Drivers of Oral Health and Dental Access for Children with Autism Spectrum Disorder

Induja Maheswaran

Maheswaran, Induja
Faculty / Advisor: Velasco, Maria
University of Pennsylvania School of Dental Medicine, Department of Preventive and Restorative Sciences, Division of Pediatric Dentistry


Autism spectrum disorder (ASD) is seen in roughly 1.5 million children in the United States, and the prevalence has been rising over time. The condition has been linked to poor oral health, however the effect of autism severity on dental access and oral health outcomes has not been elucidated. A major aim of this study was to test the hypothesis that dental access and oral health worsen as autism severity increases. Furthermore, a secondary aim looks at the medical management of autism and care coordination as a positive effect to dental access to care and improved oral health.


This was a retrospective study using the 2017-2018 National Survey of Children’s Health (NSCH). Questions from the NSCH were selected that included variables related to health outcomes, dental care access, autism severity and treatment, care coordination, age, ethnicity, and household poverty level. Chi-squared tests were performed to test for univariate associations between categorical variables. Multiple logistic regressions were then performed with the following outcomes of interest: preventive dental visit, dental radiograph, and foregone dental visit. Covariates included: ASD severity, race, poverty level, toothache, cavities, and parents’ education level.


A total of 44,952 children were included in the study cohort. Regression analysis demonstrated that the odds of a preventive visit decreases significantly as autism severity increases (73% and 39% of normal for moderate and severe autism, respectively). The odds of a foregone visit increases significantly as autism severity increases (two and five times higher for moderate and severe autism, respectively). Moderately and severely autistic children who take medications were not found to have lower odds of a preventive visit, as was the case with moderately autistic children receiving behavioral therapy. There was no association between autism severity and preventive visits when children have a medical home, and mild/moderate ASD children were not less likely to have a preventive dental visit when care was well-coordinated.


As ASD severity increases, access to dental care decreases. Treatment for behavior through medications and behavioral therapy can have an impact, but medical homes and care coordination are even more powerful at blunting this trend.