Dental care for children with disabilities.

Every child can have healthy teeth and gums. Children with disabilities are no exception This series of articles will explain some important facts about dental disease and its prevention, focusing on the particular needs of children with disabilities. Future articles will deal with a number of topics including special techniques for daily oral care, common pediatric dental problems and appropriate methods of behavior management during visits

Good oral health is an important part of a child's total health. Children with good strong teeth are able to chew a wider variety of foods for healthy nutrition. Healthy teeth aid in speech development by helping children make the proper sounds for speaking clearly. And clean, healthy-looking teeth help children look better and feel better about themselves.

With all the medical, nutritional and emotional needs of children with disabilities, it can be hard for parents to find time for proper daily oral care. Getting a child to the dental office can be difficult, too. But preventive care now can spare the child unnecessary pain and costly dental procedures later.

Prevention with daily oral care

Dental problems can be prevented before they start. That means cleaning the teeth at home every day. Daily brushing and flossing remove plaque, the primary cause of tooth decay. Plaque is a sticky, colorless film of bacteria that constantly forms on the teeth. When food particles, especially from sugary foods, stick to the teeth, the bacteria use the food to produce acids which cause cavities. If plaque is not removed every day, it can lead to gum disease; and gum disease, if left untreated, can lead to tooth loss - all of which could be painful for the child.

Although daily oral care is a necessity, it should be a pleasant experience as well. 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.

If possible, children should clean their own teeth. You can explain why daily brushing and flossing are important and show a child how to do it. By placing your hand over the child's hand, you can guide the child through each step.

Some children will be unable to clean their own teeth, however. In such cases, the parent must do the cleaning.

Where should you do it?

Daily oral care can be performed in any well-lit room that is 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 and out in a basin. The best place for daily oral care is a place where the child is most comfortable, or where you are able to give the best care.

Positions

There are a number of positions you can use to clean the child's teeth. In any position, it's important to support the child's head. Be careful to avoid choking or gagging if the child's head is tilted back. It is also important for you to be able to see what you are doing and easily manipulate dental floss and brush. Ask your dental professional to recommend the safest, most comfortable position for your child.

Wheelchair

Stand behind the wheelchair. Use your arm to brace the child's head against the chair or against your body. Use a pillow for the child's comfort.

Or sit behind the wheelchair:

Remember to lock the chair wheels first, then tilt the chair back into your lap.

Sitting on floor

The child sits on floor; you sit behind the child on a chair. The child leans his or her head against your knees. If the child is uncooperative or uncontrollable, you can place your legs over the child's arms to keep him or her still.

Lying on floor

The child lies on the floor with his or her head on a pillow. You kneel behind the child's head. You can use your arm to hold the child still.

Lying on bed

or sofa

The child lies on a bed or sofa with his or 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 his or her hands or feet as needed.

Beanbag Chair

For a child who has difficulty sitting up straight, a beanbag chair may let the child relax without fear of failing. You should be in the same position as for bed or sofa.

Special Children

are at Greater Risk

There are a number of reasons why children with disabilities are often more prone to dental disease.

Oral conditions: Some genetic disorders or very high fevers in very young children can cause defects in tooth enamel that make the enamel prone to decay. Congenitally missing teeth and teeth that do not align properly are frequently seen in children with cleft palates and other craniofacial disorders. Gum problems often occur in children with Down syndrome.

Physical limitations: Children who cannot 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 - such as those with spinal cord injuries, muscular dystrophy or cerebral palsy - 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 of tooth decay. Children who need help drinking many drink less fluid than other children, so they don't have enough fluids in their mouth to help wash food particles off of their teeth.

Medications: A number of medications that may be used more frequently by children with disabilities can lead to increased risk of dental disease. Medications that use syrup or sugar to sweeten the taste can cause tooth decay if used over a long period of time. Some seizure medications may cause the gums to bleed or become enlarged. Excessive gum growth can interfere with chewing and speech; it can also lead to ruin disease. Sedatives, barbiturates, antihistamines and drugs used for muscle control may reduce the flow of saliva. With less saliva, there is less cleansing action to help protect the teeth against cavities. Aspirin, taken in large doses and dissolved in the mouth before swallowing, can provide an acidic environment that fosters tooth decay. Some antibiotics should be prescribed with caution because they can stain or discolor newly erupting teeth.

Steven P. Perlman, D.D.S., M.Sc.D., specializes in dental care for children with disabilities. In addition to maintaining a private practice in Lynn, Massachusetts, he teaches pediatric dentistry at the Boston University Goldman School of Graduate Dentistry and serves as vice president of the Academy of Dentistry for Persons with Disabilities. Dr. Perlman also devotes much energy and time to the Special Olympics as clinical director of their "Special Athletes, Special Smiles" program. Dr. Perlman lives in Swampscott, Massachusetts with his family.