in children. March 2014. http://www.sign.ac.uk/assets/sign138.pdf. Accessed 28 Aug 2019.
  25. Stein LI, Polido JC, Mailloux Z, Coleman GG, Cermak SA. Oral care and sensory sensitivities in children with autism spectrum disorders. Spec Care Dentist. 2011;31:102–10.CrossRefGoogle Scholar
  26. Thomas N, Blake S, Morris C, Moles DR. Autism and primary care dentistry: parents’ experiences of taking children with autism or working diagnosis of autism for dental examinations. Int J Paediatr Dent. 2018;28:226–38.CrossRefGoogle Scholar
  27. Waldman HB, Perlman SP, Wong A. The largest minority population in the U.S. without adequate dental care. Spec Care Dentist. 2017;37:159–163.CrossRefGoogle Scholar
  28. World Health Organization. Oral health surveys, basic methods. Geneva: World Health Organization; 1997. p. 4.Google Scholar

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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