Children with special needs can have unique issues when it comes to caring for the health of their teeth, gums and mouth. This may be due to the symptoms of their health condition, need for medications that contain sugar, diet, trouble with eating, or oral sensitivity. Dental care may take a back seat to other urgent medical issues. Yet, because of the greater risk for children with special needs, it is vital to practice good oral health care.

Special Needs Dental Tips

Common Dental Concerns

Your child may have dental problems as a result of their health condition or from treatments, therapies or medicine that they take.  Talk with your child’s dentist and pediatrician about any questions or issues that you have.  Ask how medicine, treatment, or diet may affect your child’s oral health.

Your child’s condition may affect:

  • How their teeth and oral structures will grow.
  • How the calcium is laid down in the tooth’s enamel (the tooth’s top layer) as the teeth grow
  • How much saliva/spit your child makes in their mouth: saliva helps clear food and protects teeth.
  • How often and what your child is able to eat: soft foods and liquids do not give the teeth, gums, and muscles of the mouth the stimulation they need.  Children who use G-tubes are still at risk for cavities and may be more likely to build up tartar on their teeth, making it important to keep their teeth and gums cleaned and cared for.

 

Common dental concerns in children with special needs:

  • GERD (gastro-esophageal reflux disease):  GERD can cause your child’s mouth to be acidic which can wear down the teeth. Your dentist may prescribe pastes to help prevent teeth damage from the acid.
  • Holding food in the mouth:  Some children will hold food in their mouth or cheeks much longer than usual (this is called food pouching). This creates a good place for bacteria that cause cavities to grow.
  • Grinding (bruxism):  Your child may grind or gnash their teeth while sleeping or during the day. Over time, grinding can damage teeth. This is common and most children outgrow the habit.  Treatments are available if it becomes a problem.
  • Bad breath:  Some digestive problems, chronic sinusitis, diabetes, and certain medications may cause bad breath.
  • Dry mouth:  May be a result of your child’s condition or from medication. This can affect nutrition and can lead to tooth decay, gum disease and mouth infections. Check with your dentist and your child’s doctor for treatment ideas.
  • Delay in first teeth coming in:  This is common in children with Down syndrome.
  • Medicine can affect teeth and gums:  Liquid syrups and medicines with sugar can cause cavities. Other medicines can cause dry mouth and reduce how much saliva (spit) your child makes.  These may include: antihistamines, antidepressants, anti-GERD medicine, sedatives, and barbiturates.  Some seizure medicines may cause enlarged gums, causing them to bleed.  Help reduce the impact of medicine by rinsing or spraying your child’s mouth with water after each dose.

For more information:

 

Information based on “A Caregivers Guide to Good Oral Health for Persons with Special Needs”. Steven P Perlman, DDS, MscD, Clive Friedman, DDS, Sanford J. Fenton, DDS, MDS. Special Olympics International. 2008
Nutrition Focus for Children with Special Health Care Needs. Nutrition and Oral Health for Children. Beth Ogata, MS, RD, CD, Cristine Trahms, MS, RD, CD, FADA. Center on Human Development and Disability, University of Washington, Seattle, Washington. November/December 2003.

Tips For A Healthy Mouth

Many parents have questions about how to care for their child’s teeth.  For basic care tips, visit the American Academy of Pediatric Dentistry’s Frequently Asked Questions. For ideas to help fit your child’s unique situation, see our tips below.

Daily tooth and mouth care

  • Start cleaning your infant’s gums with a soft baby toothbrush or cloth and water.
  • Begin brushing twice daily with fluoride toothpaste when your child’s teeth begin to come in.
  • Use a very thin smear of toothpaste on the toothbrush.
  • When you are away from home, rinse your child’s mouth with water after meals, snacks and giving medicine.
  • If your child wants to brush, make sure you do a thorough cleaning at the end of the day. After your child brushes, you “check” with the toothbrush and finish with a thorough cleaning.

 

Challenges with brushing

  • Brushing does not have to happen in the bathroom-try your child’s room or other spaces.
  • Brush with your child’s head in your lap or have your child lie on a bed or sofa (helps you see the teeth better and may make it easier for your child to hold still and keep their mouth open).
  • Keep your child occupied as you brush. Give your child something to hold while you brush, have your child brush your teeth as you brush theirs, sing a song while brushing, or let your child watch in the mirror.
  • If your child is sensitive to toothpaste, dip the toothbrush (or cloth or cotton swab) into fluoride mouth rinse and use that instead.
  • For children who might gag, try letting your child get used to a toothbrush slowly.  Let your child “teeth” or chew on a toothbrush or NUK toothbrush trainer for a few weeks to get used to the feel of it in their mouth.  Then slowly take over and work toward the actual brushing.
  • If your child cannot spit try wiping their mouth with a cloth after brushing.
  • Ask for professional help to decrease mouth sensitivity and increase tolerance.
  • Find more dental care tips from the National Institute of Dental and Craniofacial Research.

Going To The Dentist

Find out when to start, how to find the right dentist and prepare your child.

When to make the first visit

All children should have their first visit to the dentist 6 months after their first tooth comes in or by 1 year of age (whichever comes first). If your family dentist is not comfortable seeing your child before age 3, you may want to see a pediatric dentist. They provide primary and specialty oral health care for children with special needs.

 

Finding the right dentist

Use the Dental Office Considerations Checklist when you call a dentist.  Good places to start your search include:

  • Directory of dentists who provide care to patients with developmental or acquired special needs in Washington State.
  • Check with the AAPD to find a pediatric dentist in your area.

 

Getting ready for your child’s appointment

Think about your child’s needs and how you can communicate this information to dental staff.  Use the Getting to Know Me Dental Questionnaire or modify our Getting to Know Me form.

  • When calling to schedule the visit, ask for the first or last appointment of the day.
  • Ask the dental office to send or email paperwork for you to fill out at home.
  • Talk with your child’s primary health care provider before you plan your dental visit. The dentist may need to consult with them before starting any dental care (especially for children with heart or lung conditions).
  • Check if your child can be treated in a private or semi private room.
  • Ask if the staff will call your cell phone while you wait outside or in your car if your child may feel uncomfortable in a waiting room.
  • Talk to your child’s dentist beforehand if you have questions about behavioral management during treatment or sedation.

 

Preparing your child

You know your child best.  Some children respond well to talking about what will happen before going to the dentist and some do not.  Some ideas that may help:

  • Play “going to the dentist” and take turns with your child being the patient and dentist.
  • Talk about what will happen at the visit.
  • Practice the “knee to knee position” at home. This is a common way that dentists care for small children or children in wheelchairs. In this position, you and the dentist sit facing each other with knees touching. You will hold your child facing toward you and then lay your child back down across your legs with their head cradled in the dentist’s lap.

Oral Health Resource List

Links to more information on dental care for children with special needs – for parents as well as medical and oral health professionals.

  • Oral Care for People with Developmental Disabilities – This free 2-hour continuing education course is for dental professionals. Topics include the health challenges and oral health problems common in people with developmental disabilities and strategies for oral care in the general practice setting.
  • Practical Oral Care for People with Developmental Disabilities – The National Institute of Dental and Craniofacial Research offers a series of booklets and fact sheets on providing care for people with mild or moderate developmental disabilities for dental professionals. The series covers autism, cerebral palsy, Down syndrome, wheelchair transfer and more.
  • Dental Office Special Needs Checklist – Families, caregivers and professionals can use this PDF checklist to explore how their dental office can accommodate a child with special health care needs. Issues to consider include: Are parents allowed in care rooms? Can x-ray equipment reach low enough for a child in a wheelchair? Are staff versed in alternative x-ray techniques?
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