Dental Management Strategies for Adults with Autism Spectrum Disorder: A Systematic Review

Abstract

Autism Spectrum Disorder is associated with communication, behavioural and sensory characteristics that may affect access to, and cooperation during, dental care. This systematic review aimed to identify and synthesise available evidence on dental management strategies for adults with Autism Spectrum Disorder. A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Embase and LILACS, following PRISMA 2020 recommendations. The protocol was registered in PROSPERO. Eligible studies included adults aged 18 years or older with Autism Spectrum Disorder and described strategies, adaptations or interventions related to dental care. Study selection was performed by two independent reviewers, methodological quality was assessed using Joanna Briggs Institute critical appraisal tools, and certainty of evidence was evaluated using the GRADE approach. The search identified 4,972 records, of which 589 were duplicates. After screening 4,383 titles and abstracts, 15 full-text articles were assessed for eligibility, and three studies were included in the qualitative synthesis. The included studies comprised one observational study, one quasi-experimental study and one retrospective study. No randomised controlled trials were identified. Reported strategies included preparatory sessions, structured clinical environments, visual supports, visual pedagogy, gradual desensitisation, behavioural modelling, the TEACCH-based approach, Tell–Show–Feel–Do, oral premedication, nitrous oxide sedation and general anaesthesia. These strategies were associated with improved cooperation, acceptance of dental examination and feasibility of care in selected contexts. However, certainty of evidence was very low for all assessed outcomes. Individualised and structured approaches may support dental care for autistic adults, but stronger studies are required to guide clinical protocols.