An ‘explosion in the mouth’: The oral health experiences of autistic children

In England, a quarter of 5-year-olds have tooth decay. For families with autistic children, establishing optimal habits (toothbrushing twice a day with fluoride toothpaste, limiting sugar intake and regular dental visits) can be difficult. Oral health experiences from the perspective of autistic children remains unexplored. Interviewing autistic children is crucial as it provides direct insights into their unique experiences and needs, ensuring their voices are represented in research. Therefore, we aimed to explore autistic children's oral health experiences, including the barriers and facilitators to optimal oral health behaviours. We sought the views of 10 autistic children (aged 7-13 years old) about toothbrushing, healthy eating and visiting the dentist, using spoken interviews and Talking Mats^®. Data were analysed using reflexive thematic analysis. Two themes were identified: (1) The diverse sensory nature of oral health activities; and (2) developing trust and routine through consistency, communication and collaboration. Our inclusive methodologies enabled autistic children with diverse communication needs to participate. Such methodologies improve the representation of autistic children in oral health research and autism-related studies more generally. The findings are informing the development of a new personalised support package to help families meet their autistic children's unique needs.Lay abstractIn England, one in four children have tooth decay by the age of 5 years. Tooth decay affects many autistic children. Communication differences, sensory sensitivities and preferred routines can make dental care difficult. Daily toothbrushing, healthy eating and drinking, and attending the dentist may be challenging for autistic children. We do not know much about how autistic children feel about looking after their teeth. Learning from them directly is important to understand their needs and make sure their voices are heard. We interviewed 10 autistic children aged between 7 and 13 years to discover how they care for their teeth, what helped and what did not. We talked about toothbrushing, healthy eating and drinking and visiting the dentist. To support our conversations, we used Talking Mats^® - a tool that can help with communication. Autistic children described a wide range of sensory issues related to looking after their teeth. This finding shows how important it is to tailor care to each child's needs. Children wanted to be included in conversations about their teeth at home and at the dentist. This was felt to make a big difference in building trust and making them feel comfortable and supported. Overall, we found Talking Mats^® can be used in dental research to engage with autistic children. By understanding children's views, we can better help professionals and parents to support their dental needs. Our research showed that every child's experience is unique, so dental support must be tailored and inclusive to meet children's needs.