In this month’s article, I would like to focus on oral health for kids and adults with special needs. The US Department of Health and Human Services has a great guide called “Dental Care Every Day” for people with developmental disabilities. I have used many of their suggestions in this article.
When you are brushing another person’s teeth you sometimes have to get creative. The bathroom is not the only location to try. Sometimes a kitchen table or couch works best. A parent or caregiver can stand behind an individual and cradle their head back, to open the mouth and get access to the teeth for brushing and flossing. It’s important to establish a routine, if you can, so that brushing and flossing become something that is expected in the morning and before bedtime. Pediatric Dentists often use a technique called “Tell-Show-Do” to help kids and adults with special needs understand dental care. For example, we tell a child that we are going to brush their teeth. We show the child how we are going to brush their teeth using a puppet or a model. Then we brush the teeth in the same way that we have explained it to the child. This gives a child familiarity and a sense of routine that can be very helpful in a new environment like the dental office.
Brushing another person’s teeth can be challenging, but there are some new adaptive aides that can help. Specialized Care Company makes a product called the Surround Brush that has bristles on three sides. The bristles “surround” the teeth and the top of the brush prevents people from biting down and closing their mouth while their teeth are being brushed. There are also adaptive mouth props or comfortable foam biting sticks that can be used to keep a person’s mouth gently open while you are brushing and flossing their teeth. Your child’s dentist can suggest adaptive aides that can help you make the most out of your home oral healthcare routine.
Tongue care is another aspect of oral health care. Many medical conditions can cause fissures or grooves in the top surface of the tongue. Just like wrinkles, these grooves can deepen as we age. The grooves need to be cleaned to remove the food debris and bacteria that can cause bad breath and also harbor bacteria that cause cavities. You can use a tongue cleaner or tongue scraper to clean the tongue’s top surface. Also, you can hold the tip of the tongue with a clean washcloth and then use a toothbrush to gently brush off the top of the tongue.
Many kids with medical conditions have some degree of dry mouth. There are many medications that can dry out the mouth by reducing the amount of saliva. Saliva usually acts as a buffer against cavities by increasing the pH level of the mouth. Bacteria that cause cavities produce acid that lowers the pH level of the mouth, turning it into an acidic environment. Tooth enamel starts to break down and “cavitate” in this low pH (acidic) environment. If your child is on medications that can cause dry mouth, it is important to talk with your child’s dentist and develop a game plan to prevent cavities and help moisten the mouth.
Dental X-rays have come a long way during the past few years. With new technology, it is now possible to take cavity-checking Bitewing X-rays from outside the mouth. This can be very helpful for patients with special needs that may have a strong gag reflex or sensitivity to things in their mouth. There is also a hand-held dental X-ray machine called the Nomad. I used this device back up in the Alaskan villages where there were no dental clinics, and we set up a dental treatment room in a school library or gym. The Nomad gives the dentist the freedom to bring the X-ray machine right to the patient instead of having to move the patient to the machine. This is just another way that modern technology can be used to make a visit to the dentist easier and more comfortable for individuals with special needs.
Another new advance is the ability to reverse the numb feeling from dental anesthesia. Phentolamine Mesylate is a drug that may be given at the end of the dental procedure to take off the numb feeling much quicker than letting it wear off on its own. It works by reversing the local anesthesia’s vasoconstrictor so that the local anesthesia causing the numb feeling flows out of the tissues. This is great for patients who may be prone to accidentally chew their lip, cheek or tongue after dental work.
“I think she ate her tooth.” This is a common thing that happens when baby teeth get loose. There is typically no issue with kids accidentally swallowing a baby tooth, even if that tooth has a filling or a silver crown. The teeth typically just pass on through and there’s no need to go looking for them. However, kids with special healthcare needs may be at an increased risk for aspirating or inhaling a loose baby tooth into their lungs, so it is a good idea to see a dentist if there is a loose tooth or loose teeth that you are concerned about in your child’s mouth.
If you have a child with special healthcare needs, it is a great idea to find a dentist that is familiar with their condition. The dentist can work with you to develop a plan that is appropriate for your child’s dental health needs. Everyone deserves to have the opportunity for a lifetime of healthy smiles and your child’s dentist can help you achieve that goal.
-by Dr. Mandy Ashley
About Our Dentists: Dr. Mandy Ashley and Dr. Madison Galloway are Board Certified Pediatric Dentists proud to serve the communities of Bowling Green, Hopkinsville, and Glasgow! We look forward to sharing our vision of excellent comprehensive dental care that is fun for children and people with special healthcare needs with your family.
SKY Pediatric Dentistry has been providing dental care to children and adults with special needs since 2013. As board-certified specialists in dentistry for children, our team strives to make going to the dentist as fun as possible while maintaining high-quality treatment and preventative measures. We tailor treatment plans to each child and offer a wide range of treatment options, including sedation, in-office general anesthesia, and also hospital-based dentistry. With over 25 YEARS of doctor experience, SKY Pediatric Dentistry is a great choice for children’s dental care in Bowling Green, Hopkinsville, and Glasgow!
