Oral Care for People With Developmental Disabilities and special needs
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 Developmental disabilities such as autism,
cerebral palsy, Down syndrome, and mental retardation are
present during childhood or adolescence and last a lifetime.
They affect the mind, the body, and the skills people use in
everyday life: thinking, talking, and self-care. People with
disabilities often need extra help to achieve and maintain good
health. Oral health is no exception.
Over the past three decades, a trend toward deinstitutionalization
has brought people of all ages and levels of disability into the
fabric of our communities. Today, approximately 80 percent of
those with developmental disabilities are living in
community-based group residences or at home with their families.
People with disabilities and their caregivers now look to
providers in the community for dental services.
Providing oral care to patients with developmental disabilities
requires adaptation of the skills you use every day. In fact,
most people with mild or moderate developmental disabilities can
be treated successfully in the general practice setting. This
booklet presents an overview of physical, mental, and behavioral
challenges common in these patients and offers strategies for
providing oral care.
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Health Challenges and Strategies for Care
Mental capabilities
Behavior problems
Neuromuscular problems
Cardiac disorders
Gastro esophageal reflux
Seizures
Hearing loss and deafness
Oral Health Problems and Strategies for Care
Dental caries
Periodontal disease
Malocclusion
Damaging oral habits
Oral malformations
Tooth eruption
Trauma and injury
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Health Challenges and Strategies for Care
 Before the appointment, obtain and review the patient’s medical history. Consultation with physicians, family, and caregivers is essential to assembling an accurate medical history. Also, determine who can legally provide informed consent for treatment.
Mentalcapabilitiesvary :- in people with developmental disabilities and influence how well they can follow directions in the operatory and at home.
Each patient’s mental capabilities and communication skills is determined through talking with caregivers about how the patient’s abilities might affect oral health care.
Behavior problems :-
can complicate oral health care. Anxiety and fear about dental treatment can
cause some patients to be uncooperative. Behaviors may range from fidgeting or
temper tantrums to violent, self-injurious behavior such as head banging. This
is challenging for everyone, but the following strategies can help reduce
behavior problems:
Through involving the entire dental team—from the receptionist’s friendly
greeting to the caring attitude of the dental assistant in the operatory.
A desensitizing appointment is essential to help the patient become familiar
with the office, staff, and equipment before treatment begins.
Some patients’ behavior may improve if they bring comfort items such as a
stuffed animal or a blanket. Asking the caregiver to sit nearby or hold the
patient’s hand may be helpful as well.
Appointments would be short whenever possible, providing only the treatment that
the patient can tolerate. Praise and reinforce good behavior and try to end each
appointment on a good note.
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Neuromuscular problems:- can
affect the mouth. Some people with disabilities have
persistently rigid or loose masticatory muscles. Others have
drooling, gagging, and swallowing problems that complicate oral
care.
If a patient has a gagging problem, schedule an early morning
appointment, before eating or drinking, and a short-lasting form
of anesthesia may work well.
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Cardiac DISORDERS:- can
affect the delivery of oral health care. Many people with Down
syndrome, for example, have congenital heart disorders that
place them at risk for bacterial endocarditic. Antibiotic
prophylaxis is prescribed when indicated. Contacts to patient’s
primary care physician is essential to answers to questions
about the medical history.
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 Gastroesophagealreflux:-
sometimes affects people with central nervous system disorders
such as cerebral palsy. Teeth may be sensitive or display signs
of erosion. Rinsing with plain water or a water and baking soda
solution. Doing so at least four times a day can help mitigate
the effects of gastric acid. Using a fluoride gel, rinse, or
toothpaste every day is essential.
Seizures accompany many
developmental disabilities. The mouth is always at risk during a
seizure: Patients may chip teeth or bite the tongue or cheeks.
Persons with controlled seizure disorders can easily be treated
in the general dental office. Information about the frequency of
seizures and the medications used to control them are
essential.Before the appointment medications must be taken as
directed. Any factors that trigger patient’s seizures should be
avoided.
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Hearinglossand:- deafness
sometimes occurs in people with developmental disabilities.
Patients may want to adjust their hearing aids or turn them off,
since the sound of some instruments may cause auditory
discomfort.
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Oral Health Problems and Strategies for Care
People with developmental disabilities typically have more oral health problems than the general population. Focusing on each person’s specific needs is the first step toward achieving better oral health.
Dental caries is common in people with developmental disabilities. In addition to discussing the problems associated with diet and oral hygiene, caution to be taken by patients and caregivers for the cariogenic nature of prolonged bottle feeding and the adverse side effects of certain medications. Preventive measures such as fluorides and sealants are recommended. Same goes for medicines that reduce saliva or contain sugar. A suggestion that the patient should drink water frequently, take sugar-free medicines when available, and rinse with water after taking any medicine.
Caregivers are advised to offer alternatives to cariogenic foods and beverages as incentives or rewards.
Daily oral hygiene independence is encouraged and follow up with specific recommendations and hands-on demonstrations to show patients the best way to clean their teeth. If necessary, a toothbrush is adapted to make it easier to hold. For example, placing a tennis ball or bicycle grip on the handle, wrapping the handle in tape, or bending the handle by softening it under hot water.Floss holders and power toothbrushes are also helpful.
Some patients cannot brush and floss independently.
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Periodontal disease occurs more often and at a younger age in people with developmental disabilities. Contributing factors include poor oral hygiene, damaging oral habits, and physical or mental disabilities. Gingival hyperplasia caused by medications such as some anticonvulsants, antihypertensive, and immunosuppressants also increases the risk for periodontal disease.
Some patients benefit from the daily use of an antimicrobial agent such as chlorhexidine.
Stress the importance of conscientious oral hygiene and frequent prophylaxis.
Malocclusion occurs in many people with developmental disabilities and may be associated with intraoral and perioral muscular abnormalities, delayed tooth eruption, underdevelopment of the maxilla, and oral habits such as bruxism and tongue thrusting. Malocclusion can make chewing and speaking difficult and increase the risk of periodontal disease, dental caries, and oral trauma. Orthodontic treatment may not be an option for many, but a developmental disability in and of itself should not be perceived as a barrier to orthodontic care. The ability of the patient or the caregiver to maintain good daily oral hygiene is critical to the feasibility and success of orthodontic treatment.
Oral malformations affect many people with developmental disabilities. Patients may present with enamel defects, high lip lines with dry gingival, and variations in the number, size, and shape of teeth. Craniofacial anomalies such as facial asymmetry and hypoplasia of the midfacial region are also seen in this population.
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 Tooth eruption may be delayed in children with developmental disabilities. Eruption times are different for each child, and some children may not get their first primary tooth until they are 2 years old. Delays are often characteristic of certain disabilities such as Down syndrome. In other cases, eruption problems are attributable to the gingival hyperplasia that can result from medications such as phenytoin and cyclosporin. Dental examination by a child’s first birthday and regularly thereafter can help identify atypical patterns of eruption.
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Trauma and injury to the mouth from falls or accidents occur in people with seizure disorders or cerebral palsy. Traumas require immediate professional attention besides that there are procedures to follow if a permanent tooth is knocked out. Also, a caregivers to locate any missing pieces of a fractured tooth, and that radiographs of the patient’s chest may be necessary to determine whether any fragments have been aspirated.
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 Making a difference in the oral health of a person with a developmental disability may go slowly at first, but determination can bring positive results—and invaluable rewards. By adopting the strategies discussed in this booklet, you can have a significant impact not only on the patients’ oral health, but on their quality of life as well.
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