Head Start
What oral health issues and challenges do children with special health care needs
commonly face?
Depending on their condition,
children with special health care needs can be more susceptible than other
children to tooth decay, gum disease, injury, malocclusion, tooth anomalies
(variations in the number, size, and shape of teeth), developmental defects,
infections, and other oral conditions. Frequently, one or more of the following
conditions occur in these children:
Dry mouth—Dry
mouth is the result of reduced saliva production caused by certain diseases
and medicines. Saliva is beneficial for the mouth because it contains antibacterial
properties, lubricates tissues in the mouth, and removes food debris from
the mouth. Dry mouth can lead to tooth decay, gum disease, and oral infections.
If a child has dry mouth, he or she may not be able to eat enough or may
have
a hard time swallowing. The child may also hold food in the mouth and not
swallow it, which contributes to tooth decay. Taking frequent sips of water
throughout
the day can increase the flow of saliva.
Bad breath—Poor
oral hygiene, gum problems, and dry mouth can cause bad breath. Digestive
and sinus problems can also cause bad breath, and so can certain medicines.
To
minimize bad breath, it is important to brush and floss thoroughly every
day. If possible, brush the child's tongue, as it can hold bacteria and
food particles
that can contribute to bad breath. Parents, Head Start staff, and other
caregivers should have opportunities to receive training from oral health
professionals
on safe and effective toothbrushing and flossing for children with special
health care needs.
Tooth grinding—Grinding
teeth usually happens at night but can happen at any time. This can lead
to wear on the teeth, flat tooth surfaces, headaches, pain, and gum disease.
Sometimes
no treatment is necessary or possible. If the habit is not outgrown,
oral appliances made by a dentist may be helpful.
The
following factors may also contribute to oral health problems in children
with special
health
care needs:
Medicines—Many medicines,
particularly anti-asthma inhalants, can cause dry mouth and
can place a child with special health care needs at risk for tooth decay,
gum disease,
and oral
infections. Medicines that contain sugar (for example, liquid
antibiotics, vitamins, gummy tablets, lollipop medicines, cough drops,
cough syrups,
and asthma syrups) may coat or stick to the teeth, which can
lead to tooth
decay.
Some seizure medications cause enlarged gums. Pills designed
to dissolve in the mouth may also contain sugar or release other erosive
agents that
promote
tooth decay. Rinsing the mouth with water or brushing the teeth
after taking medicine can help.
Soft diet—Some
children with special health care needs have trouble biting
and chewing. Because of
this, their diets may be limited to soft foods and liquids.
These children tend to hold food in their mouths, which can lead to tooth
decay. Frequent
brushing with fluoridated toothpaste and flossing throughout
the day can reduce the risk of developing tooth decay. Parents, Head
Start staff,
and
other caregivers
should have opportunities to receive training from oral health
professionals on safe and effective toothbrushing and flossing for children
with special
health care needs.
Poor oral hygiene—Because
of physical limitations, some children with special health
care needs have difficulty with toothbrushing. Many aids
are available for cleaning
the
teeth and gums of children with special health care needs.
(See the related FAQ,
Are there special aids or adaptations that can be made
to toothbrushes to make it easier for parents and caregivers
to clean the teeth
of children with special
health care needs?)
Trauma—Children
with developmental disabilities, chronic seizure disorders,
abnormal protective reflexes, or lack of coordinated
muscle movements frequently
experience
trauma
to the face and mouth. Because of the danger of damaging
the underlying permanent teeth, never attempt to reinsert
a lost
primary tooth. Children
receiving restorative
oral health care should be observed closely to prevent
them from chewing on anesthetized areas.
Physical
abuse often presents as oral trauma. Abuse is reported
more frequently in children with developmental
disabilities
than in the general population. If you suspect that
a child is being abused or neglected, call your child protective
services agency. Assistance
is
also available from the Childhelp® National Child
Abuse Hotline at (800) 422-4453 or the Child Welfare
Information
Gateway (http://www.childwelfare.gov).
Performance Standards
1304.20(c)(1)
1304.20(c)(2)
1304.20(c)(3)(i)
1304.20(c)(3)(ii)
References
Newacheck PW, McManus M, Fox, HB, Hung YY, Halfon N. 2000 Access to Health
Care for Children with Special Health Care Needs. Pediatrics 105(4 Pt 1):760-766.
Perlman
SP, Friedman C, Fenton SJ. 2008. A Caregivers Guide to Good Oral Health
for Persons with Special Needs. Washington, DC: Special Olympics, Healthy
Athletes, Special Smiles
Van
Dyck PC, Kogan MD, McPherson MG, Weissman Gr, Newacheck PW. 2004. Prevalence
and Characteristics of Children with Special Health Care Needs. Archives
of Pediatrics and Adolescent Medicine 158(9):884-890.
