Parents of CSHCN frequently report that they receive little information about their child’s oral development and that they don’t feel confident in providing oral hygiene care at home. As part of health supervision, oral health professionals should provide parents with anticipatory guidance. Anticipatory guidance refers to key information about oral development, teething and tooth eruption, oral hygiene, feeding and eating practices, fluoride, and injury prevention provided to the family about the child’s current oral health and what to expect during the next developmental stage. Although anticipatory guidance for most children is based on chronological age, in CSHCN it is based on an overall assessment of the child’s growth and development and level of functioning in activities of daily living.
How can parents provide effective oral hygiene care at home for their child with special health care needs?
Larry Salzmann, D.D.S. responds.
The best way to involve parents in their child’s oral health is to improve their understanding of oral health, and increase their confidence in their ability to provide oral hygiene care for their child. The first step is to provide them with information about how to improve their own oral hygiene and answer their questions about oral health. The next step is to explain what to look for in their child’s mouth and how to do that. And the final step is to demonstrate appropriate oral hygiene care skills for both parents and the child. Ask parents to demonstrate how they clean and inspect their child’s mouth, and discuss problems they encounter. Brainstorm with parents to arrive at realistic solutions. Offer, with permission, modifications to make the process easier and more effective. Parents’ comfort level and the types of problems encountered will change as the child progresses through various developmental stages.
Oral health professionals can share educational resources with parents and children to foster optimal oral hygiene at home. (Also see Resources for Parents.)
Some of the following special situations may arise:
Examples of a mouth prop include
Feeding and eating problems—the inability or refusal to eat certain foods because of neuromotor dysfunction, obstructive lesions, taste or texture sensitivities, or psychological factors—are more common in CSHCN than in the general pediatric population.
Some contributors to nutritional problems that are common among CSHCN include the following:
More contributors to nutritional problems that are common among CSHCN:
In general, multidisciplinary involvement is critical to promote optimal nutritional status for CSHCN. Oral health professionals should coordinate dietary and feeding recommendations with a registered dietitian/nutritionist or other health professionals (e.g., occupational therapist, psychologist) involved in the child’s nutritional care.
Oral trauma and injury from falls or accidents are common among children, especially when they are learning to walk. However, they occur more frequently in children with balance problems, seizure disorders, or cerebral palsy. Emphasize to parents that injuries require immediate professional attention, and explain the following procedures to follow if a permanent tooth is knocked out:
Physical abuse, which is reported more frequently in CSHCN than in the general pediatric population, often presents as oral trauma. (See section 3.4, Child Abuse and Dental Neglect.)
Children who engage in self-injurious behaviors may be receiving care from a therapist or psychologist. If these harmful behaviors have not been diagnosed, refer the child to the primary care health professional, who will in turn make a referral for assessment and treatment. If appropriate, oral health professionals should recommend protective oral appliances to assist in combating self-injurious behavior. (See section 3.3, Oral Examination, Oral Trauma and Injury.)
More and more often, professionals are using motivational interviewing to help parents set goals for increasing their confidence and skills in oral care. Motivational interviewing facilitates behavior change by helping the child or parents explore and resolve their ambivalence about change. It is done in a collaborative style, which supports the autonomy and self-efficacy of the patient and uses the child’s or parents’ own reasons for change. It increases the child’s or parents’ confidence and reduces defensiveness. Motivational interviewing keeps the responsibility to change with the child and/or parent, which helps to decrease staff burnout. In dentistry, it is useful in counseling about brushing, flossing, fluoride varnish, reducing sugar-sweetened beverages, and smoking cessation. Open-ended questions, affirmations, reflective listening, and summarizing characterize the patient-centered approach. It is especially helpful in higher levels of resistance, anger, or entrenched patterns. Motivational interviewing is empowering to staff, child, and parents and by design is not adversarial or shaming. 6