Oral health care for children with physical and mental disabilities

Children with certain disabilities appear to struggle with poor oral health – these conditions include Down syndrome, epilepsy/seizure disorders and cleft lip and/or palate. Also affecting oral health are structural anomalies of the head and face such as cerebral palsy, learning or developmental disabilities and vision or hearing impairments. Added to this list is children suffering of HIV infections and children with mental disabilities.

Children with disabilities may have impaired cognitive abilities, behavioural problems, impaired mobility, neuromuscular problems (like difficulty with drooling, gagging and swallowing), uncontrolled body movements, gastroesophageal reflux or seizures. These complications can be barriers to adequate oral care and put them at higher risk for developing oral health problems.

There are also other contributing factors to poor oral health in children with disabilities:

Oral conditions

Some genetic disorders in young children can cause defects in tooth enamel, missing teeth and teeth that do not align properly. Children with Down syndrome often suffer from gum disease.

Physical limitations

Children who cannot chew or move their tongues properly do not benefit from the natural cleaning action of the tongue, cheek, and lip muscles.

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Mental capabilities

For these children it might be difficult to follow instructions to assist you in taking proper care of their teeth and mouth.

Behaviour problems

Children with behaviour problems like anxiety might find it difficult to cooperate with dental care.

child brushing teeth: helping your disabled child with their oral health

Uncontrolled body movements

Children with uncontrolled body movements and/or poor motor coordination such as spinal cord injuries, muscular dystrophy or cerebral palsy may not be able to clean their own teeth or use the usual brushing and flossing methods.

Mobility problems

It is often very difficult for a child in a wheelchair to get close to a basin to brush their teeth. Often all kinds of adjustments need to be made to be able to practice a good enough dental hygiene routine.

Neuromuscular problems

This might go hand in hand with persistently rigid or loose chewing muscles, drooling, gagging and problems with swallowing.

Cardiac disorders

Especially mitral valve prolapses, and heart valve damage are common in Down syndrome children. Such children might need pre-medication before their dental visits. Consult your cardiologist in this regard.

Reduced saliva flow

Children who need help drinking may drink less fluid and may not have enough saliva to help wash away food particles.

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Medications

Sweetened medications used over a long period of time can cause tooth decay. Some anti-seizure medications may cause swelling or bleeding of the gums.

Gastroesophageal reflux

This might affect central nervous system disorders such as cerebral palsy. Teeth might be sensitive and/or evidence of erosion might be present.

Seizures

During a seizure the child might bite their tongue or cheeks or might even chip their teeth.

Visual impairment and hearing loss

This is often the case in children with developmental disabilities whereby it is difficult for them to follow instructions and for you to teach them to take care of their teeth.

Restricted diets

Children who have difficulty chewing and swallowing may often eat soft food. Unlike hard fruits and vegetables that help removed plaque when chewing on it, soft foods do not have the ability to assist in cleaning the teeth.

Latex allergies

Sometimes a child might have an allergy to latex which makes dental treatment more difficult.

oral health care for children with physical and mental disabilities: teeth

How do you know your disabled child might suffer from oral health problems?

When there are oral health problems one or more of the following may happen:

  • the child might start grinding his/her teeth
  • he/she might refuse food or prefer softer foods
  • changes in behaviour such as touching in or around the mouth, teeth, jaws, and cheeks
  • foul smelling breath
  • discoloured teeth

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The following oral health problems are common in children with disabilities:

  • tooth eruption depends on genetic factors, growth of the jaw, muscular action, and medications. This might be delayed, accelerated or inconsistent. Some children may not get their first primary teeth until 2 years of age.
  • dental cavities are common in children with developmental disabilities. In addition to problems with diet and oral hygiene, prolonged bottle feeding, and the adverse side effects of certain medications contribute to dental decay.
  • periodontal disease occurs more often and at a younger age in children with developmental disabilities.
  • Overgrowth of gums caused by medication used for treating seizures, high blood pressure and weak immune systems also increase the risk for periodontal disease.
  • Malocclusion (a poor fit between the upper and lower teeth and crowding of teeth) occurs in many children with developmental disabilities. It may be associated with muscular abnormalities, delayed tooth eruption or underdevelopment of the jaw. Teeth that do not align properly can make chewing and speaking difficult and increase the risk of periodontal disease, dental caries, and oral trauma.
  • Damaging oral habits such as grinding/clenching, food pouching, mouth breathing, tongue thrusting, picking at the gums or biting of the lips can be very difficult to deal with.
  • Tooth anomalies such as variation in number, size and shape of the teeth are common in children with disabilities.
  • Trauma and injury to the face and mouth from falls or accidents occur more frequently in children suffering from seizures, cerebral palsy, abnormal protective reflexes, or poor muscular coordination.

Facts to remember when it comes to oral care for your disabled toddler:

  • Adults can spread germs. Do not put anything in your child’s mouth if it has been in yours.
  • Children, but especially the ones with special needs require an adult’s assistance with brushing your teeth.
  • Look for toothbrushes with thicker handles or modify the handle of the toothbrush to make it easier for the child to hold. Just like any child, the disabled child might also express the need to brush his/her own teeth. Allow this, but always assist.

modified toothbrush for a disabled child

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  • Remember that good nutrition is as good for the body as it is for the mouth. Soda, sweet drinks, candy, and other sweets containing sugar can cause cavities. Additional damage to the teeth is not a good idea.
  • Using fluoride reduces cavities. A fluoride toothpaste and additional fluoride treatments are recommended. Speak to your dental professional to get advice.
  • Regular dental visits are of utmost importance.
  • Start a good and regular oral hygiene routine from birth and prevent baby bottle tooth decay and do not allow your baby to go to sleep with a bottle with anything other than water.
Sarie traded a glamorous career as a lecturer at a finishing school for a new adventure as a dental hygienist and lecturer when she went to university to retrain at the age of 31. Sarie found her passion in helping people, saying ‘it’s much more than working on someone’s mouth, it’s restoring confidence, creating opportunities and being part of making it all happen, not only for the patient, but also for myself.’ A mom of one herself, Sarie has a special interest in working with children.