Acceptance and efficacy of music augmented manual tooth brush in plaque removal among children with autism spectrum disorder- A Randomiziesd controlled trial

Autism Spectrum Disorder (ASD) is a genetically diverse condition that significantly hampers mental and emotional development, leading to challenges in learning, communication, and social interaction.  It is characterized by  male-to-female ratio of 4 :1. The disorder involves a complex interaction between genetic inheritance and environmental factors, influenced by epigenetic mechanisms  .Children with autism also tend to prefer repetition and sameness. Whether it’s for their preferred activities, hobbies, mealtimes, or bedtime, routines come naturally to them.1

Oral problems in individuals with autism may arise from behaviours associated factors such as personal neglect, self-injurious behaviours, dietary habits, the impact of medication, resistance to dental care, inability to cooperate in dental settings, hyposensitivity to pain, and possible avoidance of social contact . They exhibit a preference for sweets and soft foods, coupled with a tendency to retain food within their mouths, particularly in areas such as the vestibule, interdental, and occlusal regions. Given these considerations, a proactive dental prevention approach is required more effective than treatment for children with autism.2

A study  by Sikarwar et al. showed that children with autism had poor oral hygiene and gingival health with a higher incidence of periodontal disease than normal children. People with ASD tend to have higher plaque and gingival index scores ,often requiring more periodontal treatments like scaling and root planning .Frequent gingivitis in people with autism is linked to a number of factors, including inconsistent brushing practices, a lack of manual skills, inadequate hand-eye coordination, poor oral health awareness, ignorance of teeth, and adverse drug reactions from several drugs used to treat various autistic symptoms4.  Dental caries is  a common oral manifestation among children with Autism Spectrum Disorder (ASD), representing a chronic condition that typically occurs over a lifetime. If left untreated, dental caries can lead to more severe clinical results such as pulp involvement and abscess formation, significantly affecting the quality of life for affected children5. The prevalence of dental caries in individuals with ASD is  high, reaching up to 77%, compared to 46% in non-ASD children. Additionally, gingivitis affects 97% of ASD children, while only 41% of their non-ASD counterparts experience this condition. Due to their specific dental needs, children with ASD necessitate preventive

Tooth brushing plays a crucial role in maintaining oral health and is considered a fundamental self-care skill. Nevertheless, there is evidence suggesting that children with Autism Spectrum Disorder (ASD) encounter challenges in their daily tooth brushing practices, as found by the study conducted by Du, Yiu, King, and colleagues (2019). Preventive educational interventions, focusing on imparting a simple, correct, and effective tooth brushing technique, may be beneficial in enhancing oral health, especially for young individuals with Autism Spectrum Disorder (ASD), as highlighted in the study by Piraneh and colleagues (2022).3

The majority of children with autism spectrum disorder (ASD) tend to resist brushing and may attempt to avoid this daily task due to perceiving it as a tedious and disliked procedure. Parents often employ various strategies such as contingency management, offering gifts, and even using bribes to motivate their children for regular brushing. However, despite these efforts, many parents struggle to instill a genuine interest in brushing for their children.6

Literature states that calming, non-lyrical, low tone, wind, and string instruments produce a soothing effect during dental treatment for patients. Recognizing the importance of cultivating the child’s interest in brushing, new devices have been introduced to make the experience enjoyable. One such innovation is the musical tooth brush. This toothbrush plays music when the child starts brushing making it cheerful process .7

So, this study will be aimed to evaluate the efficacy and acceptance of musical toothbrush with manual toothbrush in children with Autism spectrum disorder in Dakshina Kannada district, Karnataka.