Behavioral responses and management strategies in children with Autism spectrum disorder during fissure sealant treatment: A clinical observational study

Background: Children with Autism Spectrum Disorder (ASD) often present behavioral challenges and sensory sensitivities that complicate dental care, particularly preventive procedures such as fissure sealant application. This study aimed to evaluate behavioral responses of children with ASD during fissure sealant treatment and to identify effective management strategies to improve cooperation. 
Methods: A descriptive observational study was conducted involving 23 children with ASD aged ≥7 years from inclusive schools in Surabaya. The fissure sealant treatments were performed at the Pediatric Dentistry Clinic, Dental Hospital, Universitas Airlangga. The dental team consisted of pedodontists, residents, and supporting staff. Pre-treatment preparation included visual communication methods, such as the Picture Exchange Communication System (PECS) and educational videos, alongside collaboration with parents, teachers, and caregivers. Behavioral observations were conducted throughout the procedure and analyzed descriptively using frequency distributions. 
Results: Behavioral responses were classified into six categories: (1) difficulty opening the mouth; (2) sensitivity to new stimuli; (3) inability to focus and remain calm; (4) anxiety; (5) difficulty in communication or understanding instructions; and (6) covering the ears. The most frequently observed behaviors were the inability to focus and remain calm, and ear-covering behavior, highlighting the influence of sensory sensitivity and attention deficits. Despite these challenges, most patients demonstrated positive cooperation. Successful outcomes were associated with individualized behavioral approaches, environmental modifications, gradual desensitization, and multidisciplinary collaboration. 
Conclusions: The study showed that behavioral responses in children with ASD during fissure sealant treatment are influenced more by sensory and attentional factors than age. Treatment success depends largely on psychological readiness and environmental support.