We know the difficulties of managing the dental needs of a disabled child. We know it through training and through personal experience
Post by Kristie Chambers
One of the challenges of a modern dental practice is dealing with the dental needs of a disabled child. When I did my Nursing Certificate, I learnt a lot about disability, illness and oral health. It was interesting learning how different medications can lead to problems like dry mouth and bleeding gums. Then we had our daughter, who has cerebral palsy. So now we’re living it.
Some of the issues we’ve faced in our own lives are oral health needs common to all disabled children. A lot of children with special needs have seizures as part of their condition. So they take seizure medication, which can cause problems with their oral health as a side-effect. That’s if they take the medication in the first place.
Hiding the taste of the medication can also cause problems. My daughter, for example, suffers from constipation. She has to have a powder mix that we pop into milk, and of course, milk is one of those really acidic type drink that kids can have and causes caries. Juices are the same. We find a lot of times its very difficult to hide the medications with plain water. So you really do have to give it to them in flavoured drinks and they’re exactly the kind of drinks you should be avoiding to maintain good oral health.
There was a stage where our daughter had to have about six doses of medication at different times of the day. So, giving that with food, of course, meant she was grazing on food six times a day. And grazing causes caries.
When you have a disabled child, you’re generally having to deal with a large number of different doctors. As a result, dealing with one more doctor—the dentist—tends to get pushed into the background. Also, sometimes it’s difficult to know there’s a problem at all. A little while ago we knew a child who wasn’t progressing the way he was supposed to, and I spoke to his mum and as it turned out, she could smell some odour coming from his mouth. I suggested that she take him to the dentist, and of course, they found caries there. But with a lot of these kids, because they’re non-verbal as well, or they just don’t understand how to explain things like that, that quite often, unless you’re like me in the industry, it’s not something you can readily identify.
You see a lot of kids like that particular one where they’re having issues about progressing or them putting on weight, and it is possible the problem has its roots in their oral health. It wasn’t the parents’ fault because at the end of the day, our lives are overwhelming. The last thing you think about is hair and teeth and trimming their nails and that sort of thing. Because our kids keep their mouths closed a lot of the time too, because of the spasticity in their muscles, unless they’re screaming their heads off and you happen to look inside, you’re not going to even visually see a problem.
Brushing their teeth is a major issue. You can’t brush the teeth of kids who have sensory issues. If my daughter doesn’t want her teeth brushed, she will just jam her mouth shut and there’s nothing you can do about it.
Bruxism, or grinding teeth, is a very big problem too. A lot of disabled kids are highly stressed. They suffer a lot of muscle cramping, and feel a lot of frustration because they can’t do what other kids can do. So you find there’s a really high incidence of bruxism.
How do you deal with it in the chair? The answer, in one word, is patience. If you force something on a child then you’re going to make them fearful.
We have no hard-and-fast policy at Greenwood Dental. This is one of those issues that has to be dealt with case-by-case. As a rule, it’s always good to get kids familiar with dental practice as young as possible. That means before they have even got their first tooth. It’s always nice for them to come in with mummy and daddy and become familiar with the surgery, even if it is just a couple of times a year for the check-up. And if they do that, it’s nice for them to have a ride in the chair and you can maybe even just get them to laugh or smile and have it count that way.
When it comes to their first checkup, if they’re still very uncomfortable then we can refer them off to a special needs dentist. But often it just comes down to taking that bit of extra time. Because we know that if we push them too far when they’re little, it’s just going to make it extremely difficult to treat them further in the future.