Developmental disabilities such as autism, cerebral palsy, Down syndrome, and other cognitive disabilities create challenges in accomplishing daily activities, especially self-care activities. People with these disabilities may need extra help to achieve and maintain good health, which includes oral health. To achieve and maintain good oral health, people with mild or moderate developmental disabilities often require a special approach to dental care.
- Mental capabilities will vary from person to person and may have an impact upon how well someone can follow directions in a dental office and at home.
- Behavior problems can complicate oral health care. For example, anxiety caused by a developmental disability may make someone uncooperative.
- Mobility problems may require a person to use a wheelchair or a walker to move around. Access to the dental operatory and chair may require special arrangements and assistance with patient transfer. Longer appointment times may be needed.
- Neuromuscular problems can affect the mouth. Some people with disabilities have persistently rigid or loose chewing muscles, or have drooling, gagging, and swallowing problems that complicate oral care.
- Uncontrolled body movements can jeopardize safety and the ability to deliver oral care.
- Cardiac disorders, particularly mitral valve prolapse and heart valve damage, are common in people with developmental disabilities such as Down syndrome. Consult a cardiologist to determine the need for pre-treatment antibiotics.
- Gastroesophageal reflux sometimes affects people with central nervous system disorders such as cerebral palsy. Teeth may be sensitive or display signs of erosion.
- Seizures accompany many developmental disabilities. Patients may chip teeth or bite the tongue or cheeks during a seizure.
- Visual impairments and Hearing Loss and Deafness may also be present in people with developmental disabilities.
- Latex allergies may be more likely in people with developmental disabilities.
Oral Health Problems:
- Tooth decay is common in people with developmental disabilities.
- Periodontal (gum) disease occurs more often and at a younger age in people with developmental disabilities. Difficulty performing effective brushing and flossing may be an obstacle to successful treatment and outcomes.
- Malocclusion occurs in many people with developmental disabilities, which can make chewing and speaking difficult and increase the risk of periodontal (gum) disease, dental caries, and oral trauma.
- Damaging oral habits such as teeth grinding and clenching, food pouching, mouth breathing, and tongue thrusting can be a problem for people with developmental disabilities.
- Oral malformations may cause enamel defects, high lip lines with dry gums, and variations in the number, size, and shape of teeth.
- Delayed tooth eruption may occur in children with developmental disabilities such as Down Syndrome. Children may not get their first baby tooth until they are 2 years old.
- Trauma and injury to the mouth from falls or accidents may occur in people with seizure disorders or cerebral palsy.
Taking care of someone with a developmental disability requires patience and skill. As a caregiver, you know this as well as anyone does. You also know how challenging it is to help that person with oral health care. It takes planning, time, and the ability to manage physical, mental, and behavioral problems. Oral care isn't always easy, but you can make it work for you and the person you help.
- Brush every day. Depending on whether the person you care for is able to brush his or her teeth, you may need to take on the job of brushing their teeth yourself, or modify the toothbrush to accommodate physical limitations to allow the person to continue brushing his or her own teeth.
- Floss regularly. Some people with developmental disabilities may find flossing a real challenge. You may need to do the flossing yourself, or obtain aids such as floss holders or floss picks.
- Visit a dentist regularly. Professional cleanings are an important part of maintaining good oral health. It may take time for the person you care for to become comfortable at the dental office. A "get-acquainted" visit with no treatment provided might help to familiarize them with the office and the exam routine before a real visit.
FOR DENTAL PROFESSIONALS
Providing oral care to patients with developmental disabilities requires adaptation of the skills you use every day. Most people with mild or moderate developmental disabilities can be treated successfully in the general practice setting.
As a dental professional you also need to be aware of the special challenges – behavioral, physical, and cognitive – that someone who arrives at the dental office with developmental disabilities may have. Learning appropriate skills and techniques to meet the unique oral health needs of people with developmental disabilities will help you be successful in delivering care to these patients.
Below are some general tips to help you adjust to the special oral health care needs of people with developmental disabilities.
- Determine your patient's mental capabilities and communication skills. Talk with the patient and their caregivers about how the patient's abilities might affect oral health care. Be receptive to their thoughts and ideas on how to make the experience a success.
- Set the stage for a successful visit. Involve the entire dental team--from the receptionist to the dental assistant.
- Observe if physical manifestations of the disability(ies) are present. How does the patient move? Look for challenges such as uncontrolled body movements or problems with sitting in the dentist’s chair.
- Ask if the patient has an allergy to latex before you begin treatment. Latex allergies can be life threatening.
- MedlinePlus: Developmental Disabilities and Oral Health
The National Library of Medicine's collection of links to government, professional and non-profit/voluntary organizations with information on developmental disabilities and oral health.
- Special Care Dentistry Association
- Developmental Disabilities Nurses Association
- Dental Education in the Care of Persons with Disabilities (DECOD)