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Oral Health Care for Children with Physical and Developmental Disabilities and Systemic Diseases
Children with disabilities are at increased risk for dental malformation and oral diseases. A number of factors put these children at greater risk
Physical limitations and behavioral
problems
Children with disabilities that affect
their motor coordination may have
difficulties with chewing and swallowing.
In addition, they may not have proper
movement of their tongue and lack the
tongue's natural cleaning action in the
mouth. Children with disabilities may
also lack the ability to brush and floss
their teeth appropriately or at all.
Children with behavioral limitations
often lack the motor coordination and
attention span for good oral hygiene.
Special diets
Children who need help drinking and
eating may drink fewer fluids so they do
not receive enough fluids to wash away
food particles in their mouth.
Additionally, children who have
difficulty chewing and swallowing often
eat pureed food, which sticks to their
teeth. Sticky foods and drinking formula,
milk or juice from a bottle, especially
before and during bedtime, makes the
child more susceptible to dental decay.
Medications
Medications often contain syrup and
sweeteners to make them more appealing to
the children who have to take them.
Children often take medication
before bedtime or during the night which
makes them more susceptible to dental
decay. Several seizure medications
including Dilantin, Phenobarbital and
Tegretol are often associated with
gingival bleeding, enlargement and
overgrowth that can lead to gum disease.
Sedatives, barbiturates, antihistamines
and drugs used for muscle control cause
decreased salivary flow. Less saliva in
the mouth leads to poor self-cleansing
and food clearance.
Oral Conditions
Prenatal and birth related difficulties,
in addition to high fevers, have been
associated with enamel and dentin defects
that make teeth more prone to dental
decay. Congenitally missing teeth and
teeth/jaws that do not align properly are
commonly seen in children with
craniofacial anomalies. Children who have
open mouth postures and/or are obligate
mouth breathers will often have red,
inflamed gums. Gum disease is often found
in children with systemic illnesses
including Diabetes, Downs Syndrome and
AIDS.
Good oral health and prevention
against tooth and gum disease is most
important in patients with mental,
physical, and developmental disabilities.
Early referral to the dentist can be
beneficial to the parents for dental
anticipatory guidance and oral hygiene
education. In addition, treatment of
conditions in the early stages is often
easier for the patient and dental
practitioner.
Children with Systemic Disease
The literature has reported that the most common unmet
health care need of this group of children is dental
care. Parents of children with special health care needs
often have calendars that are filled with many
appointments to meet the child's physical, social,
behavioral and educational needs. In addition, there are
a limited number of dentists that are comfortable with
treating these children in a private office setting.
Children with special health care needs can be more
susceptible to dental decay for the following reasons:
- frequent medications that are sweetened for a better taste,
- behaviorally resistant to oral hygiene and dental treatment,
- frequent hospitalizations make dental appointments difficult,
- lack of motor coordination and/or craniofacial anomalies makes oral hygiene difficult, alternative treatments may be necessary because of the child's medical condition,
- medical management is required for dental evaluation and treatments.
Hematological disorders
Children with anemias, clotting
dysfunction, platelet deficiency and
other hematological disorders are
susceptible to medical crises that are
brought on by dental emergency and
infection. Medical management in
coordination with dental evaluation and
treatment is often required. Early dental
evaluation is important for anticipatory
guidance and dental education and
prevention.
Cardiovascular disorders
Children with cardiovascular disorders
are susceptible to problems secondary to
dental infection and benefit from
prevention and early intervention. Dental
evaluation and treatment in this group of
children is often delayed until there is
an emergency. Dental treatment can be
completed with coordinated medical and
dental management.
Neurological disorders
Children in this group are susceptible to
dental trauma during a seizure or from
decreased motor coordination. Frequent
liquid medication intake makes them more
susceptible to dental caries. Several
anti-seizure medications contribute to
gingival overgrowth and poor oral
hygiene. This group often has poor food
clearance in their mouth due to decreased
fine motor coordination of the facial
muscles and the tongue. Over-retained
food and poor oral hygiene are also
contributors to dental caries and gum
disease. Dental evaluation should not be
delayed in these patients.
Immunocompromising disorders
Children with a diagnosis of HIV and AIDS
often have coincident oral manifestations
of the disease. In addition, these
children are often on around-the-clock
drug regimens that make them more
susceptible to dental caries. For these
reasons, immunocompromised children should have early dental
evaluation.
Cancer diagnosis
Children with a diagnosis of cancer are
at risk for developing infections,
bleeding problems and oral manifestations
associated with chemotherapy and
radiation therapy. Soon after diagnosis,
these children should have a dental
evaluation to identify any potential
problems and to educate the patient and
family. Chemotherapy and radiation can
have direct effects on growth and dental
development.
Organ and Marrow transplants
All patients that require an organ or
bone marrow transplant are at risk for
oral related problems. A baseline
evaluation is beneficial prior to the
transplant and allows for dental
education and prevention. Oral health can
play an important role in the morbidity
of the transplant.
