When your child flashes you a big, toothy grin, you know they are truly happy. But a smile tells you more than that. Having a healthy mouth is an important part of overall health.
Sometimes, when your child has a disability or special health care needs, taking care of their teeth is tricky. Certain diseases or medications make it harder to keep your child’s teeth healthy. Brushing takes a lot of skills: being okay with the sensation, motor skills, and just a willingness to do it. Your child might not have all of those skills. They might have muscle spasms or become aggressive at the sight of the toothbrush. For some parents, brushing their child’s teeth is a contact sport, and some children might need to go under anesthesia to get their teeth cleaned.
These are very real challenges. But having decayed teeth or gum disease can cause severe pain, affect other areas of health, and even be life-threatening.
On this page, we have tips to help you boost your child’s oral health. We have another page that talks about dental care too.
Why Oral Health Is Important
A toothache is known to be one of the worst forms of pain. It’s very intense and may be hard to manage or get rid of. If your child has a toothache and has to have teeth removed because of it, they can have a harder time eating, sleeping, talking, or even using their face to show feelings. This can affect their whole life: physical health, emotional health, and even the way other people treat them.
Your child’s mouth can also protect them from some of the bacteria, viruses, or toxins that come from eating, drinking, and breathing. When your child’s gums and teeth are healthy, your child has a lower risk of getting sick.
Good oral health is about much more than just a pretty smile; it’s about your child’s overall health.
Dealing With Oral Defensiveness
Some children just can’t allow anything inside their mouths. This is called oral defensiveness. While it might seem like something they’re doing on purpose, it’s not. It’s a very serious problem, usually caused when a child has trouble with sensory integration (meaning the way the brain gets and understands messages from your child’s senses). Eating through a feeding tube might also spark oral defensiveness.
For these children, eating and brushing teeth can seem very painful. They cannot bear the taste of toothpaste or the feeling of a toothbrush. They might feel like they need to protect themselves. Some children who are orally defensive even have trouble eating solid food.
If you have an orally defensive child, here are some suggestions:
- Try to avoid sticky or starchy foods like Cheetos, goldfish, or candy. These stick to your child’s teeth longer and cause more decay.
- Give your child water to drink at the end of every meal. This washes some of the food and bacteria off their teeth.
- Talk to an occupational or speech therapist who understands oral defensiveness. They might be able to help your child overcome it. You can find some tips in this article on oral defensiveness and sensory processing disorder.
- Use anesthesia (a medicine that puts your child to sleep) for dental visits.
A special toothbrush might help too. Electric or power toothbrushes, like Oral-B or Sonicare, clean better in a shorter time and the vibration may actually help with sensory integration. Three-sided toothbrushes, like Surround and Denticare-3, cover more surfaces of the teeth in a brushing. So even if you only get 20 seconds in your child’s mouth, you reach more areas.
It’s also important to try to stay positive during brushing. This can be hard when your child becomes aggressive at the sight of a toothbrush. Your child knows when you are getting frustrated and that can make the situation even harder.
Here are some ideas for keeping it positive:
- Think about brushing as a long-term project. Sometimes you might have to lose a battle one night to make brushing easier in the longer term.
- Try different toothpastes. Having the right flavor or texture can make a big difference. Have your child do a small taste test before you put it on the brush.
- If it makes it easier to brush longer or more often, you can also skip toothpaste and you or your child can brush their teeth without it.
- Move out of the bathroom. You (or they) might brush their teeth in front of their favorite TV show or even outside.
- Have a song you play or sing for brushing to make brushing more fun and help your child know how long it will last.
- Find the right timing. If your child is in the middle of a favorite activity and has to stop to brush their teeth, it’s going to feel like punishment. Make it part of a routine at certain times of day.
- Give them their independence. Even if your child can’t do a full job of brushing, help them feel good about doing as much as they can. Try putting your hand on top of theirs on the toothbrush so they still do most of it themselves while you help. Or have them do part of it and you finish.
Brushing Someone Else’s Teeth
Brushing someone else’s teeth can be awkward, but sometimes it’s necessary. Here are a few tips to make this easier:
- Have your child sit in a chair or stool.
- Stand behind or next to your child and tilt their head back slightly. This gives you a better angle for getting into their mouth. Be careful, especially with younger children, to support their neck and not strain it.
- Talk gently and explain what you’re doing. Use the “tell, show, do” method as you’re brushing. Try to get as much of their agreement and cooperation as you can.
- Be consistent with who helps with brushing.
- A foam mouth prop is not expensive and helps to keep your child’s mouth open while you brush.
- A suction toothbrush like the Toothette will vacuum out toothpaste, liquid, and bits of food while brushing so your child doesn’t accidentally breathe them in. If your child is on a feeding tube, you can ask your child’s medical doctor if this counts as medical equipment so you can get help paying for it.
Specialized Care has many mouth props and special toothbrushes. They carry all types of oral care products for people with disabilities and special health care needs.
Transitioning Into Adulthood
Dental care is different for adults. Here are some ways to get ready for that transition:
- If your child was on Children’s Health Insurance Program (CHIP) or children’s Medicaid, their dental care coverage may change when they switch to adult Medicaid. Different plans offer different dental benefits. You can call the phone number on the back of your child’s Texas Medicaid ID card to find out what is covered and what is not.
- If your child needs anesthesia to get dental care, try to get a full set of X-rays and any other dental work done before they turn 18 years old or go off your health insurance.
- Ask your child’s dentist to recommend another dentist they can see as an adult.
- See our page on dental care for ideas on paying for your child’s adult dental care.
Special Oral Health Concerns
There are some decisions about oral health that will be different for a child with disabilities or special health care needs:
- If your child needs to have teeth removed, talk to your dentist about a care plan before you replace the teeth. Bridges, implants, and dentures may cause damage to other teeth if they aren’t cleaned properly. These might bother your child more than having missing teeth.
- Children with feeding tubes and liquid diets will get more tartar on their teeth. Before a cleaning, talk to the hygienist about how much of this needs to be removed. Balance out the extra cleaning time with your child’s comfort.
- Braces might make your child’s teeth straighter and make it easier for them to chew. But if it’s too hard to keep them clean, that might cause extra tooth decay.
Your child’s dentist can help you make these decisions.
There is no one-size-fits-all approach to oral health care for children with disabilities or special health care needs. After all, your child is unique and what works for someone else might not work for them. But with patience, and a little trial and error, you can help your child have healthier teeth and gums.
Going Beyond the Brush
Here are a few ways that you can help your child have better oral health care that don’t need a toothbrush:
- Ask them to run their tongue over their teeth after eating, if they can, to take off bits of food. See if they’ll drink water, especially after a sweet drink or dessert, to wash off their teeth.
- Try to limit candy, sodas (even diet soda), sports drinks, and juice. Maybe there are times where the promise of a sweet treat or sugary drink is the only way that you can get your child to do something. But if you can think of a different reward that works, use it instead.
- If the dentist thinks it’s right for your child, ask them to do a fluoride varnish at each of your child’s visits. This may protect your child’s teeth for longer after the visit.
- Encourage your child to eat crunchy fruits and vegetables (like apples or carrots) if they can. These help clean their teeth after a meal.