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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
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.
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 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.
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.
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.
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.
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.
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.
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.