One in six children in the United States is diagnosed with having a developmental disability or delay.  Developmental disability is a broad term that can include conditions such as autism, behavior disorders, cerebral palsy and intellectual delays. Strategies for medical providers in improving oral health for children with developmental disabilities include:

1. Learning how to assess dental and periodontal health.
2. Recognizing risk factors that contribute to poor oral health.
3. Developing a dental referral that that can accommodate special needs.
4. Incorporating anticipatory guidance and oral hygiene counseling to caregivers.
5. Being an advocate for oral care for patients.
6. Working collaboratively with dental professionals to coordinate care.

Providers should be aware of how the physical, behavioral or intellectual impairments that accompany developmental disabilities can contribute to risk factors that challenge a person’s oral health. 

Oral aversions
Children with autism spectrum disorders may have oral aversions due to the sensitivities to textures and tastes, which may limit the foods that they eat. This can cause nutritional deficiencies, resulting in weakened immune response susceptibility to oral infection and gingivitis. The aversion to tastes and textures often interferes with brushing or flossing, which effects good home hygiene. 

Diet
Because diet is a major factor for caries risk, children with developmental disabilities are predictably at greater risk of developing dental disease as a result of modifications in diet.  Preference for carbohydrate rich foods, use of medications that contain sugar, medications with xerostomia as a side effect and oral aversions all contribute to high caries risk.

Tube feeding or all liquid diets have been shown to cause changes to the oral environment with increased calculus formation and periodontal disease. In addition to poorer nutritional status, children with oral dysphagia can pocket food which leads to decay. Increased incidence of gagging and reflux can cause acid erosion of tooth enamel. 

Craniofacial anomalies
Children born with craniofacial anomalies can experience malocclusion, disruptions in tooth eruption, orofacial clefts, underdevelopment of maxilla, enamel hypoplasia and variations in number size and shape of teeth. Close collaboration among a team of medical and dental providers is necessary to coordinate the multiple surgeries required to correct for the malformations. Abnormal placement of teeth can cause areas of food impaction. Because orthodontic treatment is needed to correct for any malocclusions, dental appliances worn during treatment can create areas of plaque retention that are difficult to clean. 

Parafunctional oral habits
Neurodevelopmental disorders see increased incidence of parafunctional oral habits include bruxing, clenching, repetitive biting of nonfood objects or other self-injurious behavior involving the mouth. The excessive forces created from the behaviors can present as cracked teeth, abnormal wear patterns on teeth, temporomandibular joint pathology, gingival recession and tooth loss. Because the typical treatment for parafunctional habits requires cooperation of the patient to tolerate appliances to modify behavior, children with developmental disabilities have difficulties in complying with treatment to successfully overcome the habit.

Challenges with self care
Self-care skills in children with intellectual and developmental disabilities are often undermined due to delays in coordination and motor abilities. Without the ability to properly care for themselves, special needs children rely heavily on caregivers for daily home hygiene activities. This is further complicated when combined with behavioral problems that prevent the child from being treated at a traditional office setting for dental care. 

Establishing a dental home
The American Academy of Pediatrics recommends all children to have a dental home by the age of one.  Children with disabilities are no different and can benefit from a referral to the dentist sooner during the first 6 months of life. Identifying resources early can help to address barriers that caregivers have in accessing oral care. HPP’s Special Needs Unit can assist in finding a dental provider; call 866-500-4571.

Resources

• https://www.nidcr.nih.gov/sites/default/files/2017-09/practical-oral-care-development-disabilities.pdf
• https://publications.aap.org/pediatrics/article/131/3/614/31027/Oral-Health-Care-for-Children-With-Developmental
• https://www.dentalproductsreport.com/view/children-s-developmental-delays-and-dentistry