Our special needs dental care resources includes tips on how to maintain a healthy mouth, suggestions on how to prepare for your next dental visit, links to help you find a special needs dentist in your area and condition specific dental fact sheets.

Special Needs Dental Care informationChildren with special needs can have unique issues when it comes to their oral health. This may be due to 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 medical or behavioral issues. Yet, because of the greater risk for children with special needs, it is vital to practice good oral health care.

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:

  • Visit the Oklahoma Association of Community Action Agencies’ Oral Health Care Guide (includes care for children with social, cognitive, and communication disabilities, oral aversions, autism and more).
  • Tips for a Healthy Mouth.

 

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.

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.

Healthy Smiles for Autism: Dental Guide and Tips for Children with Autism Spectrum DisorderThe National Museum of Dentistry has created a new resource to help parents of children with autism spectrum disorders succeed in teaching good oral healthcare. Healthy Smiles for Autism (PDF) is available for free download.

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

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  what information to share with dental staff. Some thinks other parents have found helpful include:

  • When calling to schedule the visit, ask for the first or last appointment of the day.
  • 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).
  • 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.

 

Use this checklist of questions and considerations from the National Maternal and Child Oral Health Resource Center when talking with a potential oral health care provider for your child.

  1. Is your office wheelchair accessible?
  2. If we need help getting our child to the office from the parking lot, is there someone on the staff who can help? Staff may be able to help by carrying personal items or equipment.
  3. Do any staff members know how to perform safe wheelchair transfers and use a transfer board?
  4. Do your dental chairs have movable armrests for easy access? It can be a challenge to lift children over armrests or to move them into a dental chair without removable armrests if they are wearing leg or back braces.
  5. Can a wheelchair fit parallel to the dental chair in most of the exam and treatment rooms? Doing exams and preventive care with children in their wheelchairs is sometimes preferred to transferring the child, particularly if the wheelchair can be adjusted. Transfers are also more difficult if the exam room is too crowded to line up the wheelchair close to the dental chair.
  6. What are your policies on late arrivals or cancellations? Families with children who have health or developmental needs that are unpredictable may need special arrangements for appointments.
  7. How are your exam and treatment rooms arranged? Is it an open room with many chairs? Is a private room an option?
  8. What kind of x-ray equipment do you use? Can it reach low enough for young children or children in wheelchairs? Do you have options for alternative x-ray techniques?
  9. Can parents and caregivers stay in the exam or treatment room with their child?
  10. Do you have a policy on protective stabilization? Any techniques for stabilization or that restrict movement must have informed consent from parents.
  11. What is your informed consent process for: Examination? Treatment? Behavior management techniques?
  12. Do you have any health history or other forms that you can send me to complete before our first visit?
  13. May we schedule an orientation or first visit session? A meet and greet visit will allow you and your child to see the office, meet the dental team members and ask questions.
  14. Are you able to schedule appointments to allow for flexible staffing and assistance if needed? For example, the dental hygienist may need a dental assistant to help place sealants or take x-rays, or additional staff members may be needed to assist with a wheelchair transfer.
  15. What type of payment methods/arrangements do you accept? Are you aware of any community resources for financial coverage for children with special health care needs who cannot afford oral health care?
  16. Have any of the dental team members received special training in working with children with special health care needs?

Adapted with permission from National Maternal and Child Oral Health Resource Center at Georgetown University, 2000. Special Care: An Oral Health Professional’s Guide to Serving Young Children with Special Health Care Needs. Washington, DC: National Maternal and Child Oral Health Resource Center at Georgetown University. http://www.mchoralhealth.org/SpecialCare.

Download the dental office checklist.

 

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.

Find specific dental care tips for your child’s health condition.

Special Needs Dental Fact Sheets from the University of Washington School of DentistryYour child’s health, developmental, behavioral or mental health condition may have an impact on their dental health. These special needs dental fact sheets were created to help you partner with your doctor and dentist to get the best dental care possible for your child. If your child’s condition is not listed below, you can use the “General Guidelines” handout. The facts sheets can help you:

    • Know what to say when you call to schedule a dental visit
    • Prepare for the dental appointment
    • Care for your child’s oral health needs

 

Special Needs Fact Sheets:

Special Needs Dental Care fact sheets are shared with permission of the University of Washington School of Dentistry. Fact sheets were developed by the University of Washington and the Washington State Department of Health – Oral Health Program.

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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