Sensory Adaptations in Dental Environments (SADE)
Director: Sharon Cermak EdD, OTR/L, FAOTA
The Sensory Adaptations in Dental Environments lab, led by Sharon Cermak, studies interventions that alter the sensory characteristics of the dental environment in order to decrease children’s physiological anxiety and negative responses during oral care and contribute to increased child comfort as well as safer, more efficient, and less costly dental treatment. If successful, this intervention has the potential to revolutionize clinic-based dental care for the growing population of children with autism spectrum disorder, as well as for typically developing children with dental anxiety and/or sensory over-responsivity.
The SADE-2 study is a randomized clinical trial of 184 ethnically diverse children with autism spectrum disorder (ASD). We are investigating the efficacy of a sensory adapted dental environment (SADE) compared to a regular dental environment (RDE) to decrease children’s physiological anxiety,…
Period: May 2015 – Apr 2022
Federal Funding $3,783,021
Abstract The goal of this research project is to collect information that will support a later clinical trial on the effectiveness of a specially adapted dental environment for children who have difficulty tolerating oral care in the dental clinic. Within this project, two groups of children will be…
Period: Sep 2011 – Aug 2015
Federal Funding $531,376
Stein Duker, L. I., Como, D. H., Jolette, C., Vigen, C., Gong, C. L., Williams, M. E., Polido, J. C., Floríndez-Cox, L. I., & Cermak, S. A. (2023). Sensory adaptations to improve physiological and behavioral distress during dental visits in autistic children: A randomized crossover trial. JAMA Network Open, 6(6), e2316346. https://doi.org/10.1001/jamanetworkopen.2023.16346 Show abstract
Importance Autistic children have poorer oral health and greater oral care challenges, which are often associated with sensory overresponsivity, than neurotypical peers. It is important to identify innovative solutions enabling dentists to successfully perform standard clinic-based procedures for this population.
Objective To determine whether a sensory-adapted dental environment (SADE) reduces physiological and behavioral distress in autistic children undergoing dental cleanings, compared with a regular dental environment (RDE).
Design, Setting, and Participants This randomized crossover trial was conducted at a pediatric dentistry clinic in a large urban children’s hospital between May 2016 and April 2022. Coders were blinded to study condition for physiological but not behavioral measurements. Autistic children aged 6 to 12 years were identified and invited to participate. Interested families were enrolled consecutively; after confirmation of autism diagnosis, children were randomized. Analysis for this per-protocol study were conducted from April to October 2022.
Intervention Each child underwent 1 RDE and 1 SADE dental cleaning, administered in randomized and counterbalanced order approximately 6 months apart. SADE included modified visual, auditory, and tactile stimuli.
Main Outcomes and Measures The primary outcome was physiological stress, assessed by electrodermal activity. The secondary outcome was behavioral distress measured from video recordings.
Results Among 452 families invited to participate, 220 children were enrolled, and 162 children (mean [SD] age, 9.16 [1.99] years; 136 [84.0%] male) with confirmed autism were randomized, with 83 children receiving RDE first and 80 children receiving SADE first. Most children (94 children [58.0%]) had moderate autism severity. Children had significantly lower physiological stress during dental care in SADE compared with RDE (mean difference in skin conductance level, −1.22 [95% CI, −2.17 to −0.27] μS), suggesting decreased sympathetic activity and increased relaxation during SADE dental care. No significant differences were found in nonspecific skin conductance responses (mean difference, −0.30 [95% CI, −0.86 to 0.25] per min). Video-coded frequency and duration of behavioral distress (but not questionnaire) measures were significantly lower in SADE vs RDE (Cohen d = −0.84 to −1.19). Physiological stress was associated with behavioral distress during the dental cleaning (eg, nonspecific skin conductance responses associated with the Frankl Scale: β = −0.29; 95% CI, −0.39 to −0.19); age, IQ, and expressive communication moderated the intervention’s success. No participants withdrew due to adverse effects.
Conclusions and Relevance In this randomized crossover trial of autistic children, using SADE was safe and efficacious in decreasing physiological and behavioral distress during dental care. This is important because enhancing oral care is critical for autistic children; this intervention may also be beneficial for populations beyond autism.
Trial Registration ClinicalTrials.gov Identifier: NCT02430051
Stein Duker, L. I., Floríndez, L. I., Como, D. H., Tran, C. F., Henwood, B. F., Polido, J. C., & Cermak, S. A. (2019). Strategies for success: A qualitative study of caregiver and dentist approaches to improving oral care for children with autism. Pediatric Dentistry, 41(1), 4E-12E. Show abstract
Purpose. Oral health is important to physical and psychological health. Individuals with autism spectrum disorder (ASD) experience significant oral care challenges, but little research exists that examines efficacious interventions to improve care. The purpose of this study was to qualitatively explore parental and dentist reports of successful strategies implemented during dental care with children with ASD.
Methods. Focus groups were conducted with parents of children with ASD (N = two groups) and dentists treating children with ASD (N = two groups). Focus group transcripts were transcribed verbatim and analyzed using a thematic analysis approach.
Results. Three key themes were identified from the parent focus groups: (1) what makes a good dentist; (2) flexibility and techniques—strategies used by the dentist; and (3) preparation—strategies for parents and caregivers of children with ASD. Four themes emerged from the dentist groups: (1) parents know best; (2) practice; (3) flexibility; and (4) a network of colleagues. Areas of overlap between the parents and dental providers included the importance of preparation, necessity of flexibility and creativity, and value of collaboration.
Conclusions. Our findings provide insight into techniques perceived by parents and dental providers to facilitate successful dental encounters for children with ASD.
Cermak, S. A., Stein Duker, L. I., Williams, M. E., Dawson, M. E., Lane, C. J., & Polido, J. C. (2015). Sensory adapted dental environments to enhance oral care for children with autism spectrum disorders: A randomized controlled pilot study. Journal of Autism and Developmental Disorders, 45(9), 2876-2888. https://doi.org/10.1007/s10803-015-2450-5 Show abstract
This pilot and feasibility study examined the impact of a sensory adapted dental environment (SADE) to reduce distress, sensory discomfort, and perception of pain during oral prophylaxis for children with autism spectrum disorder (ASD). Participants were 44 children ages 6-12 (n = 22 typical, n = 22 ASD). In an experimental crossover design, each participant underwent two professional dental cleanings, one in a regular dental environment (RDE) and one in a SADE, administered in a randomized and counterbalanced order 3-4 months apart. Outcomes included measures of physiological anxiety, behavioral distress, pain intensity, and sensory discomfort. Both groups exhibited decreased physiological anxiety and reported lower pain and sensory discomfort in the SADE condition compared to RDE, indicating a beneficial effect of the SADE.
Sensory adapted dental rooms significantly reduce autistic children’s physiological and behavioral stress during teeth cleanings ⟩
Results of USC–CHLA study of 162 autistic children show that safe and feasible adaptations to the clinic environment created more relaxed, less anxious dental care experiences.
June 2, 2023
Group Helps Get Kids With Autism Get Through Dental Visits ⟩
Research study changes exam room to be more friendly for children on autism spectrum
KCBS2-TV/KCAL9-TV | June 8, 2018
Can researchers enhance the dental experience for children with autism? ⟩
Record-setting grant will help USC division study sensory stimuli that lessen a child’s anxiety during oral care
Mike McNulty, in USC News | June 15, 2015
Children with autism dread the dentist, but USC research may help ⟩
Sharon Cermak wants to make the experience more kid-friendly
Rob Russow, in USC News | April 25, 2014
Grant Awarded to Study Dental Environments ⟩
A two-year grant of $531,376 has been awarded to the USC Division of Occupational Science and Occupational Therapy by the National Institute of Dental and Craniofacial Research.
Vivian Tang, in USC News | October 12, 2011