ORAL ALTERATIONS ASSOCIATED WITH AUTISM SPECTRUM DISORDER: INTERACTION BETWEEN BEHAVIORAL A ND METABOLIC FACTORS - LITERATURE REVIEW

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Introduction: Individuals with Autism Spectrum Disorder (ASD) show a greater predispo sition to oral health problems due to factors such as limitations in self -care, food selectivity, and sensory alterations that hinder oral hygiene. Furthermore, recent studies have demonstrated an association between alterations in the oral and intestinal microbiota and the clinical manifestations of ASD, suggesting the involvement of the gut -brain and oral - brain axes in neuroinflammatory and behavioral processes. Objective: To analyze the relationship between ASD, oral microbiota, and oral health, highlighting the main risk factors. Materials and Methods: This is a narrative literature review based on studies published in the PubMed database in the last two years. The descriptors used were: "autism spectrum disorder" and "oral health". Original articles, systematic reviews, and meta-analyses were included. Results: The findings indicate that individuals with ASD frequently exhibit food selectivity, as well as cariogenic eating habits, such as a preference for sugary and soft foods. Difficulties with oral hy giene are also common, involving both self -performance and supervision or performance by a caregiver, often associated with sensory hypersensitivity and behavioral resistance. The oral microbiota of these individuals shows significant alterations compared to neurotypical individuals, with evidence of dysbiosis associated with inflammatory processes and possible impacts on the central nervous system. Metabolites such as acetate, propionate, and indoles are increased, while butyrate is reduced, indicating rel evant metabolic alterations. Individuals with ASD have a higher incidence of self -harming behaviors, which contributes to an increased risk of oral pathologies, including traumatic lesions. The frequent use of medications, such as antipsychotics and antico nvulsants, contributes to a reduction in salivary flow, increasing the risk of caries. Behaviors such as bruxism and deleterious oral habits are also frequent, increasing the risk of trauma and periodontal diseases. Despite this, evidence suggests that ASD, in isolation, is not a determining factor for oral diseases, with the main risk factors related to inadequate hygiene, diet, and caregiver support. Studies also highlight that the knowledge and attitudes of caregivers directly influence the oral health o f children. Conclusion: Oral health in individuals with ASD is mainly influenced by hygiene, diet, medication use, and caregiver actions. Oral dysbiosis may be associated with systemic alterations, but there is no evidence that ASD, in isolation, is a dete rmining factor for oral diseases, reinforcing the importance of preventive and educational strategies.