Why Children with Disabilities More at Risk for Dental Caries and Gum Disease

  • Many medications that people with disabilities require cause dry mouth. When a person has dry mouth, their mouth is more acidic, and plaque sticks more easily to tooth surfaces. Many medications also contain large amounts of sugar to make it taste better. Whenever possible, ask for a sugar-free substitute.

  • Anticonvulsants, antihypertensives, and immunosupressants, which are taken by some people with disabilities, are all medications that can cause gum tissue to enlarge and "over-grow." This can contribute to and/or cause gum disease. If this side effect is noticed, sometimes the medication can be altered or changed to one that may not cause this side-effect. However, this should be discussed with the patient’s physician. Again, this condition makes good oral hygiene even more important for the patient.

  • Some people with disabilities have congenitally malformed or missing teeth, such as those with Down Syndrome. The crowns (the part of the tooth that shows) and roots are shorter, and may be more conical-shaped which can lead to gum disease and early tooth loss. When teeth are missing, a space maintainer may be made by a professional and worn by the child/patient, if it can be tolerated. A special x-ray called a panograph can show tooth development and is better tolerated than a series of single tooth x-rays.

  • Many people with disabilities are bottle-fed or breast-fed for prolonged periods of time. Sometimes parents or caregivers reward or give sweets as incentives. Both behaviors should be avoided because they contribute to a higher incidence of tooth decay. Healthy snacks or treats is recommended such as cheese or peanut butter.

  • Some patients with disabilities have damaging oral habits. Some may pick at their gums, bite their cheeks or lips, or eat things like cigarette butts, gravel, or other unhealthy objects. They may also grind or clench their teeth (bruxism). If they can tolerate a mouth guard, it can help to prevent these oral injuries.

  • Other patients with disabilities may have gastroesophageal reflex, such as those with cerebral palsy. The excess gastric acid in their mouth erodes the inside surface of the teeth and may cause the teeth to be more sensitive. It is important to have the patient rinse with water or water and baking soda frequently to help prevent erosion. Of course, it is essential for this patient to use fluoride gels, rinses, and/or fluoride toothpaste (check with the patient’s dentist to see which or if all apply).

  • These patients may have difficulty brushing or flossing for themselves. They may lack the manual dexterity to do this for themselves. It is important that the caregiver be educated on the importance of helping their patient with oral care. It is helpful if a routine can be established so that a regular place and time be given for oral care. Sometimes the patient can care for their teeth themselves with supervision and the use of modified toothbrushes and flossers.

  • High fevers and prolonged illness can cause hypoplasia (defective or incomplete enamel development) or hypocalcification (deficiency of minerals in the development of enamel). Both of these conditions make teeth more susceptible to tooth decay and gum disease.

  • Trauma from falls or bruxism can cause teeth to chip, break, or be knocked out. TRAUMAS REQUIRE IMMEDIATE PROFESSIONAL TREATMENT. It is important for the caregiver to look for the pieces of tooth that are chipped or broken. If they cannot be found, it may be necessary for a chest x-ray to ensure that the missing piece has not been aspirated. If the tooth has been knocked out, follow the steps to save the tooth listed below:
      1. Rinse tooth in cool water. Do NOT scrub tooth.
      2. If possible, replace tooth in socket and hold it in place.
      3. If this cannot be done, put the tooth under the patient’s tongue, or wrap it in a wet cloth, or drop it in a glass of milk.
      4. See a dentist immediately.

      A group home should have a tooth-saving kit and be aware of the above steps for knocked out teeth.

  • Patients who have frequent surgeries or with spina bifida are especially susceptible to latex allergies, which can be life threatening. It is important to check with the physician regarding this possible allergy development. This is important to know for caregivers that wear gloves when brushing and flossing the child/patient’s teeth.

  • Many patients with developmental problems such as Down Syndrome, also have congenital heart disorders that can place them at risk for bacterial endocarditis. It may be indicated for them to receive antibiotic prophylaxis, so it is very important to know their health history. Check with the primary care physician to see if the patient needs this treatment before taking them to a dental appointment. You can contact www.americanheart.org for more information.

  • Patients with compromised immune systems have more frequent oral and systemic infections. Aphthous ulcers, oral candida (yeast) infections, and acute necrotizing ulcertative gingivitis (ANUG) are common.

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