Salivary antioxidants and oral health in children with autism

Abstract

Individuals with autism vary widely in abilities, intelligence, and behaviours. Autistic children have preferences for soft and sweetened food making them susceptible to caries. A wide spectrum of medical and behavioural symptoms is exhibited by children with autism, which makes routine dental care very difficult in them. Mental retardation is evident in approximately 70% of individuals with autism and most psychiatric disorders including autism are associated with increased oxidative stress.

Objectives

To evaluate the oral health status of children with autism and to determine the salivary pH and total salivary antioxidant concentration (TAC).

Materials and methods

101 subjects with autism between age group of 6 and 12 year were part of the study and 50 normal healthy siblings of same age group were taken as control group. Oral health status was analysed using oral hygiene index-simplified and dentition status index. The salivary total anti-oxidant level was estimated using phosphomolybdic acid using spectrophotometric method and the salivary pH using the pH indicating paper. The results were statistically analyzed using Mann–Whitney U test.

Results

A statistically very highly significant difference was seen in the mean oral hygiene index scores (autistic group – 1.2 and control group – 1, P < 0.001) and the mean salivary total antioxidant concentration (autistic group – 5.7 μg/ml and control group – 38 μg/ml, P < 0.001). No statistical significant difference was observed in the dental caries status and the salivary pH of autistic group and the control group.

Conclusions

Similar dental caries status was observed in children with autism and their healthy normal siblings. Oral hygiene was poor in children with autism whereas the Salivary TAC was significantly reduced in autistic children.

Introduction

Autism is a complex neurological disorder which compromises of physical, psychological, emotional and social components. Individuals with autism vary widely in abilities, intelligence, and behaviours. There are enormous variations in the behavioural patterns and the severity of illness among individuals with autism.¹

Autistic children have preferences for soft and sweetened food2, 3 making them susceptible to caries. Speculation that the lack of one of the protective mechanisms may pose a threat to the oral health of children with autism. Various studies4, 5 have found no or little difference in the caries status of children with autism when compared with normal healthy individual thereby necessitating the need to assess the protective role of saliva.

A wide spectrum of medical, psychological and behavioural symptoms is exhibited by children with autism, which makes routine dental care very difficult in them.⁶ This behavioural and physical conditions limits these patients from maintaining a good oral hygiene.

Most psychiatric disorders including autism are associated with increased oxidative stress.⁷ The behaviour pattern of these children exhibiting temper tantrums, hyperactivity, self injurious behaviour and their inability to express themselves due to impaired communication and emotional reciprocity further increases the stress levels and may alter the antioxidant levels and general well being of the individual.

As there is paucity of studies on autism and there is little or very few facts available on the oral health status and dental needs of children with autism in India, hence, relevance of this study. Hence, the need to evaluate the oral health status, salivary pH and salivary total antioxidant concentration of these children.