Sensory Adapted Dental Environments to Enhance Oral Care for Children

 描述(由申请人提供)：该项目建立在我们之前的R34 NIDCR规划和可行性研究的基础上，旨在检验感官适应牙科环境(SADE)改善儿童口腔护理的有效性。将研究两组儿童：患有自闭症谱系障碍(ASD)的儿童和典型发育期(TD)儿童。患有自闭症的儿童和部分患有自闭症的儿童在面对牙科检查的体验方面时，表现出感官过度反应，例如暴露在明亮的荧光灯下，触摸口腔或口腔周围，或各种口腔护理产品的质地和气味。这通常会导致焦虑和负面行为反应的增加，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SADE干预措施，旨在减少儿童在口腔护理过程中的焦虑和负面反应。Sade干预措施包括调整光线，在天花板上移动投影(鱼，泡泡)，暴露在舒缓的音乐中，以及应用带翅膀的蝴蝶背心来包裹孩子，以提供镇静的感觉。具体目的是进行一项随机临床试验，以：1.确定相对于常规牙科环境(RDE)，SADE是否可以减少ASD和TD儿童在清洁牙齿过程中的生理性焦虑和负面反应(行为困扰、疼痛感觉、感觉不适)，并测试SADE对ASD组的影响是否更大。2.确定生理焦虑是否调节干预的有益效果，以及ASD的严重程度和沟通能力(ASD组)、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/节省。研究参与者将是220名6-12岁的不同种族儿童，110名自闭症儿童和110名TD儿童。使用随机平衡研究设计，每个儿童将接受两次牙科清洁，每四个月一次：一次在RDE，一次在Sade。这一项目意义重大，因为这是旨在减少自闭症儿童口腔护理问题的干预措施的第一次全面试验。这在理论上很重要，因为它将阐明SADE干预效果的基础机制，并有助于确定哪些儿童亚群，包括TD和ASD，将从这一方法中受益最大。根据研究结果，我们将开发一种模式，通过改变牙齿环境的感官质量来改变儿童牙科护理的标准；该模式将有潜力在全球牙科诊所使用。因此，该项目有望对公共卫生产生重大影响，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.