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Oral Care for The Special Needs (Part 1)

According to the American Association of Paediatric Dentistry, special health care needs include any physical, developmental, mental, sensory, behavioural, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialised services or programs. Some of the diagnoses for special needs are autism, cerebral palsy, muscular dystrophy and Down’s syndrome. For these individuals with special needs, the dentition can be affected in different ways. Some of the common dental conditions found in them include:

  • Abnormal number of teeth (may be lacking some teeth or may have many extra teeth)

  • Malformed teeth (shape may be different from normal)

  • Enamel defects (the colour of the outermost layer of the tooth may appear odd or there may be irregular surfaces or pits on the teeth)

  • Misalignment of teeth

  • Dry mouth

  • Gum swelling and disease

Dental care is often affected due to the disability and medical complications that these individuals suffer from. Some may not understand the need or have the motor ability to brush their teeth properly while others may be prone to oral diseases due to the nature of their teeth morphology or gum immunity. Therefore, a good home oral care is important to prevent the need for treatment which can be complicated due to their lack of ability to cooperate on the dental chair.

Establish a good home oral care…

A good, consistent routine is vital. This is true not only for the special needs but for all children. Establishing a routine will make things easier for most parents especially as the child gets older, more willful and stronger physically. Here are some basics for a good home oral care:

  1. Brush your child’s teeth twice daily with a fluoride toothpaste (refer to earlier posts for tips on which toothpaste to use and how to start caring for your young ones’ mouth from early on). Start brushing once the first tooth erupts and do this diligently even if each brushing session lasts for only 30 seconds. Your aim is to get your child into a routine, then slowly build the tolerance overtime.

  2. Be as consistent as you can on the routine (ie a fixed time daily for brushing). Ideally, brushing should be the first thing when the child wakes up and the last thing before bedtime. Do help your child to brush his/her teeth as it is unlikely that he/she can do a proper job.

  3. Delay introducing sweet, sugary foods and drinks to your child. For those on medications which are sweet, try to get a non-sweetened version as much as possible.

  4. Some special needs children tend to pouch (keep food in mouth) long after the mealtime is over. Use a wet towel to wipe the insides of the cheeks after each mealtime to remove any food remnants.

The earlier you start the child on regular toothbrushing, the less you will struggle overtime. Some children may be fed through naso-gastric tubes and do not eat through their mouth. Although these children are at very low risk to develop dental cavities, they can still get tartar (hardened plaque) which can contribute to gum disease. Therefore, they will still need to have their teeth brushed. If you start introducing brushing late, there is a chance that the child may develop oral aversion. Oral aversion is the reluctance, avoidance, or fear of eating, drinking or accepting sensation in/around the mouth. Children with oral aversion will need to undergo therapy to desensitize them. This will require patience and persistence on the caregivers’ part.

Toothbrushing aids

The use of an electric toothbrush may be helpful in some cases where there is reduced ability to maneouvre the toothbrush effectively in the mouth (eg tend to purse lips repeatedly during brushing, mild cerebral palsy affecting hand movement). However, caregivers should still help the younger children to brush their teeth even with the use of an electric toothbrush. For older children or teenagers who have mild motor disability and are brushing mostly on their own, an electric toothbrush may be more helpful in removing plaque compared to a normal toothbrush. Choose an electric toothbrush in which the brush head rotates. Those with mild dexterity problems can improve their grip of the toothbrush by enlarging the brush handle. This can be done by tying a thick sponge or winding an adhesive tape a few rounds around the handle.

If there is difficulty keeping the child’s mouth open, you can use a rubber teething toy for the child to bite on one side of the mouth to prop the mouth open while brushing on the other side. For older children, a mouth prop can be made by taping several tongue depressors (looks like large ice cream sticks, pic below) together. Consult your child’s dentist on how to use a mouth prop to avoid injury.

Sometimes even with toothbrushing aids, there will be some special needs children who require long-term help to brush their teeth. Therefore it is important that caregivers make toothbrushing a daily routine from early on to give a better chance for the child to accept toothbrushing as a norm.

Mouth props (L: commercial type, R: self-made type) may help to keep the child's mouth open during brushing

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