Child oral health and preventive dental service access among children with intellectual disabilities, autism and other educational additional support needs: A population-based record linkage cohort study.

This study of over 166,000 Scottish children found that children with additional support needs, including those with intellectual disabilities and autism, have worse oral health than other children. They had more tooth decay and needed more teeth removed under general anaesthetic. While school dental check-ups improved, many children with autism (40%) or intellectual disabilities (36%) refused these checks compared to only 5% of other children. These children were also less likely to receive regular dental care and preventive treatments when they did visit the dentist.

This large population-based cohort study examined oral health outcomes and dental service access among 166,781 Scottish children with additional support needs (ASN) including intellectual disabilities and autism. Children with ASN showed higher rates of dental caries, with those having intellectual disabilities experiencing 67% higher rates of tooth extraction under general anaesthesia. School-based dental inspections improved for children with intellectual disabilities and autism, though refusal rates were significantly higher (35.8% and 40.3% respectively vs 5.4% for typically developing children). Children with ASN were less likely to attend regular primary dental care, and when they did attend, those with intellectual disabilities or autism received fewer preventive treatments.

However, access to the Childsmile toothbrushing programme was similar or better for children with ASN.

Results highlight the need for tailored dental care approaches for children with additional support needs, including strategies to reduce refusal rates for dental examinations and ensure equal access to preventive treatments. Integration of oral health into broader healthcare systems for these children is essential to address identified inequalities and prevent more complex dental interventions.

The study relied on administrative databases which may have incomplete recording of additional support needs diagnoses and dental treatments. The research was conducted in Scotland's healthcare system, which may limit generalizability to other healthcare contexts. Causality cannot be established due to the observational study design.

Inequalities in child oral health are a global challenge and the intersection of socioeconomic factors with educational additional support needs (ASN), including children with intellectual disabilities or autism, have thus far received limited attention in relatively small clinical studies. We aimed to address this evidence gap by investigating oral health and access to preventive dental services among children with ASN compared to the general child population. Cohort study linking data from six Scotland-wide health and education databases compared: dental caries experience and tooth extraction via general anaesthetic; receipt of school-based dental inspection; access to primary care and hospital dental services; and access to the Childsmile national oral health improvement programme between children with a range of ASN (intellectual disabilities, autism, social and other) and their peers for the school years 2016/17-2018/19 (n = 166 781). Children with any ASN had higher rates of caries experience than those with no ASN, however, after adjustment for socioeconomic deprivation, sex, year, and school type only those with a social or other ASN remained at increased risk.

Rates of tooth extraction under general anaesthesia in hospital were higher among children with intellectual disabilities (aRR = 1.67;95% CI = [1.16-2.37]). School-based dental inspection access improved for children with intellectual disability and/or autism from 2016/17 onwards, although higher rates of child refusal on the day were observed in these groups (no ASN refusal: 5.4%; intellectual disability: 35.8%; autism: 40.3%). Children with any ASN were less likely to attend primary dental-care regularly, and in those who attended, children with intellectual disability or autism were less likely than their peers to receive prevention (fluoride varnish, oral-hygiene instruction, or dietary advice). Childsmile nursery-supervised toothbrushing programme access among children with any ASN was similar to children with no ASN and children with intellectual disability (aRR = 1.27;95% CI = [1.12-1.45]) or autism (aRR = 1.32;95% CI = [1.19-1.45]) were more likely to receive support from Childsmile dental health support worker.

We have identified inequalities in oral health and dental care for children with different ASN in Scotland with both a greater burden of disease among some groups and higher complexity of care; compounded by reduced and variable access to preventive dental services. Further efforts are needed to develop and improve preventive care pathways for children with ASN and integrate oral health to wider healthcare systems for these children to mitigate against oral health inequalities.