Abstract
This study aimed to compare oral health status, oral-related behaviors, and caregivers’ oral-health knowledge and beliefs between preschool children with autism spectrum disorder (ASD) and typically developing (TD) children. A cross-sectional study was conducted among 694 preschoolers (344 ASD, 350 TD) aged 3–6 in Changchun. Clinical oral examinations were conducted to record caries prevalence and the number of decayed, missing (due to caries), and filled teeth (dmft) index. Caregivers completed a three-part questionnaire covering demographic information, children’s oral hygiene practices and dental history, as well as caregivers’ oral-health knowledge and beliefs. Statistical analyses included univariate comparisons, multivariable logistic and negative binomial regression models adjusted for age, sex and residence. ASD children exhibited significantly lower caries prevalence and dmft values than TD children Significant intergroup differences were also observed in oral hygiene habits, snacking frequency, and dental attendance behaviors. Caregivers of TD children showed better oral health knowledge and attitudes, while parental educational level and household income were significantly lower in the ASD group. After adjusting for baseline confounding factors, ASD status remained independently associated with lower caries risk and lower dmft indices. Further sensitivity analyses excluding hospital-recruited TD children and adopting age- and sex-matched sampling confirmed the robustness of these findings. Although ASD children presented lower caries experience, they demonstrated suboptimal oral-hygiene-related behaviors and less frequent dental visits than TD children. Caregivers’ knowledge and attitudes were critical factors associated with children’s oral health. Considering baseline socioeconomic imbalances and partial hospital-based recruitment of TD controls in this cross-sectional study, these findings should be interpreted cautiously, and definitive causal relationships cannot be established.