Sensory Adapted Dental Environments to Enhance Oral Care for Children

 描述（由申请人提供）：该项目建立在我们以前的R34 NIDCR规划和可行性研究的基础上，旨在研究感官适应性牙科环境（SADE）的有效性，以提高儿童的口腔护理。将研究两组：自闭症谱系障碍（ASD）儿童和典型发育（TD）儿童。ASD儿童和TD儿童的一个子集在面对牙科就诊的体验方面时表现出感觉过度反应，例如暴露于明亮的荧光灯下，口腔内或周围的触摸，或各种口腔护理产品的质地和气味。这通常会导致增加焦虑和消极的行为反应，从而阻碍牙医进行治疗的能力。在拟议的项目中，我们测试了一种SADE干预措施，旨在减少儿童在口腔护理过程中的焦虑和消极反应。SADE干预包括适应性调整，如调暗灯光，移动天花板上的投影（鱼，气泡），暴露于舒缓的音乐，以及应用蝴蝶背心，翅膀缠绕在孩子身上，以提供平静的感觉。 具体目的是进行随机临床试验，以便：1。确定SADE相对于常规牙科环境（RDE）是否减少ASD和TD儿童在牙齿清洁期间的生理焦虑和负面反应（行为困扰，疼痛感知，感觉不适），并测试SADE的效果是否对ASD组更大。2.确定生理焦虑是否介导干预的有益效果，以及ASD和沟通能力（ASD组）的严重程度，或牙科焦虑，感觉过度反应和年龄（两组）是否作为调节变量。3.评估与SADE相关的牙齿清洁的护理质量和成本效益/节约。 研究参与者将是220名6-12岁的不同种族儿童，其中110名患有ASD，110名TD。采用随机平衡研究设计，每名儿童将接受两次牙齿清洁，间隔4个月：一次在RDE中进行牙齿清洁，一次在SADE中进行牙齿清洁。 该项目意义重大，因为它是第一个旨在减少ASD儿童口腔护理问题的干预措施的全面试验。这在理论上很重要，因为它将阐明SADE干预效果的机制，并有助于确定哪些儿童亚组，包括TD和ASD，将从这种方法中受益最多。根据研究结果，我们将开发一种模型，通过改变牙科环境的感官质量来改变儿童牙科护理的标准;这种模型将有可能在全球牙科诊所中使用。因此，该项目有望产生重大的公共卫生影响，因为在口腔健康，儿童舒适度和成本节约方面的潜在收益将是巨大的，可能适用于超过四分之一的儿童。

 DESCRIPTION (provided by applicant): This project, which builds upon our previous R34 NIDCR Planning and Feasibility study, is designed to examine the efficacy of a sensory adapted dental environment (SADE) to enhance children's oral care. Two groups will be studied: children with autism spectrum disorders (ASD) and typically developing (TD) children. Children with ASD, and a subset of TD children, exhibit sensory over-responsivity when confronted with experiential aspects of dental visits such as exposure to bright fluorescent lighting, touch in or around the mouth, or the texture and smell of various oral care products. This often results in increased anxiety and negative behavioral responses, which hinder the dentist's ability to perform treatment. In the proposed project, we test a SADE intervention designed to reduce children's anxiety and negative responses during oral care. The SADE intervention includes adaptations such as dimmed lighting, moving projections on the ceiling (fish, bubbles), exposure to soothing music, and application of a butterfly vest with wings that wrap around the child to provide calming sensations. The specific aims are to conduct a randomized clinical trial in order to: 1. Determine if SADE, relative to a regular dental environment (RDE), reduces physiological anxiety and negative responses (behavioral distress, perception of pain, sensory discomfort) during dental cleaning for children with ASD and TD children and test whether SADE's effect is greater for the ASD group. 2. Identify whether physiological anxiety mediates the beneficial effects of the intervention and whether severity of ASD and communication ability (ASD group), or dental anxiety, sensory over-responsivity, and age (both groups) act as moderating variables. 3. Assess the quality of care and cost effectiveness/savings of the dental cleaning associated with SADE. Research participants will be 220 ethnically diverse children aged 6-12 years, 110 with ASD and 110 TD. Using a randomized counterbalanced study design, each child will undergo two dental cleanings four months apart: one dental cleaning in RDE and one dental cleaning in SADE. This project is significant because it is the first full-scale trial of an intervention designed to reduce oral care problems in children with ASD. It is theoretically important because it will elucidate the mechanisms that underlie the effects of the SADE intervention and help to identify which subgroups of children, both TD and with ASD, which will benefit most from this approach. Based on the study findings, we will develop a model to transform the standard of pediatric dental care by modifying the sensory qualities of the dental environment; this model will have the potential to be utilized in dental clinics worldwide. As such the project promises to have a major public health impact insofar as the potential gains in oral health, child comfort, and cost-savings will be dramatic, potentially applying to more than one-fourth of all children.