This information is provided as a clinical support tool and does not warrant continuing education credit.
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Oral Health Problems and Strategies for Care
Dental Caries
- Recommend preventive measures such as fluorides and sealants.
- Caution patients or their caregivers about medicines that reduce saliva or contain sugar. Suggest that patients drink water frequently, take sugar-free medicines when available, and rinse with water after taking any medicine.
- Advise caregivers to offer alternatives to cariogenic foods and beverages as incentives or rewards.
- Educate caregivers about preventing early childhood caries.
- Encourage independence in daily oral hygiene. Ask patients to show you how they brush, and follow up with specific recommendations. Perform hands-on demonstrations to show patients the best way to clean their teeth.
- If necessary, adapt a toothbrush to make it easier to hold. For example, place a tennis ball or bicycle grip on the handle, wrap the handle in tape, or bend the handle by softening it under hot water. Explain that floss holders and power toothbrushes are also helpful.
- Some patients cannot brush and floss independently. Talk to caregivers about daily oral hygiene and do not assume that they know the basics. Use your experiences with each patient to demonstrate oral care techniques and sitting or standing positions for the caregiver. Emphasize that a consistent approach to oral hygiene is important–caregivers should try to use the same location, timing, and positioning.
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, anti-hypertensives, 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.
Damaging Oral Habits can be a problem for people with developmental disabilities. Some of the most common of these habits are bruxism, food pouching, mouth breathing, and tongue thrusting. Other oral habits include self-injurious behavior such as picking at the gingiva or biting the lips; rumination, where food is chewed, regurgitated, and swallowed again; and pica, eating objects and substances such as gravel, sand, cigarette butts, or pens.
- For people who pouch food, talk to caregivers about inspecting the mouth after each meal or dose of medicine. Remove food or medicine from the mouth by rinsing with water, sweeping the mouth with a finger wrapped in gauze, or using a disposable foam applicator swab.
- If a mouth guard can be tolerated, prescribe one for patients who have problems with self-injurious behavior or bruxism.
Oral Malformations affect many people with developmental disabilities. Patients may present with enamel defects, high lip lines with dry gingiva, and variations in the number, size, and shape of teeth. Craniofacial anomalies, such as facial asymmetry and hypoplasia of the mid-facial region are also seen in this population. Identify any malformations and explain to the caregiver the implications for daily oral hygiene and future treatment planning.
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.
Trauma and Injury to the mouth from falls or accidents occur in people with seizure disorders or cerebral palsy.
- Suggest a tooth-saving kit for group homes.
- Emphasize to caregivers that traumas require immediate professional attention and explain the procedures to follow if a permanent tooth is knocked out.
- Also, instruct caregivers to locate any missing pieces of a fractured tooth, and explain that radiographs of the patient’s chest may be necessary to determine whether any fragments have been aspirated.