Dr C P Ravikumar

Top 10 Oral Hygiene tips for children with disabilities

Children with special health care needs are those who need extra care due to the disability they have. The disability may be in the form of physical, medical or intellectual (that is mental, communication, developmental, neurological or learning) disorders. These children need special care in the form of medical management, health care intervention and/or use of specialized services or programs. Cleft lip or palate, Down syndrome, neurological disorders, cerebral palsy, and vision and hearing impairments are common medical conditions requiring special care, as well as learning and developmental disabilities like Autism Spectrum Diseases, ADHD, etc.

  These children are often unable to take care of their own health as a result their oral health gets neglected. This substantial limitation in the proper maintenance of oral hygiene makes them susceptible to oral diseases. They are at an increased risk of developing cavities in their teeth (dental caries). Many of these children have co-morbid conditions and may require constant medications. Some long term prescriptions (like- seizure medications eg. Sodium valproate) are known to cause gingival or gum problems like inflamed and bleeding gums. Besides, a chronic neglect in oral hygiene care may also surmount to periodontal diseases in disabled children. These children may also be at a risk of developing systemic complications originating from oral diseases such as cellulitis, space infections, compromised immunity, endocarditis, etc. Dental treatment in such children is not always possible because of the lack of cooperation and anxiety. Hence it is imperative to prevent any kind of oral or dental problems to circumvent the need of any dental treatment. 

  So, how to maintain oral hygiene care in special children?
  Oral health is an integral part of any individual’s overall well-being. The importance of oral hygiene care is supreme, especially in disabled children. Parents of such children are more focused on dealing with urgent medical issues, oral health becomes neglected. It is important to maintain a balance between physical and oral health to maintain the well-being of the child. 
 
  •  Ideally, your child’s oral hygiene care routine should start right from infancy. You must clean the baby’s gums with a clean cloth or moist gauze piece after every feed. As soon as your baby’s teeth erupt, start teeth brushing it with finger brushes for infants or a gauze piece. 
  • It is advisable to avoid night-time feeding after all the baby teeth have erupted as it may lead to nursing bottle caries. 
  • Once all teeth have erupted, you must start brushing your baby’s teeth with a small, soft-bristled toothbrush using fluoridated toothpaste (using only a smear of the toothpaste) 
  • The first dental visit for your child should be by the age of 1 year. During the first visit, the dentist can evaluate your child’s dental development and assist you to build the most appropriate home care routine for your kid. 
  • The child may not be able to brush by himself/herself so the parent or caregiver must assist in teeth brushing twice daily and develop a routine. It is important to instill the importance of dental hygiene in the child’s mind from the very beginning. 
  • Generally, children with disabilities, do not have good motor skills to hold toothbrushes.  Numerous commercially available modified toothbrushes, that have been designed for disabled children to provide a handle with a stable grip, whilst its shape enables the person to perceive how to manage the brush in the mouth adequately during teeth cleaning can be used. 
  • Powered toothbrushes/ electric toothbrushes can also be given to the children who lack the manual dexterity to brush properly.Electric toothbrushes were originally designed to help kids with disability in tooth brushing. Hence they can prove to be very useful in disabled children for teeth brushing properly. 
  • You may wonder when can you first give your kid an electric toothbrush. As soon as your child can hold up the brush and use it on his/her teeth you can provide these brushes. But if a caregiver is brushing the baby’s teeth then, powered/ electric toothbrushes of baby size can be used by the adult to brush the child’s teeth right from the beginning. 
  • Electric toothbrushes not only help in proper and thorough teeth brushing but also are quicker. 
  • Some children may be unable to spit out the toothpaste, may experience gagging due to the foam or excessive foaming might cause difficulty in visualization while teeth brushing for the caregiver. In such instances, the toothbrush can simply be moistened with water or a flavorful mouthwash. 
  • Many over-the-counter mouthwashes like Listerine can be used after diluting with water, if the child does not allow teeth brushing. But he/she should be able to spit it out without swallowing. 
  • The use of antimicrobial mouthwashes especially chlorhexidine mouth rinses have been proven effective in reducing the severity of plaque accumulation and gum diseases. You can ask your dentist or your child’s pediatrician to prescribe your child the right dosage of the mouthwash which can augment the oral hygiene care of your child. 
  • Parents can also choose to get professionally applied fluoride gels from their dentist, to ensure long-term protection of teeth from dental caries. 
  • Children who may be uncooperative, unwilling or physically unable to cooperate, the parent or guardian might need to safely restrain the child if necessary.

Some guidelines to hold your child while brushing his/her child’s teeth if he/she is unable to do it on their own :

Wheelchair: If the child is in a wheelchair, you must sit behind the wheelchair and tilt the child in your lap. Brush his.her teeth from behind.
Bed or sofa: The child lies on a bed or sofa with his/her head on your lap. Support the child’s head and shoulders with your arm while teeth brushing. You may avoid toothpaste if he/she has difficulty spitting (especially in this position as the child might ingest it)
Chair:  You can sit on the chair behind the child while he/she sits on the floor with your child’s head on your lap while teeth brushing from behind.

Apart from proper oral hygiene care measures for kids, it is extremely important to maintain a healthy diet. A balanced diet full of nutrition and devoid of cavity-inducing or cariogenic food is essential not only for overall development and growth but also to maintain dental health. It is essential to limit exposure to sugary foods and starchy snacks which can get stuck in the child’s teeth especially in between meals. Whenever the child eats anything, it is important to rinse the mouth thoroughly to neutralize any acids from the sugars. 

There is an immense necessity for a child with special needs to get good dental health care. You can put a prevention plan in place with the help of your pediatrician and dentist, and thus avoid any potential dental problems completely.
Dr C P Ravikumar

Dr C P Ravikumar

CONSULTANT – PEDIATRIC NEUROLOGY
Aster CMI Hospital, Bangalore