Reynolds, K., Chimoriya, R., Chandio, N., Tracey, D., Pradhan, A., Fahey, P., Stormon, N., & Arora, A. (2023). Effectiveness of sensory adaptive dental environments to reduce psychophysiology responses of dental anxiety and support positive behaviours in children and young adults with intellectual and developmental disabilities: a systematic review and meta-analyses. BMC oral health, 23(1), 769.
Background
Intellectual and developmental disabilities (IDD) include conditions due to physical, learning, sensory or behaviour impairments that are characterised by significant limitations both in intellectual functioning and adaptive behaviour as expressed in conceptual, social, and practical adaptive skills. IDDs impact on an individuals daily functioning, well being, quality of life and physiological health including oral health. These individuals are more likely to have poorer oral health and have difficulty carrying out oral hygiene behaviours due to motor, perceptual, language, sensory, cognitive and behavioural impairments. They also have difficulty accessing dental care combined with dental anxiety which is exacerbated by over-stimulating physical environments, hyper-empathy, sensory integration issues, oral aversion, challenges with waiting room, maladaptive behaviours, and limited knowledge and understanding of dental providers. Research suggests that creating sensory adapted dental environments (SADE) with mesmerising sounds, good lighting, vibration, tactile sensation and aroma can have significant improvement in cooperation and reduction in dental anxiety and associated behaviours.
The aim of this study was to review the evidence on the effectiveness of SADE in managing dental anxiety and maladaptive behaviours in children and young adults with IDD.
Methods
Systematic Review of only RCTs with a control (no intervention), waitlist or regular dental care. The PICO is outlined in Table I. Search carried out on Medline (OVID), The Cochrane Library, Embase, Web of Science, OT seeker and Google Scholar. Risk of bias was assessed using the Cochrane Risk of Bias (RoB)-2 tool for crossover trials.
| Population | Children and adolescents (0-24) with intellectual and developmental disabilities |
| Intervention | Any interventions designed to modulate sensory sensitivities linked to any of the senses (sensory adapted environment) |
| Comparison | Regular dental environment (RDE) |
| Outcome | Compliance, cooperation, and participation. Negative behaviours or psychophysiology responses of dental anxiety (electrodermal activity, oxygen saturation, respiratory rate, skin conductance, blood pressure, and heart rate) |
Results
Out of a total of 622 studies, and as shown in Figure 1, 4 studies were included in the report, 2 of which were included in the meta-analysis comparing standardised mean change (SMC). Studies were conducted between 2009-2021 with sample sizes of approximately 16-22 participants aged 6-14 years and 16-21 years. IDD diagnosis varied from Autism Spectrum Disorder, down syndrome, cerebral palsy, developmental delay, and ADHD. One study used a single sensory adaptation (music) compared to the other three which used multi-sensory adaptations. Adaptations included visual (light reduction or slow moving colour effects), tactile, and auditory.
Figure 1: PRISMA flow chart
Three studies found SADEs to have a significant positive impact on psychophysiological outcomes (SMC -0.66; 95% CI -1.01 to -0.30; p = < 0.001) shown in Figure 2. However, there was questionable evidence of SADE for reducing maladaptive behaviours and as seen in Figure 3 there was no statistically significant difference of maladaptive behaviours compared to regular dental environments (SMC = 0.51; 95%, CI -0.20 to 1.22; p = 0.161). Studies were found to have a high risk of bias due to randomisation of participants, allocation concealment, blinding of participants, outcome assessors, intention to treat analysis, statistical power analysis and trial design.
Figure 2: Meta-analysis for the effect of SADE vs. RDE on psychophysiological outcomes during dental procedures
Figure 3: Meta-analysis for the effect of SADE vs RDE on behaviour during dental procedures
Conclusion
Evidence suggests that creating sensory adaptive dental environments with visual, tactile, and auditory adaptations in a single or multi-sensory approach can have small positive impacts on psychophysiological dental anxiety responses for children and young people with IDD. However, evidence is very limited and more research needs to be done.
Research Summary Written By: Ishmyne Bhamra, University of Manchester, BDS3