School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia.
Health Equity Laboratory, Campbelltown, NSW, 2560, Australia.
BMC Oral Health. 2023 Oct 19;23(1):769. doi: 10.1186/s12903-023-03445-6.
People with Intellectual and developmental disabilities (IDDs) experience oral health inequality due to myriad of risk factors and complex needs. Sensory processing difficulties, maladaptive behaviours and dental anxiety contribute to difficulties in receiving preventive and routine dental treatments. This study aimed to systematically review the evidence on the effectiveness of sensory adaptive dental environments (SADE) for children and young adults (up to the ages 24 years) with IDD to address cooperation and dental anxiety.
This review was reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE (Ovid), The Cochrane Library, Embase, Google Scholar, Web of Science and OT Seeker were searched using appropriate terms to identify Randomised Control Trails (RCTs) that matched inclusion criteria. Screening was conducted by two reviewers after de-duplication based on titles and abstracts followed by full text retrieval. Quality of the included studies was assessed using Cochrane Risk of Bias (ROB)-2 for crossover trials and data extracted by two reviewers. The details of the interventions and effectiveness were compared and discussed narratively, and comparable outcomes were included to meta-analyses using R software.
A total of 622 articles were identified and five articles met eligibility for inclusion. Three studies used multi-sensory adaptations and one used single sensory adaptation of music. Narrative synthesis showed some evidence of SADE reducing magnitude and duration, although, questionable for reducing the number of maladaptive behaviours. Two studies demonstrated conflicting evidence of the effect of SADE on cooperation. Three studies demonstrated significant positive impact of SADE on psychophysiological outcomes. Despite an overall tendency to favour SADE, no statistically significant difference of maladaptive behaviours was found between SADE and regular dental environment (RDE) (Standardised mean change (SMC) = 0.51; 95% Confidence Interval (CI) -0.20 to 1.22; p = 0.161). SADE was superior to RDE (SMC -0.66; 95% CI -1.01 to -0.30; p = < 0.001) in reducing psychophysiological responses of dental anxiety.
Current evidence suggests that adapting visual, tactile, and auditory aspects of the dental environment in a single or multi-sensory approach demonstrates small positive effects on psychophysiological responses and maladaptive behaviours of dental anxiety for people with IDD.
The title of this review was registered with PROSPERO (CRD42022322083).
由于众多风险因素和复杂需求，智力和发育障碍 (ID) 患者的口腔健康存在不平等现象。感觉处理困难、适应不良行为和牙科焦虑会导致预防和常规牙科治疗的困难。本研究旨在系统评价感官适应牙科环境 (SADE) 对儿童和年轻成人（至 24 岁）的有效性，以解决合作和牙科焦虑问题。
本综述根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南进行报告。使用适当的术语在 MEDLINE (Ovid)、Cochrane 图书馆、Embase、Google Scholar、Web of Science 和 OT Seeker 中进行搜索，以确定符合纳入标准的随机对照试验 (RCT)。在基于标题和摘要进行去重后，由两名评审员进行筛选，然后检索全文。使用 Cochrane 偏倚风险 (ROB)-2 对交叉试验进行质量评估，并由两名评审员提取数据。比较和讨论干预措施和效果的详细信息，并使用 R 软件对可比结果进行荟萃分析。
共确定了 622 篇文章，其中 5 篇文章符合纳入标准。三项研究采用多感官适应，一项研究采用单一感官适应音乐。虽然有一些证据表明 SADE 可以减少幅度和持续时间，但在减少适应不良行为方面存在疑问。两项研究表明 SADE 对合作的影响存在矛盾证据。三项研究表明 SADE 对心理生理结果有显著积极影响。尽管总体上倾向于支持 SADE，但在 SADE 与常规牙科环境 (RDE) 之间，适应不良行为没有统计学上的显著差异（标准化均数变化 (SMC) = 0.51；95%置信区间 (CI) -0.20 至 1.22；p = 0.161）。SADE 在减少牙科焦虑的心理生理反应方面优于 RDE（SMC -0.66；95% CI -1.01 至 -0.30；p = < 0.001）。
目前的证据表明，采用单一或多感官方法调整牙科环境的视觉、触觉和听觉方面，对 IDD 患者的心理生理反应和牙科焦虑的适应不良行为有较小的积极影响。
本综述的标题已在 PROSPERO（CRD42022322083）上注册。
