BY Dr PUJA SABHERWAL
While tending to someone with special healthcare needs, the physical and biological needs of day-to-day life may prove to be quite demanding. In such a situation, the oral health of the infant, child or teen is often neglected despite our best efforts. As per a recent survey, dental care is one of the most often unmet needs among these children. Poor socioeconomic strata, low literacy and lack of equipment to cater to these children further compound the problem. At both ends of the spectrum be it healthcare professionals or care givers barriers to meet dental needs are common. In this article we have taken up few key areas to help spread awareness among parents.
Special children are more prone to tooth cavities, gum problems including swelling and stains or discoloration on teeth. Under the age of five years, nursing bottle or early childhood caries may occur. The structure of enamel and dentin may be weaker and predispose the teeth to cavities early on. Soft and sweet food preference further adds to cavity risk. Moreover, erupted teeth may be mal-aligned with excessive spacing or crowding and require orthodontic treatment with removable plates(appliances) or braces. The table below summarises the possible dental problems in special healthcare needs. It is to note that the problems and care guidance would be specific and variable for each child.
| Special needs | Common dental problems |
| Cerebral Palsy | Drooling, oral motor dystonia, infection, bruxism(grinding of teeth), frequent dryness(eczema), finger biting/sucking or object biting |
| Down’s syndrome | Hypotonic or loose oral musculature, less development of middle of face or palate, fissured tongue, large sized tongue/macroglossia, small, conical shaped teeth(microdontia), delayed tooth eruption, dental caries, periodontal problem and problems with occlusion with prominent lower jaw (Class 3) |
| Autism spectrum disorder | Tooth grinding(bruxism), dry mouth, self-injury, gag reflex |
| Intellectual disability | Enamel defects, cavities, dry mouth, gum problems |
| Hearing disability or visual impairment | Dental deposits, gum problems, tooth cavities |
Preventive modalities like brushing guidance, fluoride application, dietary counselling, atraumatic and minimally invasive restorative options may be given palliatively a low pocket-friendly cost at paediatric dentist’s office/hospital.
Some special toothbrushing and cleaning aids may be included in daily regimen like finger brush, ball grip, long length, U-shaped and even customised grip toothbrushes. Twice daily brushing regimen and rinsing the mouth after meals or wiping teeth with moist cotton/gauze should be followed as far as possible.
As a rule of thumb all special children should be familiar with a paediatric dentist so that care is easier especially in times of emergency. A take home message for all parents and caregivers would be to build a “Dental Home” for your child with a paediatric dentist which will be best equipped to deal with dental care for the child at each age and stage of life.
More specialised multi-speciality care usually requires a trained team alongside hospital set-up for best child safety. Once line of care is agreed upon between parents and dentists, the treatment can be started. Options include-
***line of management as best suited for the case
A 6-year-old boy reported to at dental out-patient setting of Madhukar Rainbow Children’s Hospital, Malviya Nagar with complaints of increased irritability, drooling and muscle stiffness around child’s mouth and swelling. The child was a known case of cerebral palsy. The child was having trouble in feeding and sleeping at night. It was observed that the child had multiple tooth cavities and dental swelling abscess present.
So far, the child had visited multiple dentists locally and failed at out-patient care. Pre-anesthesia clearance was obtained. Hence, dental rehabilitation of the child was planned under general anesthesia along with pediatric dentistry and anaesthesia team at Madhukar Rainbow Children’s Hospital.
Dr. Puja Sabherwal, Dr. Col Rakhee Goyal and Dr. Hina Faraz were part of the team for dental rehabilitation under pediatric general anesthesia. With digital portable X-rays and a trained team in eight-handed dentistry, all specialised care was met within 1 hour and 45 minutes. After the procedure, oral care with medication was continued. The follow-ups revealed improved feeding, ability to the child to sleep better at night and improvement in oral dystonia. Although, brushing daily is a struggle with oral dystonia, it is an ongoing effort at the ends of both the caregiver and our team to manage improved quality of life for the child.
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Another case of a 3-year-old girl with left side hemiplegia(paralysis) reported to our out-patient settings with advanced stage of early childhood cavities which had spread to involve nearly all the erupted teeth.
In this case, full mouth advanced dental care with child root canals, pediatric crowns and fillings was carried out. The team included Dr. Puja Sabherwal (pediatric dentist), Dr. Col Rakhee Goyal, Dr. Deepa and Dr. Sakshi Mahajan (pediatric anesthesia) which helped to restore the little ones smile in a span of 2 hours and 30 minutes. This helped her to revive her ability to chew and smile infection-free.
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Dr. Puja Sabherwal
Pediatric & Aesthetic Dentist,
BDS(MAMC), MDS Pedodontics(UCMS & GTB Hosp.), Ex-res(Max Smart superspeciality hosp, Saket, GTB Hosp.), Aes Resident(King’s College London), MFDS RCS Eng, C.Ht.(American Hypnosis Association)
Clinical Lead and Head, Rainbow Dental Clinic, Madhukar Rainbow Children’s Hospital, Malviya Nagar, Delhi-110017, Specialist Consultant, Dr. Sabherwals’ Dental Centre
This article was published in association with Rainbow Children’s Hospital.