Structural-visual approach for dental examination in children with autism spectrum disorder: A systematic review

Conducting Dental examination in children with autism is challenging due to the limitation in cooperativeness that is caused by impairment of communication, social interaction, and sensory sensitivities. This study aims to provide evidence base for the structural-visual approach in reducing uncooperativeness behavior to dental care in children with autism spectrum disorder (ASD). Searches were conducted in the electronic databases PubMed, PsycINFO, and Cochrane from inception to October 2021 (CRD42022383409). Randomized controlled trials (RCTs), non-RCTs, and pre/post-test and qualitative studies that conducting visual pedagogy and visual learning methods were included. The quality of evidence was assessed with Cochrane Collaboration's Risk of Bias Tool for RCTs, Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) for non-RCTs, and Critical Appraisal Skill Program (CASP) for qualitative studies. The initial search identified 270 studies, and 256 remained after removing duplicates. After screening titles and abstracts, 62 studies were remained for full-text assessed, and finally 13 eligible studies were selected for reviews. The studies analyzed various structural-visual interventions, participants, study design, countries, and outcomes. The structural-visual approach could reduce uncooperative behavior in children with ASD. Future study should investigate the wide range of age and varied behavior approach as the evidence-based of the clinical management.