Comprehensive Preventive Oral Care.

Surveys over the past decade have shown that most dental students have had fewer than eight hours of lecture material on caring for individuals with special needs. Students often experience fewer than five treatment opportunities with individuals with special needs. The educational experience for dental hygienists is similar. It is little wonder, then, that parents and caregivers have difficulty finding dental professionals who are capable and willing to treat this population! This article outlines a comprehensive program of preventive oral care for people with special healthcare needs.

Preventive oral care is much more than plaque control. Oral health status should be monitored and controlled during growth and development, and should continue over a lifetime.

Components of good oral healthcare

Prevention begins with infant care.

* Parents need to pay attention to early mouth care as well as care during teething. Early and frequent visits to the dentist between the ages of 1 and 3 years are critical. In addition, children who visit the dentist frequently for routine care do not generally develop the behavioral issues that are common among those who are seen only when there is a problem.

* Parents and caregivers should be educated about nursing-related tooth decay. They also need instructions on how to stop or prevent habits that could be detrimental to proper growth and development, such as thumbsucking and tongue-thrusting.

* A childhood fluoride program is essential. The dosage of fluoride should be personalized considering variables such as: the child's age; diet (breast milk or formula); the concentration in the local drinking water and other foods; and the amount of liquid the individual consumes. The use of topical or systemic fluoride or fluoride varnish should be considered.

* It is never too early to begin dietary counseling. The supermarket is full of snack foods that can cause tooth decay. Unfortunately, sweetened, sticky snack products are often used as rewards for positive behavior, without an eye to the long-term negative consequence for oral health. Parents and caregivers should be aware of the potential for tooth decay in children who have disabilities, especially if chewing and swallowing skills are poor or if the child is taking medications that affect quality and quantity of saliva.

* Reducing plaque formation is a vital component of preventive oral care. Chemical agents such as chlorhexidine gluconate (0.12%) should be considered an important addition to the daily oral homecare regimen. In addition to its home use, it can be used in the dental office as a pre-rinse, or it can be brushed or wiped on the teeth and gums to reduce gum bleeding. The application of sealants to teeth should also be considered where possible.

* Radiographs (x-rays) should be taken throughout childhood. Panoramic radiographs reveal much more information about growth and development than standard x-rays. This can be helpful in planning a course of treatment, particularly when orthodontics (braces) may not be a viable alternative. Physical or mechanical support may be necessary, depending on the disability and the individual's level of cooperation.

* Children up to the ages of 8 to 10 may need to be supervised and/or assisted with their daily oral hygiene program because of their lack of dexterity. In children with disabilities, this age range may need to be extended. Parents and caregivers should be instructed in the proper methods of toothbrushing and flossing.

If an individual is uncooperative or resistant to care, the dental professionals must find a way to manage that behavior so that quality care can be provided. The decision regarding the type of behavior management to be used must be based on the amount of care required, the level of cooperation, and the person's ability to tolerate the procedure.

A challenging but worthwhile undertaking

Oral health professionals are responsible for the dental care of the entire community in which they practice. This includes individuals with special healthcare needs. Lack of appropriate training for dental professionals and the need for parent awareness will continue to present challenges. Dental health professionals can find resources about programs, projects, training, options, and organizations for individuals with disabilities through the Academy of Dentistry for Persons with Disabilities (ADPD).

Academy of Dentistry for Persons with Disabilities (ADPD) 211 E. Chicago Ave., Fifth Floor Chicago, IL 60611 Web site: http://www.bgsm.edu/ dentistry/foscod/adpd.htm

(The ADPD does not provide referral services for consumers. For the time being, parents and caregivers should contact their state's dental society to obtain a referral to a dentist in their area.)

Steven P. Perlman, DDS, MScD, specializes in dental care for people with disabilities. In addition to his private practice, he teaches pediatric dentistry at the Boston University Goldman School of Dental Medicine. He is the Clinical Director for the Special Olympics Special Smiles program.

Christine Miller, RDH, MHS, MA, serves on the faculty of the Department of Dental Practice and Community Services at the University of Pacific School of Dentistry, where she is Director of Community Services. She also serves on the board of the Academy of Dentistry for Persons with Disabilities.

This article is adapted with permission from "Preventative Oral Care for Patients with Disabilities," Compendium of Continuing Education in Oral Hygiene, Vol. 4, No. 2, 1997.