Oral Health and Tooth Brushing for Children with Special Needs

Kevin Boyd, DDS, and Janet Pannaralla, DDSKevin Boyd, DDS, and Janet Pannaralla, DDS

Poor oral health in young children can cause pain, infection and lead to problems associated with eating, speaking, sleeping, breathing and learning. In fact, poor oral health affects children in the U.S. more than any other chronic disease. However, these problems can be accentuated in children with special needs.

Children with special needs may be at a higher risk for dental problems for various reasons: required medications can sometimes be harmful to dental health, some children are prescribed soft diets which also can lead to dental problems, others may have physical limitations that make it difficult to carry out dental hygiene practices such as brushing and flossing. Finally, poorly developed teeth and jaws can lead to mouth breathing, a common cause of oral and overall general health problems.

For these and other reasons, special needs children - including those with physical and/or neurological disabilities - are more likely to develop gum disease, lose teeth and/or experience other oral and general health problems. Discovering a dental problem before it gets worse can become a challenge because they may not be able to communicate as other children do.

We at Dentistry for Children and Families believe that children with special needs should have equal access to every dental service that is readily available to children without disabilities. This requires dental professionals to enlist the assistance of those who observe children regularly in the home or the school, such as teachers, teacher's aides, school nurses, daycare supervisors, parents/caregivers and nannies.

Spotting problems

Teachers and school nurses are sometimes the first to identify an oral health problem in a special needs child. They may observe young children drooling frequently or snoring at naptime, or may notice children breathing through their mouths or their tongues hanging out. Children experiencing pain in their mouth may stop eating or drinking normally. They may have increased aggressive behaviors such as biting and kicking. All of these are possible signs that the child should visit a pediatric dentist, pediatrician, otolaryngologist or possibly even a sleep medicine physician.

Teaching good habits

Teaching good dental hygiene habits to special needs children can be difficult. When teaching children better oral health, or even in helping them prepare for a dental exam, the Tell-Show-Do Technique is often an effective way to achieve success.

The first step ("TELL") is to discuss a topic, such as brushing teeth, in a way the child can understand. The second step ("SHOW") is showing the child how it's done in a non-threatening way. Once the child feels comfortable with the second step, the final step ("DO") is doing the actual procedure.

While these techniques are effective in a dental office, they can also be used in an early childhood setting that includes special needs students. While the first step of the Tell-Show-Do Technique can be presented by a pediatric dentist or hygienist and teachers can be encouraged to use this technique as part of their lesson plans.

Using a large replica mouth model can be a great way to show young students the first steps to brushing. Teachers may reinforce the brushing technique by integrating it into a daily lesson plan. For example, during math children may be taught how to count to 20 by explaining that 20 counts is how long to brush one section of teeth before moving to another. At playtime, teachers may encourage children to pretend that they are a giant tooth and that their hands are magic toothbrushes as they scratch their "tooth bodies" with their "toothbrush" fingers. Other exercises designed to strengthen fine motor skills can also help with learning how to hold a toothbrush and move their hands in an up and down motion.

Dental professionals should encourage parents and older siblings to invite younger children to watch them brush their own teeth. When it's time to start brushing, it's best to start with a very small amount (pea sized amount) of toothpaste on the toothbrush. Some children with special needs are also more sensitive to flavors so it is important to work with parents in understanding what toothpaste "flavors" their child prefers. If a child doesn't like the foaminess and or taste of toothpaste, it's ok to brush with just fluoridated tap water.

Throughout the Tell-Show-Do learning process, it's important to constantly provide positive feedback and reinforcements; this gets children engaged and eager to brush regularly. Whether the child has a special need or not, parents can reinforce proper brushing by examining areas that were not cleaned properly and showing these areas that may need to be more focused upon, especially near the gum line.

As dentists who are exclusively focused on children, we have a responsibility to prevent dental diseases and even reverse certain disease conditions that may be related to poor oral health, such as gingivitis, mouth- breathing, poor sleeping, and even attention deficit disorder (ADD), which all can be worsened by poor oral care. In order to achieve this it will require collaboration with school nurses, parents and teachers. Together, we can help young children succeed in health and in learning.

About the Author

Dr. Boyd, a board-certified pediatric dentist and Dr. Pannaralla, a child focused general dentist have a practice that specializes in the oral health of young children and those with special needs. They follow a "non-traditional" approach to provision of children's oral healthcare that is largely centered around their academic backgrounds in Biological Anthropology. For more information go to: www.dentistry4children.net.