The American Academy of Paediatric Dentistry defines special health care needs as “any physical, developmental, mental, sensory, behavioural, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. The condition may be congenital, developmental, or acquired through disease, trauma, or environmental cause and may impose limitations in performing daily self-maintenance activities or substantial limitations in a major life activity”

Children with special needs exhibit higher rates of decay and gum disease due to a number of factors such as high carbohydrate diets or sugary medications. Moreover, their lack of ability to maintain proper oral hygiene often increases their susceptibility to poor oral health.

Common pathologies found in these individuals include:

• Caries - children with physical and/or mental disabilities have a greater risk of developing caries due to several factors including a lack of adequate dexterity to perform proper oral hygiene practices, dental malformations, high carbohydrate diets, frequent exposure to sugar-containing medications and a reduced salivary flow caused by certain medications.
• Malocclusion – Certain genetic disorders including Down syndrome can cause delays in tooth eruption, sometimes by up to two years. These children may also exhibit malformed or extra teeth, or even congenitally missing teeth. Crowding and poor alignment can increase the likelihood of tooth decay and gum disease.
• Swallowing difficulties – Some children may have difficulties in swallowing which results in food staying in the mouth for longer periods.
• Tooth wear - In cases of severe intellectual disability or cerebral palsy, children may habitually grind their teeth, making them flat as they gradually wear down the enamel and dentine.
• Gingival overgrowth – Certain medications, particularly epilepsy medications, can cause enlargement and overgrowth of the gums.
• Gum disease – Often due to inadequate dexterity or even the lack of oral care, plaque and calculus build up results in gingivitis and sometimes periodontitis.
• Xerostomia – Xerostomia or dry mouth is a side effect of many medications.
• Erosion – Gastroesophageal reflux can cause significant erosion of the teeth.

Oral care tips:

• Medication – When your doctor prescribes medication, inquire if there are any sugar-free options. If not, ensure that your child rinses with water after each dose. Rinsing is also recommended after inhaler use.
• Brushing and flossing – If your child exhibits a lack of dexterity with brushing and flossing, it would be best for you to assist them in doing a thorough job. It may be more convenient to be positioned behind your child’s head to allow for better visibility and control of the toothbrush. This technique is particularly helpful for wheelchair- bound children.
• Fluoride – Ask your dentist to recommend an appropriate fluoride mouthwash and toothpaste for your child, to assist in cavity prevention. Mouthwashes and toothpaste are prescribed according to your child’s ability to rinse.
• Diet – Limit sugary sweets and snacks and ensure that your child rinses after a sweet treat.
• Water – Other than the numerous health benefits, drinking water assists in reducing the symptoms of a dry mouth. We also recommend rinsing with water and not brushing after an episode of reflux in order to flush out the acid rather than brushing it into the teeth.
• Dental visits – Find a dentist that your child will be comfortable with from an early age and ensure that they go in for check-ups at least every 6 months. Each dentist will have a variety of approaches to treating children with special needs. It is wheelchair-bound to focus on preventative care and establishing a ‘dental home’ from when your child is at least a year old.