DENTAL CARE FOR SPECIAL NEEDS.

CARING FOR CHILDREN WITH AUTISM

The dental management of autistic children requires an understanding and patient dentist who can accommodate individual cases of impaired communication, erratic or unpredictable behaviour or possible hypersensitivity to smells, sights and sounds.

I have spent many years developing simple strategies to ease the dental experience for autistic children and I would like to share them with you.

1. Children with autism need steadiness and continuity in their environment, I therefore suggest slow exposure to the dental clinic and staff.
2. It is best to make the first appointment a short and positive experience, during which questions can be asked and all the necessary dental equipment can be introduced and explored. Likewise, more frequent visits to my practice will give your child and my dental team increased opportunities to learn about one another and to provide preventative support.
3. During these visits my team and I familiarise ourselves with the different communication aids that your child may be using. Photographs or images can be put together in the form of a storyline so that your child is prepared for their dental visit. This will help reduce any build up of anxiety by making events more predictable.
4. Similarly, I find that some patients’ behaviour improves if they bring comfort items such as a stuffed animal or blanket with them to the appointment. I also ask you to sit nearby or even to hold your child’s hand.

Oral health problems in autism and strategies for care.

Autism causes few unusual oral health conditions, however it is the commonly prescribed medications and damaging oral habits that may cause problems. Damaging oral habits include bruxism, bitting on lips or chewing on objects such as pens. In these cases, I recommend the use of a dental guard to prevent self-injurious behaviour.

The likelihood of dental decay increases in patients who have sticky or sweet foods, or for those who have difficulty with brushing and flossing. This is why children and caregivers should be advised about correct daily oral hygiene routines as early as possible. Preventative measures such as additional fluorides, sealants, drinking water throughout the day and taking sugar-free medicines, where appropriate, are recommended.

I would like to conclude that extraordinary children, particularly with autism, require the support of a dental team that truly cares about them as an individual and by adopting these strategies I can work with you to best care for your children.

CARING FOR CHILDREN WITH CEREBRAL PALSY

Aspects of Cerebral Palsy make a child more susceptible to oral health conditions

Although Cerebral Palsy does not cause oral abnormalities, those with Cerebral Palsy have a greater tendency to develop oral hygiene conditions. In particular, your child’s teeth may look crowded, vary in size and shape, be misaligned (malocclusion), or your child may incur damage from grinding his/her teeth (bruxism).

Children with Cerebral Palsy are also prone to bacterial infections (periodontal disease) or redness and swelling (gingivitis).

Some aspects of Cerebral Palsy make your child more susceptible to oral health conditions, for example a child who experiences frequent seizures, is more prone to head and mouth trauma, grinding of their teeth, and biting their lips or cheeks.

If your child is not able to control their facial muscles or has trouble swallowing (dysphagia) and chewing they may have difficulty brushing, rinsing, flossing, and clearing food pouches after a meal.

Misalignment of the “bite” (upper and lower teeth), referred to as malocclusion, is commonly found in children with Cerebral Palsy. I often find that the lower teeth rest outside the upper teeth which provides less protection for the jaw and tongue.

Children with Cerebral Palsy are prone to tooth decay

Bacterial plaque can form on teeth exposed to a considerable amount of acid, particularly in children who have gastroesophageal reflux and those who have difficulty with swallowing and chewing. In addition, prescribed medication is often sugary and attaches to tooth enamel. If your child takes longer than normal to consume a meal, food stays in their mouth longer and can increase the potential for cavities. With appropriate oral hygiene tooth decay can be avoided.

CARING FOR A CHILDREN WITH DOWNS SYNDROME

Delayed Eruption

On average, babies with Down Syndrome get their first teeth at 12 to 14 months, but in some cases it can be as late as 24 months of age and your child may not get all 20 baby teeth until he/she is 4 to 5 years of age. The front permanent teeth and permanent 6 year old molars may also not erupt until 8 or 9 years of age. It is also common for your child’s teeth to erupt in a different order.

Small and Missing Teeth

It is common that children with Down Syndrome have smaller than average teeth and may be missing some teeth. Your child my also have roots that are shorter than average.

Large Tongues

Children with Down Syndrome may have large tongues or your child may have an average size tongue and a small upper jaw which will make their tongue too large for their mouth.

Problems with Bite

The issue with small teeth is that it can cause spacing between the teeth. A small upper jaw may cause crowding of the teeth which could result in your child’s permanent teeth being “impacted” because there is no room in the mouth for them to come in. The small upper jaw may also create a situation where the top teeth do not go over the bottom teeth the way they are meant to.

Orthodontics (braces) may be able to improve some of these issues. Orthodontics require a lot of cooperation and make the teeth even more difficult to keep clean, so it may not be possible in all cases. It may be a good idea to wait until your child is older and able to tolerate it a bit better. Having orthodontic appliances in the mouth can also pose challenges to speech. It may therefore be a good idea to delay orthodontic treatment until your child’s speech has developed adequately.

Gum Disease

Children with Down Syndrome are at an increased risk for gum disease (periodontal disease), even if your child does not have a lot of plaque and tartar (calculus) because your child’s immune system is likely to be impaired and he/she will generally not have some of the natural protections against the disease. To prevent gum disease brush twice daily, focusing the bristles along the gum line, floss daily and be sure to visit me regularly to monitor your child’s gum health and to take X-rays to monitor their bone levels. If the gums bleed that means that they are inflamed. Brushing and flossing should not be stopped because of this. In fact, brushing and flossing will keep the gums clean and help to minimise the inflammation.