Oral conditions in children with special needs
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Oral Development
Tooth eruption
Tooth eruption may be delayed, accelerated, or inconsistent in children with growth disturbances. Gums may appear red or bluish-purple before erupting teeth break through into the mouth. Eruption depends on genetics, growth of the jaw, muscular action, and other factors. Children with Down syndrome may show delays of up to 2 years.
Malocclusion
Malocclusion, a poor fit between the upper and lower teeth, and crowding of teeth occur frequently in people with developmental disabilities.
Nearly 25 percent of the more than 80 craniofacial anomalies that can affect oral development are associated with intellectual disability.
Muscle dysfunction contributes to malocclusion, particularly in people with cerebral palsy. Teeth that are crowded or out of alignment are more difficult to keep clean, contributing to periodontal disease and dental caries.
Tooth anomalies
Tooth anomalies are variations in the number, size, and shape of teeth. People with Down syndrome, oral clefts, ectodermal dysplasia, or other conditions may experience congenitally missing, extra, or malformed teeth.
Developmental defects
Developmental defects appear as pits, lines, or discoloration in the teeth. Very high fever or certain medications can disturb tooth formation and defects may result. Many teeth with defects are prone to dental caries, are difficult to keep clean, and may compromise appearance.
Oral Trauma
Trauma
Trauma to the face and mouth occur more frequently in people who have intellectual disability, seizures, abnormal protective reflexes, or muscle incoordination. People receiving restorative dental care should be observed closely to prevent chewing on anesthetized areas. If a tooth is avulsed or broken;
- Take the patient and the tooth to a dentist immediately.
- Counsel the parent/caregiver on ways to prevent trauma and what to do when it occurs.
Bruxism
Bruxism, the habitual grinding of teeth, is a common occurrence in people with cerebral palsy or severe intellectual disability. In extreme cases, bruxism leads to tooth abrasion and flat biting surfaces.
- Refer to a dentist for evaluation; behavioral techniques or a bite guard may be recommended.
Oral Infections
Dental caries, or tooth decay, may be linked to frequent vomiting or gastroesophageal reflux, less than normal amounts of saliva, medications containing sugar, or special diets that require prolonged bottle feeding or snacking. When oral hygiene is poor, the teeth are at increased risk for caries. Counsel the parent/caregiver on daily oral hygiene to include frequent rinsing with plain water and use of a fluoride-containing toothpaste or mouth rinse. Explain the need for supervising children to avoid swallowing fluoride.
- Refer to an oral health care provider and/or gastroenterologist for prevention and treatment. Prescribe sugarless medications when available.
Viral infections
Viral infections are usually due to the herpes simplex virus. Children rarely get herpetic gingivostomatitis or herpes labialis before 6 months of age. Herpetic gingivostomatitis is most common in young children, but may occur in adolescents and young adults. Viral infections can be painful and are usually accompanied by a fever. Counsel the parent/caregiver about the infectious nature of the lesions, the need for frequent fluids to prevent dehydration, and methods of symptomatic treatment.