Survival of different caries managements in children with autism and unaffected peers: a retrospective cohort study

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ABSTRACT

Aim

Dental caries is a common oral disease in children with special needs such as those with autism spectrum disorders (ASDs). The aim is to assess whether the type and survival of three caries management, conventional resin restorations (CR), ART technique (ART) and SDF application without caries removal (SDF), in primary teeth carried out at the Pediatric Dentistry Department of San Paolo Hospital (University of Milan) differed between children with ASDs and unaffected peers.

Methods

Data from a convenience sample of children with and without ASDs, who have received dental care for caries in primary teeth from January 2019 to June 2022, were analysed. Medical history, age, sex, teeth treated, and type of treatment were collected from dental charts. Data on success and minor and major failures of each treatment were also collected. Two survival analysis were performed, one considering both major and minor failures, a second considering only major failures. Cox Proportional Hazards multivariate logistic models were run to assess factors associated with failures. The statistical significance was set at 5% (p< 0.05).

Results

Overall, 233 conventional restorations, 136 ART restorations, and 78 SDF applications were analysed. A statistically significant difference was found in the prevalence of the three caries managements performed in the two cohorts of children (p<0.01); SDF was the most used in ASDs cohort (41.13%), while conventional treatment in unaffected cohort (52.13%). At 6-month follow-up, the success rate was found to be high (>86%) in both cohorts for all caries managements (p>0.05). At 12- and 18-month follow-ups, success rate of the three managements decreases, with no statistical differences between cohorts (p>0.05). In the cohort with ASDs, CR showing the higher number of successes (p=0.02 at 12 months; p<0.01 at 18 months). Considering major and minor failures together, treatment success was not associated with any of the variables considered in the ASDs cohort, while considering only major failures, treatment success was associated with caries severity (p=0.01).

Conclusion

In children with autism, the different techniques for approaching caries lesions seem to have the same probability of success. Therefore, the choice of treatment should be patient-oriented rather than lesion-oriented. In unaffected children, the gold standard always seems to be traditional restorative treatment.

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