ARCHIVED Oral Conditions in Children with Special Needs A Guide for Health Care Providers

Oral Development

Tooth eruption Malocclusion, a may be delayed, poor fit between accelerated, the upper and or inconsistent lower teeth, and in children crowding of teeth with growth occur frequently disturbances. in people with Gums may appear developmental red or bluish- dis abilities. purple before Muscle erupting teeth dysfunction break through contributes to into the mouth. malocclusion, Eruption depends on genetics, growth of the jaw, muscular particularly in people with cerebral palsy. Teeth that are action, and other factors. Children with Down syndrome may crowded or out of alignment are more difficult to keep clean, show delays of up to 2 years. Offer information about the contributing to and dental caries. Refer to an variability in eruption patterns and refer to an oral orthodontist or pediatric for evaluation and specialized health care provider for additional questions. instruction in daily .

Tooth anomalies Developmental are variations defects appear in the number, as pits, lines, or size, and shape discoloration in the of teeth. People teeth. Very high with Down fever or certain syndrome, oral medications clefts, ectodermal can disturb tooth dysplasias, or formation and other conditions defects may result. may experience Many teeth with congenitally defects are prone missing, extra, or malformed teeth. Consult an oral health care to dental caries, are difficult to keep clean, and may compromise provider for dental treatment planning during a child’s appearance. Refer to an oral health care provider for evaluation growing years. of treatment options and advice on keeping teeth clean.

Oral Trauma

Trauma to the Bruxism, the face and mouth habitual grinding occur more of teeth, is frequently in a common people who occurrence in have intellectual people with disability, seizures, cerebral palsy or abnormal severe intellectual protective disability. In reflexes, or muscle extreme cases, incoordination. bruxism leads People receiving to tooth abrasion restorative dental care should be observed closely to prevent and flat biting surfaces. Refer to a dentist for evaluation; chewing on anesthetized areas. If a tooth is avulsed or broken, behavioral techniques or a bite guard may be recommended. 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. ARCHIVED Oral Infections

Dental caries, or tooth Viral infections are decay, may be linked usually due to the to frequent vomiting herpes or gastroesophageal simplex virus. reflux, less than normal Children rarely amounts of saliva, get herpetic gingivo- medications containing or herpes sugar, or special diets labialis before 6 that require prolonged months of age. bottle feeding or Herpetic gingivo- snacking. When oral stomatitis is most hygiene is poor, the common in young teeth are at increased risk for caries. Counsel the parent/caregiver on children, but may occur in adolescents and young adults. Viral daily oral hygiene to include frequent rinsing with plain water and infections can be painful and are usually accompanied by a fever. use of a fluoride-containing toothpaste or mouth rinse. Explain Counsel the parent/caregiver about the infectious nature of the the need for supervising children to avoid swallowing fluoride. lesions, the need for frequent fluids to prevent dehydration, and Refer to an oral health care provider and/or gastroenterologist for methods of symptomatic treatment. prevention and treatment. Prescribe sugarless medications when available. Gingival Overgrowth

Early, severe Gingival overgrowth periodontal (gum) may be a side effect disease can occur in from medications such children with impaired as calcium channel immune systems or con- blockers, phenytoin nective tissue disorders sodium, and and inadequate oral cyclosporine. Poor hygiene. Simple oral hygiene aggravates results from an the condition and can accumulation of bacterial lead to superimposed plaque and presents as infections. Severe red, swollen gums that overgrowth can bleed easily. Periodontitis is more severe and leads to tooth loss if impair , chewing, and appearance. Refer to an oral not treated. Professional cleaning by an oral health care provider, health care provider for prevention and treatment. A preventive systemic antibiotics, and instructions on home care may be needed regimen of antimicrobal rinses and frequent appointments may to stop the infection. Explain that the parent/caregiver may need be needed. Consider alternative medications if possible. to help with daily toothbrushing and flossing and that frequent appointments with an oral health care provider may be necessary.

Suggested Readings Tips for Health Care Providers Section III: Developmental Disabilities. In Batshaw ML, Pellegrino L, Roizen NJ (eds.). Children With Disabilities (6th ed.). Baltimore, MD: Paul H. Brookes Publishing Co., 2007. • Take time to talk and listen to parents and caregivers. Health Resources and Services Administration, Maternal and Child Health Bureau. Children with Special Health Care Needs in Context: A Portrait of States and The Nation • Tell parents and caregivers to seek a dental 2007. Retrieved February 4, 2012, at http://www.mchb.hrsa.gov/nsch/07cshcn/. consultation no later than a child’s first birthday. Health Resources and Services Administration, Maternal and Child Health Bureau. Special • Seek advice on behavior management Care: An Oral Health Professional’s Guide to Serving Young Children with Special Health techniques; early intervention and familiarization Care Needs. 2006. Retrieved February 4, 2012, with the dental team may take several visits. at http://www.mchoralhealth.org/SpecialCare/index.htm. • Evaluate and treat orthodontic problems Weddell JA, Sanders BJ, Jones JE. Dental Problems of Children with Special Health Care Needs. early to minimize risk of more complicated IN: Dean JA, Avery DR, and McDonald RE, McDonald and Avery’s Dentistry for the Child and problems later in life. Adolescent (9th Edition). Maryland Heights, MO: Mosby/Elsevier, 2011. pp 460-486. • Advise caregivers to avoid serving snacks at bedtime. Credits Beverly Isman, RDH, MPH and Renee Nolte Newton, RDH, MPA, California Connections Project (MCJ#06R005), Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. Reprinted by the National Institute of Dental and Craniofacial Research. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Photo credits Health Resources and National Institutes David Rothman, DDS, MS; Paul Casamassimo, DDS, MS; James F. Steiner, DDS; Services Administration of Health Robert Feigel, DDS, PhD; Lawrence A. Kotlow, DDS. Maternal and Child National Institute of Dental and Health Bureau Craniofacial Research For additional copies contact: National Institute of Dental and Craniofacial Research August 2016 National Oral Health Information Clearinghouse 1 NOHIC Way • Bethesda, MD 20892–3500 NIH...Turning Discovery Into Health® 1–866–232–4528 • www.nidcr.nih.gov