3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Evaluating the effectiveness of behaviour guidance intervention on tolerance for dental treatment in autistic children from a Johannesburg school(2017) Crous, StephanusIntroduction: The prevalence of Autism Spectrum Disorder is increasing exponentially with most affected individuals coming from middle and low-income countries. Managing this condition throughout a lifetime is costly and therefore the World Health Organization (WHO) has called for cost-effective behavior management solutions that can be used by non-professionals in lower resource settings. Dental care is the highest unmet health care need in individuals with special health care needs, autism being the most prominent. The objective of this study was to investigate the effectiveness of two behaviour guidance techniques, a visual schedule and social story, in facilitating successful dental treatment and to describe the relationship between oral health status and level of functioning. Materials and Methods: A cluster randomised controlled trial (CRCT) was implemented to evaluate the effectiveness of a specific combination of behavioural interventions: a social story and visual schedule on oral health examination and treatment outcomes. Twenty-five classes were randomized from the low, middle and high support levels to the control or intervention arms. The primary outcomes of interest were: sitting in the dental chair, cooperative behavior as rated by the Frankl scale and the number of fissure sealants placed. In addition, the oral health status was measured for the high, middle and low support groups. The intervention was administered by classroom teachers daily for two weeks prior to the dental visit. Intention-to- treat analysis was conducted. Data were analyzed using t-tests, ANOVA and chi-squared tests to compare the intervention and control groups. Multivariate models were built to test the hypothesis that the oral health status differed by level of support while controlling for age. Results: One-hundred and sixty-five children from the 25 classes obtained parental consent to participate in the study. There were no differences between the study arms for the outcome of sitting in the dental chair (p=0.6) or the number of fissure sealants placed (‘Fisher’s exact’ p = 0.24). However, the evidence suggests that the intervention group performed marginally better and more dental treatment was possible over a longer period of time, (‘Fisher’s Exact’ p = 0.057). There was a significant difference between the treatment and control arms in behavior as measured by the Frankl scale where the control groups displayed more cooperative behavior (‘Fisher’s exact’; p=0.014). When analyzing these outcomes against the level of support, significant differences was found showing that as the level of support needed to function increases, children became increasingly more uncooperative during sitting in the dental chair, behavior was more uncooperative (p<0.001) and fewer fissure sealants could be placed (p<0.001). Logistic regression analysis showed that level of support was the strongest predictor for sitting, behavior and fissure sealant placement while controlling for socio-demographic characteristics and treatment arm. More caries was observed in the primary teeth with caries prevalence of 42.7% and mean decayed, missing, filled teeth (dmft) of 2.01 (Std Dev.=3.07; 95% CI: 1.34; 2.69) compared to the secondary teeth 28% of children had caries and the mean DMFT was 0.9 (Std Dev = 1.91; 95% CI: 0.54; 1.25). Higher mean DMFT score were associated with increased level of support (p=0.001) and children with a DMFT score of 3 and more, required the highest level of support (level 3) and experienced the highest burden of decay while controlling for age. (aOR = 4.6; p<0.006) Conclusion: Level of support required by children with ASD was the strongest predictor of ability to sit in the dental chair, behave in a cooperative way and placement of fissure sealants and none of the primary outcomes were associated with the intervention. The severity of caries observed in the permanent dentition was positively associated with higher levels of support required to function. The social story was ineffective in improving the primary outcomes in the less structured environment of the classroom and administered by non-professionals.