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).