Zanco Journal of Medical Sciences
Skip Navigation Links
Available Issues
Editorial Board
Information for Authors
Review Process
Links and Contacts
  Zanko J Med Sci:  Apr. 2018; 22 (1): 73-81

Dental caries experience and periodontal health status in a sample of autism children

Fighan Jalal Hussein *, Alaa Mahmud Mustafa *, Sazgar Muhammed Sabir *

* Department of Peadodontics, Orthodontics and Preventive Dentistry, College of Dentistry, Hawler Medical University, Erbil, Iraq.


Background and Objective: Autism is a persistent neurodevelopmental condition. This study aimed to investigate carious and periodontal problems among a sample of children with autism in Erbil, Iraq.

Methods: A total of 44 autistic children aged 1-14 years (30 males and 14 females) attending Erbil, Iraq Autism Centers were enrolled in the study. The control group consisted of 44 non-autistic children chosen from different schools which represent different geographical locations in Erbil city in the period between September, 1st 2014 to January, 1st 2015 to have matched age, sex and socioeconomic status. Each patient received an assessment of caries prevalence. Other conditions assessed were oral hygiene and gingival health status. The t-test of significance was used to compare groups.

Results: Data analyzed for the present study comprised observations from a group of children (cases = 44) diagnosed with autism matched with healthy children (controls = 44). The autistic children had lower decayed, missing or filled teeth than unaffected children with nonsignificant differences. The mean decayed-missing-filled teeth in primary teeth (dmft) of the autistic group was 11.57 ± 11.41 while that of the controls was 15.36 ± 12.81. The mean Decayed-Missing-Filled teeth in permanent teeth (DMFT) of the autistic group was 2.36 ± 3.86 and 2.89 ± 3.78 in the controls. With advancing age, the value of decayed, missing and filled teeth increased. Almost all of the autistic children had fair oral hygiene (1.291 ± 0.89) and had gingivitis.

Conclusion: Autistic children displayed lower dmft, DMFT scores compared to control group, fair oral hygiene level, and had gingivitis than did the unaffected control children. Hence, non-autistic children need further consideration.

Keywords: Dental caries; Periodontal problems; Autistic spectrum disorders; Children.


1. Russel G, Rodger LR, Ukommune OC, Ford T. Prevalence of Parent-Reported ASD and ADHD in the UK: Findings from the Millennium Cohort Study. J Autism DevDisord 2014; 10:10803-13.

2. DeMattei R, Cuvo A, Maurizio S. Oral Assessment of Children with an Autism Spectrum Disorder. J Dent Hyg 2007; 81(3):1-11.

3. Amaral DG, Schumann CM, Nordahl CW. Neuroanatomy of autism. Trends Neurosci 2008; 31:137-45.

4. Orellana LM, Silvestre FJ, Sanchis SM, Mihi VM, Bautista D. Oral manifestations in a group of adults with autism spectrum disorder. Med Oral Patol Oral Cir Bucal 2012; 17(3):e415-9.

5. JABER MA. Dental caries experience, oral health status and treatment needs of dental patients with autism. J Appl Oral Sci2011; 19(3):212-7.

6. Geschwind DH. Autism: many genes, common pathways? Cell 2008; 135:391-5.

7. World Health Organization. Pervasive developmental disorders. In: International Statistical Classification of Diseases and Related Health Problems (ICD-10). Geneva: WHO; 2006.

8. Rogers SJ. What are infant siblings teaching us about autism in infancy? Autism Res 2009; 2:125-37.

9. RapinI, Tuchman RF. Autism: definition, neurobiology, screening, diagnosis. Pediatr Clin North Am 2008; 55:1129-46.

10. Ferrando-Lucas MT, Martos-Pérez J, Llorente-Comí M, Freire-Prudencio S, Ayuda-Pascual R, MartínezDíez-Jorge C, et al. The autistic spectrum. An epidemiological study and analysis of pos­sible subgroups. Rev Neurol2002; 34 Suppl1:S49-53.

11. Namal N, Vehit HE, Koksal S. Do autistic children have higher levels of caries? A cross-sectional study in Turkish children. J Indian Soc Pedod Prev Dent 2007; 25:97-102.

12. Waldman HB, Perlman SP, Borg PA. Are dental hygienists prepared to meet the needs of patients with disabilities?. J Pract Hyg 2003; 12:22-4.

13. Waldman HB, Fenton SJ, Perlman SP. Preparing dental graduates to provide care to individuals with special needs. J Dent Educ 2005; 69(2): 249-54.

14. Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Lewy SE, et al. The epidemiology of autism spectrum disorders. Annu Rev Public Health 2007; 28:235-58.

15. Fombonne E. Epidemiology of pervasive developmental disorders. Pediatr Res 2009; 65:591-8.

16. Rutter M. Incidence of autism spectrum disorders: changes over time and their meaning. Acta Paediatr 2005; 94:2-15.

17. Fahlvik-Planefeldt C, Herrstrom P. Dental care of autistic children within the nonspecialized Public Dental Service. Swed Dent J 2001; 25:113-8.

18. Shapira J, Mann J, Tamari I, Mester R, Knobler H, Yoeli Y, et al. Oral health status and dental needs of an autistic population of children and young adults. Spec Care Dentist1989; 9:38-41.

19. Loo CY, Graham RM, Hughes CV. The caries experience and behavior of dental patients with autism spectrum disorder. J Am Dent Assoc 2008; 139:1518-24.

20. World Health Organization. Oral Health Survey. Basic Methods. 4th ed. Geneva: Switzerland; 1997.

21. Shah AF, Tangade P, Ravishankar TL, Tirth A, Pal S, Batra M. Dental Caries Status of Institutionalized Orphan Children from Jammu and Kashmir, India. Int J ClinPediatr Dent 2016; 9(4):364-71.

22. Peter S. Indices in dental epidemiology. Essentials of preventive and community dentistry. 2nd ed. AryaMedi publishing house, New Delhi 2004, 127-240.

23. Oredugba FA, Akindayomi Y. Oral health status and treatment needs of children and young adults attending a day center for individuals with special health care needs. Biomed Chromatogr Oral Heath 2008; 8:30.

24. Sabir SM. Caries experience, periodontal health status and treatment needs among 6-18 years old type 1 diabetic patients 2010. M. Sc. Thesis (unpublished). Hawler Medical University, Collage of Dentistry; Iraq.

25. Sikarwar AS, Parolia A, Runai FA, Barua A. Relationship between Gingivitis and Autism in children: A Matched Case- control Study. British Microbiology Research Journal 2015; 7(4):174-79.

26. American Psychiatric Association. Pervasive developmental disorders. Diagnostic and statistical manual of mental disorders. Washington DC: American Psychiatric Association; 2000. P. 69-70.

27. Barmes DE. Indicators for oral health and their implications for developing countries. Int Dent J 1983; 33:60-6.

28. Murshid EZ. Oral health status, dental needs habits and behavioral attitude towards dental treatment of a group of autistic children in Riyadh, Saudi Arabia. Saudi Dent J 2005; 17:132-9.

29. National Institute of Dental and Craniofacial Research. Epidemiology and oral disease prevention program. Oral health of United State children, the national survey of dental caries in U.S. school children: 1986-1987. Bethesda: NIDCR; 1989. (NIH Publication No. 89-2247)

30. Rajic A, Dzingalasevic G. Autistic children and dental care. Acta Stomatol Croat 1989; 23:175-83.

31. Klein U, Nowak AJ. Autistic disorder: a review for the pediatric dentist. Pediatr Dent 1998; 20:312-7.