A visit to the dentist can be stressful and frightening for any child. Children and teens with disabilities are even more likely to have a bad experience at the dentists because of factors such as heightened pain sensitivity or overstimulation — these factors can make even day-to-day oral hygiene a significant obstacle. However, there are steps any parent or guardian can take to make oral care and hygiene a better experience for your child with special needs.
Common Dental Problems in Children and Teens with Special Needs
Children and teens with special needs are at particular risk for certain oral health issues. Common dental problems that children and teens with special needs are more at risk for include:
- Bruxism: grinding, gnashing, or clenching teeth.
- Congenitally missing teeth: A genetic mutation that can cause a person to be born without certain teeth. The most common teeth affected are the wisdom teeth and secondary molars, but primary teeth can also be congenitally missing and can cause difficulty chewing, speaking, as well as malocclusion.
- Crowding and/or impacted teeth: Crowding teeth occur when there is not enough space in the mouth for all the teeth, causing some teeth to grow at an angle. Impacted teeth occur when teeth grow horizontally in the mouth toward other teeth.
- Erosion: the decay of tooth enamel due to genetic hypoplasia, consumption of certain foods, or lack of oral hygiene.
- Hyper gag reflex: this can be caused by physical and psychological factors, and can limit food advancement and nutrition and restrict medical treatment options. Habitual or frequent vomiting can also erode teeth.
- Jaw misalignment: Often seen as overbites or underbites, jaw misalignment can be a symptom of other dental problems, like malocclusion or microdontia, or can exist on its own. Jaw misalignment can cause chronic headaches, difficulty sleeping, or temporomandibular joint dysfunction (TMJ).
- Malocclusion: Improper positioning or alignment of the teeth when the mouth is closed can be caused by habitual behavior, such as thumb sucking, or genetic factors, such as the jaw being too small for the teeth. Malocclusion can cause discomfort and difficulty chewing, and dry mouth from habitually sleeping or breathing with the mouth open.
- Microdontia: When one or more teeth are smaller than the rest of the teeth. This is a genetic mutation and can cause more frequent cavities.
- Non-nutritive chewing: chewing non-nutritive substances such as plastics or metals that can cause tooth damage.
- Self-injury: intentional or unintentional injury of the jaw, tongue, mouth, or teeth.
- Tongue thrusting: a muscle imbalance where the tongue protrudes through the front incisors during swallowing, speech, and while the tongue is at rest.
- Xerostomia (dry mouth): when salivary glands in the mouth do not produce enough saliva, it can impede swallowing and the washing away of food particles in the mouth, which can cause cavities and enamel decay.
Identifying Oral Health Issues in Children With Special Needs
Children with special needs may sometimes have difficulty communicating, or may not be aware, that they are experiencing oral discomfort. There are a few ways that you can externally evaluate whether your child is experiencing an oral health issue:
- Halitosis: Also known as bad breath, recurring halitosis can be a sign of improper oral hygiene.
- Swollen/red gums: if your child’s gums are red, swollen, or prone to bleeding, this can be a sign of many dental problems, such as impacted teeth, gingivitis, high amounts of plaque, and in some cases infection.
- Tooth coloration: If your child’s teeth have a dull white band around the gum, or brown or yellow concentrated spots, this can be a sign of tooth decay or cavities.
- Increased sensitivity: Increased sensitivity to hot, cold or sweet foods can indicate enamel decay, cavities, and tooth root.
It’s important to note that you should not wait to go to the dentist until your child is showing these symptoms. Maintaining a regular oral hygiene regimen and scheduling check-ups with your dentist every six months is the best way to ensure your child’s dental health.
Patients With Special Needs and Orthodontic Corrective Treatment
Some dental health issues require long-term orthodontic treatment and can be especially difficult for children with special needs to handle. These treatments can be disruptive to the routine they are comfortable with and can pose difficulties for the child receiving the treatment, the parent overseeing the treatment, and the dentist administering the treatment. Here are some common long-term orthodontic treatments, their symptoms, and what you can do as a parent to mitigate difficulties.
Braces are corrective metal banding adhered to the teeth to straighten or realign them. Teens are a common demographic for braces, as they likely have lost all of their baby teeth, but their adult teeth have not completely settled. Getting braces can be an uncomfortable process, as metal braces can cause:
- Jaw pain and soreness;
- Sensitivity when eating;
- Speech impediments;
- Overproduction of saliva;
- Gum blisters.
There are a few ways that you can help your child get accustomed to their braces; first, have their dentist explain the entire process to both you and your child, so that they can ask questions and foster an understanding. Similarly, getting a doll with braces or buying storybooks that feature characters with braces can help enforce a sense of normalcy and comfort.
Invisalign are clear, plastic teeth aligners that are typically a more comfortable alternative to braces. However, these aligners are not bonded to the teeth like braces, so your child will be responsible for keeping them in. It’s important when considering Invisalign treatment that you gauge your child’s ability to wear them consistently. Though more comfortable, Invisalign can cause similar symptoms to braces, including:
- Mouth soreness;
- Speech impediments;
- Dry mouth;
- Increased teeth clenching or grinding.
A permanent retainer is a metal wire glued to the backside of your child’s teeth, and is used to prevent teeth from shifting for becoming crooked. Permanent retainers can serve as a follow-up treatment to Invisalign or braces. Permanent retainers come with far fewer symptoms and discomfort than both braces and Invisalign. It’s important to have good oral hygiene habits if you have a permanent retainer, as plaque can build up around and underneath the metal band and damage teeth. Permanent retainers can be removed by an orthodontist if the orthodontist feels it is no longer necessary.
A palate expander is a metal device adhered to either the top or bottom jaw to expand the space, and create proper alignment. Palate expanders are often used to combat jaw misalignment and malocclusion. There are several different types of palate expanders, ranging from temporary to permanent, but all of them can typically be adjusted. Palate expanders can cause:
- Mouth soreness;
- Pressure in the tongue, mouth, and sinuses;
- Speech impediments.
Like a permanent retainer, it is important to maintain good oral hygiene with a palate expander, as food can get lodged between the expander and roof of the mouth, causing bacteria to grow.
Challenges in Going to an Office Appointment
Even barring uncomfortable long-term treatments, routine dentistry for patients with disabilities can be uncomfortable and stressful. Here are some possible issues you may run into with a patient with special needs at the dentist’s office and ways to solve them.
Issues Related to Stress
There are several things in the dentist’s office that can trigger a stress response in a child with special needs. Being overstimulated because of lights or sounds, fear of the unknown, and a pain association with dentistry can all cause routine check-ups to become a stressful affair. Here are a couple of ways you can reduce stress at the dentist for your child with special needs :
- Establish familiarity: Bringing something familiar from homes, such as a blanket or toy can help your child feel grounded. You can also have a designated activity bag for appointments, which can establish a routine that feels safe and familiar when it’s time to go in for a check-up.
- Reward systems: Establishing a reward system for appointments can help your child reduce stress by giving them something to look forward to. This can be a physical reward, like a toy or sticker, or intangible reward, like a round of applause or words of affirmation.
- Build relationships: If you can, try to build or encourage a rapport between your child and the staff at your dentist’s office. This can make a visit to the dentist feel like a chance to see a friendly face, reducing stress related to strangers or foreignness. It’s important to note that these relationships should be built on your child’s terms so that they feel safe and comfortable.
Some individuals with special needs experience communication barriers, which can hinder their ability to speak, hear, or cognitively process information. Miscommunications in any health field can lead to prolonged pain, misdiagnosis, or mistreatment of the issue. If you are a parent of a child with communication problems, it’s important to establish an effective way to communicate before stepping into the dentist’s office. Simple hand signals for yes, no, or stop can be easily taught, and give your child a direct way to communicate without needing to verbalize. You can also look into special needs dentistry.
Children with special needs may exhibit some behavioral problems in response to stress, fear, or frustration. These behavioral problems may manifest as aggression, defiance, excessive movement, yelling, and even getting physical, like biting or hitting. You can use some of the strategies for reducing stress to curve behavioral problems, such as setting up a reward system to reward good behavior or by bringing a comforting toy or item.
What to Do in Preparation for an Appointment
There are a few ways that you can prepare for a dentist appointment with your child with special needs that can make the process smoother for you, your child, and your child’s dentist:
- Office tour: If it’s your child’s first dentist appointment, scheduling a time to tour your dentist’s office and meet the staff can be a great way to reduce anxiety before an appointment. By getting familiar with the surroundings beforehand, when it’s time for the appointment, your child may feel more at ease knowing what to expect. You may even try taking a virtual tour in advance of the physical office visit.
- Tell-Show-Do: The tell-show-do technique is used to reduce fear and stress in dental work. First, your dentist will tell your child what they are going to do, then they will show them the tools involved, and then they will perform the procedure. Tell-show-do is about arming patients with knowledge and can help establish a rapport between your dentist and your child. You can ask before your appointment if your dentist can take a tell-show-do approach with your child.
- At-home preparation: This can take a lot of different forms, depending on your child’s regular routines. You can have a pretend appointment where you are the patient and your child is the dentist — you can demonstrate proper appointment behavior while giving your child control of the situation. You can read storybooks about going to the dentist to normalize the experience, or make a question list for the dentist or staff. At-home preparation can be an outlet for exploring the idea and potential happenings of a dentist appointment in a place your child feels safe.
Talking to Prospective Providers About Your Concerns
Whether you’re looking for a new dental care provider or you make an appointment with your family dentist, it’s important to talk to your provider about your child’s special needs and what accommodations may be available. Some providers may be equipped with certain staff training or alternative care options for patients with special needs. Even if your office doesn’t have these options, you can still make a plan. Talk with your provider about the available accommodations so that when the time comes for an appointment, everyone has had time to prepare and make the best experience possible.
Alternative Dental Care Solutions
Some patients with special needs may benefit from alternative dental care practices. Here are some alternative options to ask your dentist about:
- Conscious sedation dentistry: If your child is especially nervous, or prone to uncontrollable movements, conscious sedation dentistry may be the safest and easiest option for everyone. Conscious sedation allows the patient to remain conscious while being physically relaxed and feeling virtually pain-free. Factors, such as weight, age, condition, and medication interaction should be considered by both your pediatrician and dentist before deciding on conscious sedation.
- Facility accommodations: Sometimes, there are things you or your dentist office staff can do to make the dentist’s office itself a more welcoming and friendly place for your child. This might include playing certain music during their appointment, reserving the first or last appointment of the day so that there is a reduced amount of people in the office, or even just dimming the lights. Talk to your dentist’s staff if you think changes like these would make a difference during your child’s appointment.
- Splitting appointments: If you can, splitting appointments up can reduce anxiety and behavioral problems in some patients with special needs. This can be made possible through preventive care, such as the use of silver diamine fluoride, which can prevent further decay (but cannot reverse it), and improved at-home hygiene.
Maintaining Healthy Dental Habits At Home
As previously mentioned, children with special needs are at a higher risk of chronic dental problems, so it is especially important for them to develop healthy dental habits at home. Dentists recommend brushing twice a day for two minutes and flossing once. However, if your child takes a medication high in sugar, has oral trauma — such as misformed teeth, chronic sores, habitual lip, cheek, and tongue biting — or lacks the ability to brush on their own, these standards can pose challenges. Fortunately, there are some simple strategies you can use to encourage healthy dental habits in your child. Here’s how you can meet some of the challenges your child may face with oral hygiene at home:
- Get the right tools: Specially designed toothbrushes and other at-home hygiene tools can help make the physical task of brushing more effective and easy for children with special needs. Tools developed with individuals with special needs in mind include three-sided toothbrush heads, toothbrushes with thicker, easy-grip handles, automatic flossers, and xylitol wipes and rinses that can combat sugars and other corrosive deposits from medication.
- Create positive associations: Building positive associations in your child’s at-home dental care can help your child look forward to their dental care routine and help them maintain it long-term. This can look like a game, a reward system involving stickers or special privileges, or simple bonding time.
- Be consistent: Establish a routine and stick to it. Consistency and routine are often very important to children with special needs, so even if you initially experience behavioral push-back, keeping a consistent routine will help communicate to your child that practicing good dental hygiene is a priority.
Organizations Providing Support for Patients With Special Needs
For specific resources and support for patients with special needs in the dentist office, you can check out the following organizations:
- Dental Lifeline: Dental Lifeline works specifically with individuals and families that are elderly, have special needs, or otherwise medically fragile individuals who may not be able to afford dental care.
- Charitable Smiles: Charitable Smiles is a nonprofit that matches patients in need of dental care with dentists willing to take pro-bono cases.
- Humanitarian Foundation: The Humanitarian Foundation is committed to providing “special smiles” to kids with special needs, and helps parents cover the cost of necessary dental treatment and anesthesia.
- America’s Toothfairy: America’s Toothfairy sponsors nonprofit dental clinics and community partners by donating equipment, starting education programs, and providing financial assistance. They also have a nonprofit community clinic directory and free educational videos.