Crianças com Transtorno do Espectro Autista: avaliação da condição bucal e qualidade de vida da familia

Abstract

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by difficulties in communication and social interaction, as well as repetitive behaviors and restricted interests. Over the past decades, its global prevalence has increased substantially, influenced by socioeconomic, environmental, and epigenetic factors, along with changes in diagnostic criteria. Children with ASD face specific oral health challenges, such as food selectivity (with a preference for sugar-rich foods), aversion to toothbrushing, and barriers in accessing dental care, which increase the risk of dental caries and negatively affect family quality of life. This thesis comprised two complementary studies. The first was a systematic review with meta-analysis, conducted in accordance with PRISMA guidelines. A total of 2,103 records from databases such as PubMed, Embase, and Scopus were screened, resulting in 25 included studies. Although DMFT/dmft indices did not differ significantly between individuals with and without ASD, the DMFS index was significantly higher in the ASD group (p < 0.05), indicating greater severity of caries lesions. The second study, a cross-sectional investigation, assessed 99 children with ASD (mean age: 3.99 ± 1.12 years) assisted by a care center in Contagem, Minas Gerais, Brazil. Oral health was evaluated using the dmft index (mean: 0.99 ± 2.25), and Family Quality of Life (FQoL) was measured using the Family Quality of Life Scale (FQoLS), validated for the Brazilian population (mean: 98.75 ± 14.38). Examiners were trained according to WHO (2013) guidelines, with kappa values ranging from 0.66 to 0.80. Negative binomial regression models revealed positive associations between higher dmft scores (PR = 1.09; 95%CI: 1.01–1.17), maternal employment (PR = 1.59; 95%CI: 1.16–2.17), and the presence of comorbidities (PR = 1.66; 95%CI: 1.24–2.23) with better FQoL scores, while older child age was associated with lower FQoL scores (PR = 0.83; 95%CI: 0.72 0.96). These findings suggest the presence of the "disability paradox," in which ongoing exposure to challenges fosters resilience, stronger support networks, and the redefinition of family expectations. Maternal employment emerged as a protective factor, possibly due to expanded access to resources. Although the prevalence of caries did not differ markedly between groups, the greater severity among children with ASD underscores the need for preventive protocols tailored to their sensory characteristics. The development of interdisciplinary policies is recommended, integrating professional training, psychosocial support, and caregiver inclusion, to promote both oral health and family quality of life. Study limitations include its cross sectional design, single-center sample, and absence of a control group, highlighting the need for multicenter longitudinal studies.