Preventing Dental Disease in Children with Disabilities
Every child can have healthy teeth and gums, and children with disabilities are no exception. But with all the medical, nutritional, and emotional needs of children with disabilities, it can be difficult to find time for proper daily oral care. And getting the child to the dentist office can be difficult, too. But preventing cavities and gum disease now is easier than correcting them later. Your preventive care can spare the child unnecessary pain and costly dental procedures.
Special children are at greater riskThere are a number of reasons why children with disabilities are often more prone to dental disease.
- Oral Conditions. Some genetic disorders or high fevers in young children can cause defects in tooth enamel that make it prone to decay. Congenitally missing teeth and teeth that do not align properly are frequently seen in children with cleft palates. Gum problems often occur in children with Down syndrome.
- Physical Limitations. Children who can't chew or move their tongues properly cannot benefit from the natural cleaning action of the tongue, cheek, and lip muscles. Children with disabilities, especially those with poor motor coordination (from spinal cord injuries, muscular dystrophy, or cerebral palsy, for example) may not be able to clean their own teeth or may not be able to use the usual brushing and flossing methods.
- Special Diets. Children who have difficulty chewing and swallowing may often eat pureed foods, which tend to stick to their teeth. Frequent eating of sugary foods or sleeping with a bottle of formula, milk, or juice can increase the chances for tooth decay. Children who need help drinking may drink less fluid than other children, so they don't have enough fluids in their mouth to help wash away food particles.
- Medications. Medications using syrup or sugar to sweeten the taste can cause tooth decay if they're taken for a long time. Some seizure medications may cause bleeding or enlarged gums, and excessive gum growth can hamper chewing and speech and lead to gum disease. Sedatives, barbiturates, antihistamines, and drugs used for muscle control may reduce saliva flow. With less saliva, there's less cleansing action to help protect against cavities. Aspirin, taken in large doses, and dissolved in the mouth before swallowing, can provide an acidic environment which fosters decay. Some antibiotics should be prescribed with caution because they can stain or discolor newly erupting teeth.
Make oral care easier for the child...and you!Daily oral care should be a pleasant experience as well as a necessary one. Even if the child can't brush and floss properly, letting the child play at cleaning a little when you're finished can add to the fun. Children should clean their own teeth, if possible. You can explain why daily brushing and flossing are important and show them how to do it. By placing your hand over the child's hand, guide the child through the steps. However, you will have to do the cleaning if the child is unable to do it. Here are some things that will make it easier for you both.
Location of cleaning:Use any well-lit room that's convenient. If the child is in a wheelchair, the kitchen might be ideal. If the child is in bed, that's okay, too. Have the child sit up. Then let the child sip water from a glass through a straw and rinse out in a basin. The best place is where the child is most comfortable, or where you're able to give the best care.
Positions for cleaning:There are a number of positions you can use to clean the child's teeth. Remember that supporting the head, seeing properly, and ease of manipulation are important.
- Bed or sofa. Have the child lie on abed or sofa with his/ her head in your lap. Support the child's head and shoulders with your arm. If the child is uncooperative or uncontrollable, a second person can hold the child's hands or feet if needed.
- Wheelchair. Stand behind the wheelchair. Use your arm to brace the child's head against the chair or your body. Use a pillow for the child's comfort. Or sit behind the wheelchair. Lock the chair wheels first, then tilt the chair back into your lap.
Remember, in any position, it is important to support the child's head. Take care to avoid choking or gagging the child if the child's head is tilted back.
Reprinted from a parental education pamphlet "Preventing Dental Diseases in Children with Disabilities," from the American Dental Hygienists Association.