Developmental disorders such as autism, cerebral palsy, Down syndrome and other cognitive disabilities create challenges in performing daily activities, especially self-care activities. People with these disabilities may need additional help to achieve and maintain good health, including oral health. To achieve and maintain good oral health, people with mild or moderate developmental disabilities often require a special approach to dental care.

Health Challenges:

• Mental capacities vary from person to person and can affect how well a person can follow directions in a dental office and at home.
• Behavioral problems can make oral care difficult. For example, fear caused by a developmental disorder cannot be cooperated.
• With mobility issues , a person may need to use a wheelchair or walker to get around. Access to the dental office and chair may require special facilities and assistance in moving the patient. Longer appointment times may be required.
• Neuromuscular problems can affect the mouth. Some people with disabilities have persistent stiff or loose chewing muscles, or drooling, retching and swallowing difficulties that make oral care difficult.
• Uncontrolled body movements can compromise safety and the ability to provide oral care.
• Heart disease, especially mitral valve prolapse and heart valve damage, are common in people with developmental disabilities such as Down's syndrome. Consult a cardiologist to determine the need for antibiotics for treatment.
• Gastroesophageal reflux sometimes affects people with central nervous system disorders, such as cerebral palsy. Teeth may be sensitive or show signs of erosion.
• Attacks are associated with many developmental disorders. Patients may break off teeth or bite the tongue or cheeks during an attack.
• Visual impairments and hearing loss and deafness can also occur in people with developmental disabilities.
• Latex allergies are more common in people with developmental disabilities.

Oral Health Problems:

• Tooth decay is common in people with developmental disabilities.
• Periodontal disease (gums) occurs more often and at a younger age in people with developmental disabilities. Difficulty brushing and flossing effectively can be an obstacle to successful treatment and results.
• Malocclusion occurs in many people with developmental disabilities, which can make chewing and speaking difficult and increase the risk of periodontal disease (gum disease), dental caries and oral trauma.
• Harmful oral habits such as grinding and clenching teeth, food bags, mouth breathing, and tongue thrusting can be a problem for people with developmental disabilities.
• Oral malformations can cause enamel defects, high lip lines with dry gums, and variations in the number, size, and shape of teeth.
• Delayed tooth eruption can 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 mouth injuries from falls or accidents can occur in people with seizure disorders or cerebral palsy.

Helpful Hints

FOR CAREERS

Caring for someone with developmental disabilities requires patience and skill. As a caregiver, you know this as well as anyone. You also know how challenging it is to help that person with oral care. It takes planning, time and the ability to deal with physical, mental and behavioral problems. Oral care isn't always easy, but you can make it work for you and the person helping you.

• Brush every day . Depending on whether the person you are caring for is able to brush his or her teeth, you may have to take on the task of brushing his or her teeth, or adjust the toothbrush for physical limitations so thatthe person can 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 purchase aids such as floss holders or floss sticks.
• Visit a dentist regularly . Professional cleanses are an important part of maintaining good oral health. It may take a while for the person you are caring for to feel comfortable with the dental office. An introductory visit without treatment can help familiarize them with the office and exam routine before an actual visit.

FOR DENTISTICS

Providing oral care to patients with developmental disabilities requires adapting the skills you use every day. Most people with mild or moderate developmental disabilities can be treated successfully in general practice.

As a dentist, you should also be aware of the special challenges - behavioral, physical, and cognitive - that someone arriving at the dental office with developmental disabilities can face. By learning the right skills and techniques to meet the unique oral health needs of people with developmental disabilities, you can successfully deliver care to these patients.

Below are some general tips to help you adapt to the special oral care needs of people with developmental disabilities.

• Determine your patient's mental and communication skills . Talk to the patient and their caregivers about how the patient's capabilities can affect oral care. Be open to their thoughts and ideas for making the experience a success.
• Pave the way for a successful visit . Involve the entire dental team - from the receptionist to the dental assistant.
• Check for physical manifestations of the disability (s). How does the patient move? Look for challenges such as uncontrolled body movements or problems sitting in the dental chair.
• Ask if the patient is allergic to latex before starting treatment. Latex allergies can be life-threatening.