Dental caries risk and prevention in children and adolescents with special needs: a retrospective cross-sectional study

Background: Children and adolescents with special needs are at elevated risk for oral diseases. This study examines factors contributing to dental caries among students attending special needs schools in Sydney to inform targeted preventive strategies. Methods: A cross-sectional analysis was conducted using retrospective data from 320 individuals aged 5–19 years, obtained through school-based oral health assessments and parent/caregiver questionnaires. Results: Autism was the most common condition (75%), particularly among younger children. Notably, 24% of children aged 5–12 had never visited a dentist. Chi-square analyses showed a higher caries risk in children with multiple medical conditions (χ2 = 5.312, p = 0.021), but no significant associations were observed with autism, toothbrushing frequency, toothpaste type, or sweet drink intake. Logistic regression identified medication use (B = 6.421, p = 0.011) and frequent sweet snack consumption (B = 3.998, p = 0.046) as strong predictors, while autism remained non-significant. This suggests that broader behavioural or physiological factors may be more important determinants of caries risk than individual oral hygiene practices alone. Conclusion: Reducing sugary snack intake may help lower caries risk. School-based oral health education and self-care support can promote better hygiene habits and long-term independence. Future research should evaluate the feasibility of these caries preventive strategies in children and adolescents with special needs.