Oral Health Care Strategies for Children & Youth with Special Needs

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clip_image002_0004Information in this article was made available from a guide for parents and dental providers of children with special needs developed by the Oklahoma Dental Foundation in partnership with several funders.  The entire guide is available for download at: Oral Health Care For Children With Special Health Care Needs

The following is an excerpt from pages 8-10 of the guide.

Good oral care begins at home. Children need a daily routine of care for their teeth and gums to
stay healthy. Many children can be taught how to brush, rinse and floss independently. Some will
need continued supervision through adulthood, and others will need this task performed for
them. All will benefit from this routine activity becoming a standard part of everyday life. Daily
home care is the best way to prepare the child for care in a dental office.

The person teaching or providing home oral care will face many of the same challenges as the
dentist in getting the child to cooperate. Other sections of this guide have useful information
about behavioral and/or physical challenges. The following tips will also help to overcome the challenges of creating or providing an oral care routine.

toothbrushSet the Stage
• Choose a comfortable location – the bathroom is not the only place to brush teeth
• Have adequate light, fresh water for rinsing, and a mirror if needed
• Have a toothbrush, floss and/or flosser, gloves if used, toothpaste and any rinses and/or swabs ready in advance
• For children who might gag or swallow the toothpaste, use ½ a pea sized amount of paste, plain water or diluted fluoride mouthwash on the brush
• Use adaptive toothbrushes and flossers to make things easier for both of you. See the resource section of this guide for specialty dental products

istock_000015183453xsmallSet the Atmosphere
• Approach oral care with a positive attitude and make it fun for the child
• Use a tell, show, do approach when introducing new items or steps
• Build trust and take it slow. Make the first several attempts positive to gain more cooperation later on. If you have used force in the past, start over and give the child a chance to comply. It may take time to rebuild trust
• Use picture books, homemade experience books and puppets or toys to demonstrate.
• Give lots of positive feedback to reinforce good behavior

Set the time
• Have a routine. Same place, same time, same steps. This consistent routine builds confidence and the child will look forward to daily oral care
• Brush, rinse, floss and/or apply dental agents according to the dentist’s instructions. Some children will need to have oral care several times each day
• Keep a logbook of what works, what doesn’t, and questions for the next dental visit
• Stay positive and keep working at it. The rewards are worth it for you and the child

istock_000003522757xsmall-1Aversions (Oral and Touch)
Children who have had trauma of any kind to their mouths can develop oral aversions. Aversion is a strong dislike of something. Oral aversion can be caused by a dislike of strong tastes or textures, cleft lip or palate, use of ventilator or feeding tubes, or from something more direct such as oral/facial surgery or trauma. Some may have an aversion to touch and dislike being
handled by dental staff. This can make oral care in a typical setting challenging or in some cases impossible. It is important to determine the level of aversion before proceeding with care.

Oral Effects
There are no specific oral effects from aversions, however, children with aversion are often
unable to undergo routine oral care and may not have visited a dentist for some time.

Strategies for Care
Pre-appointment interviews are critical in dealing with aversions. Discuss how to approach the
child and gain the most cooperation. Discuss if the child will require anesthesia or stabilization
methods. When practical, allow comfort items such as stuffed animals or blankets to stay with
the child. Give lots of praise for effort.

Physical/Behavioral Concerns Strategies for Care

Physical/Behavioral Concerns Strategies for Care
Fearfulness

Mild oral aversions

• Use a clear face shield instead of a mask
• Tell, show, do
• Slowly place instruments into the mouth and avoid
sudden movements and noises
• Allow the child to handle instruments that are safe
• Start the oral exam with something familiar like a
toothbrush or just fingers
Moderate oral aversions • Make several appointments to give the child a chance to
get used to the dental office
• Include physical and/or speech therapy
• Sedation
Severe oral aversions • Anesthesia
Touch aversions • Go slowly and avoid touching when possible
• Tell, show, do
• Ask permission either directly or with body language
• Allow the child to get in/out of chair unassisted
• The child or dental provider may wish to stand
• Minimize lights and noise to avoid overstimulation

istock_000010534340mediumCognitive, Communication, and Social Disabilities
It is important for the dental staff to know the child’s level of understanding. The family member/caregiver will need to communicate this in the pre-appointment interview. Make sure you are speaking at a level the child can understand. Give simple, matter of fact instructions and repeat often to deal with any memory issues.

Start out slow. Allow the child to get comfortable in the dental office. Start with just fingers and
step into using instruments slowly. It may take several visits to accomplish a thorough exam, but
after several positive experiences the child is very likely to become more and more cooperative.

Many children understand far more than they can communicate. Many others can communicate if given enough time. Each child should be spoken to directly and in a friendly tone, even when they are resisting treatment. Children are more likely to be acting out of fear than defiance, so keeping a calm tone and having a smile ready will communicate more than words.

Some children are overly curious and impulsive. Others may engage in perseveration, a steady
repetition of words, sounds, actions or gestures. Providers should expect that children may do
and say things that do not seem appropriate. Keep dental instruments out of reach to avoid injury,
and do not leave a child unattended at any time. The family member/caregiver should be allowed
to be with the child during the visit. In some cases extra dental staff may be needed.

istock_000011817608smallThe Tell, Show, Do Approach

Tell the child what you are about to do with a dental instrument before starting. Show them on a
model or their hand what the instrument will do. This is especially important for instruments that
make vibrations or sounds. Once they are comfortable with it, then get their permission and Do,

by slowly introducing it into their mouths. When handled this way, most children will comply
and may even have fun with it.

Use the tell, show, do approach even when the child does not acknowledge the dental staff. It is
impossible to know just how much the child understands, and this approach ensures they are
treated with respect, even when they are unable to communicate it back.

Picture books are an excellent tool to prep a child for dental treatment. Puppets also work well
and give the child a sense of comfort and familiarity. It may be a good idea to let them “play
dentist” in the chair with a puppet or doll using safe plastic instruments. Allow comfort items
such as stuffed animals or blankets to stay with the child during dental treatment.

Related Information:
Dental Visit Social Story
Oral Basics for the First Visit

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