Homecare Tips for Children with Special Needs

Everyone needs a healthy mouth and teeth so we can speak more clearly and eat a healthier variety of foods. Our teeth also help us to feel better about ourselves when they look good and are free from plaque, food, or decay. And, our breath is fresher. A healthy mouth is also pain-free, and does not interfere with our ability to sleep, so we can have better concentration and ability to focus and learn. In fact, taking care of our dental needs is just as important as taking our medications and exercising!

Providing people with special needs oral care at home can be done by an adaptation of skills that most of us use already every day. The important thing is to access your child’s particular limitations and be creative. The following are some helpful tips and stratagies for providing and teaching good oral care at home.

  • Make dental care routine. Keep the same time and place everyday for home oral care.
  • Remember that the bathroom is not the only place to brush someone’s teeth. Design an area that is comfortable for your child. Try sitting at a table, and place the toothbrush, toothpaste, floss, fluoride rinse (if applicable), and spitting bowl within reach.
  • It is also helpful to provide good lighting, so that your child can see inside his/her mouth. You can also provide a mirror so your child can watch, if this is appropriate to their level of maturity and ability.
  • If your child cannot sit at a table, try sitting her/him on the floor, with you behind them on a chair. Have him/her lean his/her head against your knees, lean back, and open his/her mouth so you can brush for them. You can also use a bean bag chair, or sit on the couch or on the floor with his/her head in your lap. Make sure the child’s head is always supported. If the child is uncooperative, or is not able to control motor function, have a second person help to hold hands and feet, or blanket wrap them comfortably for control.
  • Dental care can frighten some children, so try the “tell, show, do approach” to teach them. Tell the child what you are going to do before you do it. Show how you are going to do each step before you do it. When you start, do the steps in the same way that you showed the child.
  • Give the child a favorite toy or special item, such as a favored blanket, for comfort.
  • Many children with disabilities like music. So, have some relaxing music in the background, or something the child enjoys listening to during this time. Making it a game might make it more fun.
  • Give positive feed back, reinforce good behavior, and use body language and tone of voice to show your child that you care about them. Show them that brushing is important by doing it together.
  • Remember the three steps to a healthy mouth for everyone, is to brush every day, floss, and visit the dentist regularly. First, brush twice daily, once in the morning and once at night before bed. Second, floss once every day. Sometimes this may be difficult, so try flossing the upper teeth one night and the lower teeth the next, and then rotate. Third, take your child to the dentist regularly, and be consistent. Many children with special needs may actually need to go to the dentist more often—3 or 4 times a year for routine care as opposed to the usual 2 times a year.

Brushing

  • If you are teaching your child to brush, guide the toothbrush by gently placing your hand over your child’s hand as he/she brushes.
  • If your child cannot brush their teeth themselves, remember to wash your hands before starting with soap and water. Disposable gloves are also recommended, and remember to use vinyl or nitrile if your child has a laytex allergy.
  • Always use a toothbrush with soft bristles.
  • Use a very small, pea-sized amount of fluoridated toothpaste, and only if your child is able to spit. If your child cannot spit, try using fluoridated water instead. The water here in Kern County is not fluoridated, so fluoridated water must be purchased at a grocery or health food store.
  • Brush every side of every tooth—cheek side, tongue side, and tops of every tooth. Start at one side of the mouth and work around from one end to the other so no teeth are missed. Brush in short strokes, back and forth and hold the brush at a 45-degree angle to the teeth.
  • Gently brush your child’s tongue and roof of the mouth when you are done with the teeth.
  • Help your child rinse with water. If your child is unable to rinse, use a soft gauze around your finger to gently sweep the mouth.
  • Make the toothbrush easy to hold. Be creative! You can use a velcro strap, a large, or a wide elastic band to help the child grip the brush. You can cut a hole in a tennis ball and slide the toothbrush in the hole, or you can also slide a bicycle grip onto the handle to aid in grasping the brush. There are also age-appropriate toothbrushes with wider handles available. Foam tubing may also be helpful.
  • Power brushes may make brushing easier, but remember to take time to have your child get used to the feel of using a power brush (battery or electric), and the child should be supervised at all times. If the child is really young, a manual toothbrush is probably better. And make sure that the toothbrush head is not too big for the mouth!

Flossing
Usually, children cannot floss their teeth until they have the manual dexterity to tie their own shoe laces. Until then, flossing should probably be done for them or with supervision. With a child with special needs, the ability to floss may be delayed or may not be appropriate for the child to do independently at all. It will, of course, be dependent on the capabilities of the child and the severity of the handicap or special need. However, it is important that the caregiver realize the importance of flossing because floss cleans between teeth where a toothbrush cannot reach. Therefore, if a child is unable to floss their own teeth, a caregiver must do it for them.

  • It is not usually necessary to begin flossing a child’s teeth until the teeth are touching. If there are spaced between the teeth, flossing is not usually indicated.
  • Remember to find out what kind of floss the child prefers. There are so many on the market—flavored, unflavored, waxed, unwaxed, ribbon-like, string, and yarn. There is even a floss with fluoride!
  • Flossing takes practice and patience! Do not give up! In time it gets to be easier and easier!
  • Again, remember to wash your hands and wear gloves before flossing your child’s mouth.
  • To floss: Use a string about 18 inches long. Wrap each end around a middle finger, and use your index fingers and thumbs to grip the floss and manipulate it around the teeth. Start with one side, top or bottom, and work your way around all teeth. Work the floss gently in between the teeth until the floss reaches the gumline. Curve the floss around the tooth and gently slide it up and down the tooth just under the gumline. Do this for both sides of every tooth, one side at a time. A floss holder may be helpful. There are also a few power-assisted flossers available.
Dental Visits
  • A child with special health needs may need to visit the dentist more often than what is accepted as usual. Sometimes the child may need to see their dentist as much as every 2 to 3 months. It is important to follow your dentist’s recommendations and be consistent in following his/her recommendations regarding your child’s oral health.
  • All children with special needs should see a dentist 6 months after the first tooth is visible or by age 12 months.
  • It is usually best to schedule appointments early in the day when everyone is rested.
  • Dental appointments may require extra time for children with special needs, so plan on these appointments taking longer than what you may be accustomed.
  • The first appointment may just be a time for your child and the dentist and staff to get acquainted, and familiarize your child with the dental setting. This can help to establish trust and make future visits more comfortable and less threatening for your child.
  • Explain in advance to your child what going to the dentist entails in a positive, encouraging way. Tell him/her what to expect during the first visit (looking and counting your child’s teeth).
  • Be sure to check that the dentist you are taking your special needs child has experience with working with this population.
  • Additional fluoride may be recommended for your child, especially since there is no fluoride added to our water in Kern County. In addition to in-office treatments, he/she may need to take vitamins with fluoride, rinse with a special fluoride rinse, or brush with an at-home fluoride gel, or a combination of these things. It is important to follow your dentist’s instructions regarding this.
Additional Considerations
  • Your child may be also given an antimicrobial rinse to use.
  • Your child may be given a mouth guard to prevent oral trauma, and it will be important to keep this appliance clean as well.
  • If your special needs child is taking medications, he/she may have a problem with dry mouth and may be given saliva substitutions, or special rinses, gels, or sprays to alleviate the discomfort.
  • Sometimes, persons with special needs are more susceptible to oral trauma due to poor motor control. It is a good idea to have a tooth saving kit on hand and to know what to do in case of an emergency. If a tooth is knocked out, it is important to get the child to a dentist immediately. If a tooth has been broken, it is important to find all the pieces of tooth. If this cannot be done, or you are unsure whether or not all bits of tooth have been recovered, an x-ray of the child’s chest may be indicated to determine if any fragments have been aspirated.

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