For many parents of children with disabilities, pediatric dental care may be low on their list of concerns. However, children with disabilities are almost twice as likely to develop oral health problems. This is not simply a result of parental distraction – a variety of physical, behavioral, and emotional conditions can play a role (1). Some conditions that commonly require specialized dentistry include cerebral palsy, seizure disorders, vision and hearing impairments, craniofacial abnormalities, Down syndrome, and developmental disabilities like autism. Fortunately, all pediatric dentists should have training in caring for children with a variety of needs, and 99.5% also have hands-on experience treating children with disabilities (2).
Certain genetic disorders, like Down syndrome, can cause tooth malformations, delays in tooth eruption, and extra or missing teeth. These issues can lead to tooth crowding and poor alignment, which in turn makes teeth difficult to clean and predisposes children to oral health problems. Immune system and connective tissue disorders also increase the risk of tooth decay and gum disease (3).
Other disabilities do not involve inherent tooth or mouth abnormalities, but can still put children at risk of dental disease. Examples include cerebral palsy (CP) and autism spectrum disorder.
Dental Health: Cerebral Palsy
Children with cerebral palsy may experience dental deterioration due to:
- Difficulty with brushing and flossing (because of hyperactive bite/gag reflexes or impaired coordination)
- Behavioral difficulties leading to oral aversion
- Difficulty with swallowing (dysphagia), which causes food to stay in the mouth longer than usual
- Excessive teeth grinding, which wears down enamel
- Medications that are high in sugar or have the side effect of reducing saliva production
- Gastroesophageal reflux, which may erode teeth
Additionally, some children with cerebral palsy have problems with tongue thrusting, which can lead to an open bite and excessive drooling. This may be possible to correct through orthodontia, but orthodontia in children with cerebral palsy is also risky because working around corrective apparatuses like braces makes dental hygiene even more challenging (4).
Catering dental hygiene to the specific needs of a child with cerebral palsy will depend on the ways in which cerebral palsy affects them. If they have a strong gag reflex, the dentist may need to place the child’s chin in a downward position while putting instruments into their mouth. If they have cognitive deficits, dentists should carefully explain procedures at a level the child can understand. If a child has uncontrolled body movements, the dentist should minimize lights and sounds that can trigger spastic reflexes (5) .
Dental Health: Autism Spectrum Disorder
For children with autism, visiting the dentist can be a very overwhelming experience. As described by the American Speech-Language-Hearing Association (ASHA): “The sensory overload from the strange smells, loud noises, and sharp tools; the unfamiliarity of the masked adult looming; and the unpredictability of the whole process – not knowing what will happen and when it will end – are just some of the factors that make this a particularly difficult scenario for a child with autism.” As a result, nearly half of children with autism have “fair” or “poor” dental health. ASHA recommends that parents and dentists work together to create a plan to slowly acclimatize the child to dental visits. For example, they might begin by simply entering the office, greeting the staff, and leaving. Or the child could be allowed to observe a parent’s appointment before having their own (6).
Parents of children with disabilities should not hesitate to express their concerns before an appointment. “Pediatric dentists understand that each child is unique and may need extra care to feel comfortable during dental treatment,” stresses the American Academy of Pediatric Dentistry. “For example, one child might do great with positive communication, another might benefit from a body blanket to help control involuntary movements, and still another might need mild sedation to feel relaxed during treatment. Pediatric dentists stand ready with a variety of possible approaches; you can help select the approach that is best for the specific health and behavioral needs of your child” (2).
If you do not yet have a pediatric dentist you are happy with, you may find it helpful to contact the Special Care Dentistry Association (http://www.scdaonline.org/) or your local dental society.
For more information on pediatric dentistry for children with disabilities, as well as tips for maintaining dental hygiene at home, check out the following resources:
- Special Care: An Oral Health Professional’s Guide to Serving Young Children with Special Health Care Needs
- Fast Facts: American Academy of Pediatric Dentistry 2014
- Dental Health Care For Children With Special Needs
- Practical Oral Care for People with Cerebral Palsy
- Oral Health Fact Sheet for Dental Professionals: Children with Cerebral Palsy
- Autism Awareness Month: Dental Care Tips for Children with Autism Spectrum Disorder