Dental Teaching Points
for Parents of Children with Special Needs

Children with special needs often have unique issues which should be addressed with the parents in the context of dental treatment. These issues revolve around both physical anomalies/alterations in orofacial structure and/or dentition, as well as delays in self-care skills related to physical or cognitive limitations. Many children with specific physical disabilities, such as Down syndrome and cerebral palsy, experience abnormalities in dentition such as malocclusion, microdontia, oligodontia, and taurodontism. Disturbances in the oral motor mechanism may also be present and can result in difficulties such as sialorrhea, dysphagia, temporomandibular joint dysfunction, tonic bite reflex, and inadvertent protrusion of the tongue.

It is important for clinicians/practitioners to educate parents regarding dental concerns specific to their child's disability. Some points the dentist may wish to include when conversing with parents of children with disabilities are included below.

1. Parents of children with Down syndrome should be educated concerning the susceptibility of their child to periodontal disease and the importance of maintaining scrupulous oral hygiene for their child as a preventative measure.
2. Parents should also be informed concerning the potential sequelae of continued bruxism and instructed to notify the dentist should such behavior increase in severity or be accompanied by pain or other symptoms.
3. Parents of children who experience oral-motor dysfunction (such as frequently occurs in individuals with cerebral palsy) and/or gastroesophageal reflux should be counseled concerning the possibility of choking and/or erosion of tooth enamel related to this condition. Measures to prevent erosion of tooth enamel can be taught to parents, such as rinsing the teeth frequently, careful positioning during meals, and maintenance of any prescribed medication schedules. Even children whose condition precludes oral feeding (e.g., those receiving tube feedings) require frequent oral hygiene. Methods for adequately performing oral hygiene in difficult circumstances may be taught to parents - using adjuncts such as dental cleansing swabs, gauze for securing the tongue, modified toothbrushes or power toothbrushes, etc.
4. It is important to stress the importance of enforcing good dietary habits in their children to all parents. A diet high in simple sugars should be avoided in exchange for one consisting mostly of whole grains, protein, vegetables, and fruits. For children of appropriate age, raw vegetables such as carrot sticks and celery offer a beneficial snack alternative to sweets, chips, etc. Children who experience significant difficulties in oral-motor function may not be able to chew certain foods which provide natural cleansing of teeth - such as carrot sticks and raw vegetables. Thus, it is important to clean the teeth frequently.
5. Children with certain types of cognitive disabilities often require continued supervision and assistance with oral hygiene for a longer period than their typical peers. Parents should be taught methods to encourage autonomous self-care - while following up to insure adequate performance.
6. All parents, especially those of children with special needs, should be encouraged to take steps to familiarize their child with dental care at an early age. This may best be accomplished by having the child attend routine dental checkups - beginning shortly after the initial eruption of the primary dentition.
7. Encourage the parent/child as much as possible! Parents of children with significant disabilities are often taxed both physically and emotionally and may benefit greatly from your insights and support.