Children with ASD are visual learners and respond better to visual support. To increase communication with autistic children in a dental operatory the use of Augmentative and Alternative Communication (AAC) devices and programs can be implemented. One of the most widely used AAC interventions is the Picture Exchange Communication System (PECS), it is a unique AAC training package for individuals with autism and similar developmental disabilities.  It is a communication technique developed for individuals with limited to no verbal communication abilities, to express requests or thoughts using symbolic imagery. PECS has been used in clinical, dental, and educational settings for children with ASD as it is relatively simple to use and teach, inexpensive, and is considered to be a promising intervention.   Jellow Communicator is a freely downloadable app (android and iOS) that can be used as AAC for communication by those having difficulty using speech for communication. It is primarily designed for children. The Jellow App has an easy-to-learn visual interface comprising nine central category buttons and six expressive side buttons. It may give promising results in SHCN patients for improving overall oral health. In the literature, there are no studies evaluating the effect of PECS versus Augmentative and Alternative Communication app on oral health maintenance with autism spectrum disorder. The purpose of this study is to compare the effect on levels of Streptococcus Mutans in the saliva, and oral hygiene status of autistic children following the use of the PECS and Augmentative and Alternative Communication app.