Dealing with Oral Health Challenges in Children with Special Needs

Children with special needs require specific care, attention, extra help, skilled services, and accommodations. Overall, oral health is neglected in almost all individuals as compared to the health of the rest of the body, and it is more overlooked in children with special needs. Children with special needs may have specific physical, developmental, sensory, intellectual disability, emotional, and behavioral disturbances leading to limitations in oral health care. Oral health is influenced by diet and the ability to maintain good oral hygiene. Children with special needs may eat calorie-dense, sugary, and acidic foods, worsening oral health issues. Developing age and the addition of special needs may hinder children’s education and training needed for good oral health. Children with special needs may sometimes have poor motor coordination and other major systemic complications, making oral health hygiene more challenging. With minor ailments, children can be trained to brush, floss, and rinse their teeth twice a day, but in children with significant disabilities, the caregiver’s role becomes paramount. This article highlights various disabilities that require special care and the challenges faced during oral care of children with special needs, suggesting ways to deal with them.

Introduction

Oral health challenges differ in children with special needs. They may differ in developed and developing countries. Oral health challenges related to malnutrition and HIV-infected children may be more common in developing countries. In contrast, morbid obesity and calorie-dense foods-related oral health challenges may be more common in developed countries. Children with special needs may have physical ailments like muscular dystrophy, multiple sclerosis, congenital orofacial anomalies, cerebral palsy, traumatic brain injury, and epilepsy. Down syndrome, autism, hyperactivity, dyslexia, or processing disorders may lead to developmental issues. Sensory impairments, like vision and hearing impairments, and behavioral or emotional challenges, like communication disorders, ADD, bipolar, or oppositional defiant disorder, may interfere with the education and training of oral hygiene. The current trend of dental braces will also require special carefor oral hygiene. Children with HIV and malnutrition can be treated as children with special needs regarding the care of the oral cavity [1]. Oyedeji et al. studied the frequency of oral issues in HIV-infected children and the effects of treatment with HAART on their frequency. Oral lesions in 58 HIV-positive children were studied, out of which 63.8% of children were found to have oral diseases like herpes labialis, dental caries, hypoplasia of enamel, oral thrush, and angular cheilitis. The study found that the understanding of oral lesions was low in HIV-positive children and their parents, and HAART treatment may prevent oral soft tissue lesions in those children. The study advised the necessity of integration of pediatric HIV programs and oral health care for the prevention and treatment of oral health problems in patients with HIV [1].

This article provides an overview of ailments needing special care and emphasizes the role of caregivers, pediatricians, and dentists in the oral health care of children with special needs.

Discussion

Dental and Oral Health Issues in Children with Special Needs

Children with special needs may face several challenges when receiving dental care, including physical barriers. Physical limitations can make it challenging to brush teeth correctly, leading to gum disease and tooth decay. Teeth grinding, also known as bruxism, is common in children with special needs and can lead to tooth wear and jaw pain. Motor impairment, sensory sensitivities, or cognitive challenges can also make it difficult. Growth disturbances can cause teeth to erupt intermittently or be delayed. Children with special needs are more likely to have enamel hypoplasia, tooth anomalies, such as variations in the number, size, or shape of teeth, misaligned teeth, and delayed tooth eruption [2]. Waldron et al. studied the effects of oral hygiene measures, such as plaque removal mechanically, in patients with intellectual disabilities. Along with adult and children patients, caregivers were also included in the study, which found that both manual and electric toothbrushes were equally effective for reducing gingivitis in people with intellectual disability. The study advised providing oral hygiene care based on professional skills and the necessity and desire of the patients and their caregivers [2].

Children with physical disabilities may be at risk of dental damage if they fall and injure their face. Due to the possibility of being a picky eater and problems related to food texture, children with special needs may consume the same acidic and calorie-dense foods daily, increasing the risk of oral health problems. Because of poor oro-motor coordination, children may have challenges holding the toothbrush and brushing their teeth following the two-minute brushing technique, with front teeth up and down at an angle and back teeth in circles. Improper tooth brushing may not remove the plaque on the teeth, leading to gingival inflammation and dental caries. Children with special needs may need to take multiple medications to deal with other associated disabilities, which may lead to side effects on the oral cavity, such as excessive dryness of the mouth [3].

Future Directions

Special care and training need to be given to caregivers to motivate the kids, helping them brush their teeth or develop a routine so that good oral hygiene is maintained. Advice to use adaptive tools such as electric toothbrushes and modified grips. Special attention should be given to training to teach them to chew the food. Swallowing the food without chewing may cause choking hazards in children with special needs. Balanced nutrition, adequate hydration, and healthy eating habits can help the kid and parents overcome some challenges to a certain extent, minimizing emergency visits to dentists [4].

Supervision and assistance with brushing until the child can do it independently is recommended for caregivers. Advise parents to demonstrate to children how to brush gently in circles on all surfaces of the teeth and tongue for at least two minutes. Set a consistent time for brushing and flossing. Advice to limit sugary snacks encourages lots of fruits, vegetables, and dairy products. Advise caregivers to contact a dental specialty that deals with oral health issues for children with special needs. Clear communication between the caregiver and the dentists regarding the child’s specific needs, including sensory sensitivities, communication challenges, and medical conditions, may help to plan individualized care. Parents can practice role-playing dental visits at home with a toothbrush and familiar toys to prepare the child [5].

Children with special needs, especially those who are nonverbal, may not be able to communicate any pain related to dental decay. Therefore, parents should be educated to follow the routine dental check-up schedule rigorously to avoid delayed medical care. Parents should consider getting special toothbrushes with larger handles or specialized designs for an easier grip, modifying brushing techniques depending on the child’s physical abilities, and choosing fluoride-containing and flavored toothpaste based on the child’s needs. To help reduce anxiety, parents can be advised to bring patients for short visits beforehand without treatment to expose them to the dental environment [6].

To deal with challenges, pediatricians and dentists can work together to encourage routine dental checkups. Dental offices need to be equipped to accommodate patients with wheelchair access and support chairs. Dentists can use strategies like allowing breaks, establishing trust, and using positive reinforcement to help children with behavioral challenges. Flexible appointment times can help to accommodate the special needs of the children [7].

To overcome challenges in oral dental care for special needs children, health professionals should create a comfortable environment by adjusting sensory components such as lights, sounds, and textures in the dental office to minimize sensory overload. Dentists should clearly communicate the details of the procedure and should offer gradual exposure using adaptive tools. Collaborating with different therapists, such as occupational, speech, and physical therapists, can add to offering a better individualized management plan for oral health. Encourage the child to bring a favorite blanket, toy, or music to help them feel secure. Dental offices can offer a reward system with positive feedback to encourage cooperation [7]. Table I presents the summary of oral health challenges in children with special needs and their management.

Table I. Summary of Oral Health Challenges in Children with Special Needs and Management [1]–[7]

Oral condition	Reasons for challenges	Management
Poor oral hygiene	Limited motor skills	Use of adaptive tools
		Parental and caregiver education
Bruxism	Anxiety, stress	Use of mouthguards
		Relaxation techniques
		Behavior therapy
Malocclusion	Genetic and developmental	Orthodontic evaluation
		Use of braces or aligners
		Monitoring of growth
Dental caries	Reduced saliva production, poor oral hygiene, and frequent sugary foods.	Regular cleanings
		Fluoride treatments
		Healthy diet and oral care
Delayed tooth eruption	Genetic + developmental + nutritional deficiency	Monitoring
		Early intervention
Gingivitis	Poor brushing habits, medication side effects	Professional cleanings
		Antimicrobial mouthwashes
Sensory sensitivities	Discomfort with dental tools, lights, and sounds	Desensitization techniques
		Use of calming strategies
		Sedation if necessary
Dry mouth and altered taste	Medication side effects	Hydration and saliva substitutes, fluoride gels
Resist brushing, have limited communication skills, Sensory sensitivities, and behavioral challenges	Autism spectrum disorder	Positive reinforcement
		Routine establishment
		Use of visual schedules
Cleft lip and palate	Environmental + Genetic	Specialized care for cleft
Oral candidiasis, Gingivitis, Periodontitis, Hairy Leukoplakia	HIV positive	Scheduled dental checkups
		Use of PPE
		Treatment of specific conditions
		Treatment of HIV status
Delayed and defective tooth formation	Malnutrition	Scheduled dental checkups
		Nutritional support
Altered saliva composition and decreased quantity
Weak immune system

Conclusion

Children with special needs may have unique dental needs. Providing oral care by caregivers may have limitations. Educating caregivers, pediatricians, and dentists on oral hygiene techniques for children at home and in the office is very important. Collaboration between pediatricians, dentists, and therapists may help deliver the optimum oral care to children with special needs. More research may be helpful in educating pediatricians and dentists to adopt the patient-centered approach to the individual child’s needs and comfort level.