Some children are disabled due to developmental conditions, and not able to enjoy the privileges of a normal child. These conditions include Mental retardation, Down’s syndrome, Learning Disability, Cerebral palsy, epilepsy, deafness and blindness. These children present with multiple anomalies of facial structures, teeth eruption time, sequence and number, and enamel malformation. They may also show a higher prevalence of dental decay and periodontal disease, because of poor oral hygiene and decay causing diet patterns.
Misalignment occurs twice as often than in the average population. Bruxism is seen in cerebral palsy patients resulting in loss of enamel layer and jaw joint problems. Due to the nature of the disorder, these children are susceptible to trauma especially in the upper front teeth. Children may have excessive drooling and difficulty in swallowing. Such patients present with mouth breathing and open front teeth bite. That is why it is very important to take preventive measures in these children.
Disabled children have a poor standard of oral hygiene, along with a higher prevalence of periodontal disease. Prevention centers around the systematic removal of bacterial plaque. Tooth brushing and flossing, the most effective plaque controlling methods, require practice, skill, and effort. Disabled individuals may find all of these tasks daunting, and are unable to achieve adequate standards of plaque control.
The brushing techniques for these children should be carried out by the parents and guardians. An often recommended technique is the horizontal scrub method due to its ease of performance. Modification of toothbrushes can be made, i.e. the grips can be modified using the patient’s hand to custom design the handle, even bicycle handles can be fitted over the brush handle to give better grip. Electric tooth brushes can also be used.
A balanced diet is essential for nutrition as well as a part of the preventive program for handicapped children. The diet may vary depending upon the handicapping condition present. Conditions like cerebral palsy are associated with difficulty in swallowing, and the food may need to be poured. Properly timed breastfeeding and weaning should be given to decrease the chances of nursing caries.
Systemic fluoride, through the ingestion of optimally fluoridated water, should be advocated to handicapped children. Where the level is suboptimal, fluoride supplementation is required (tablets, drops, rinses). Regularly, schedule professional application of topical fluoride, both in fluoridated and non fluoridated areas. Use of fluoride containing toothpaste and daily mouth rinses are beneficial in handicapped children with very poor oral hygiene.
Familiarize the child to the dental office, and dental personnel, to reduce his/her fear of the unknown before undertaking any treatment. Speech must be slow and simple. Only one instruction at a time should be given. These fillings include the application of pit and fissure sealants, preventive resin fillings, and even steel caps (in cases of severe clenching or interdental caries).
It may seem a daunting task, but we here at H. Peter Ku D.D.S. PA Fort Worth office truly care about the dental health of everyone. We’d be honored to help you and your child feel right at home and keep their smile sparkling.