Do you ensure that your children clean their teeth carefully and regularly? Difficult, isn’t it? Getting children to be regular in their daily self-care activities is always a challenge; and children with intellectual and developmental disabilities need extra care and supervision to maintain good oral health.
Developmentally and intellectually challenged children are known to have poor oral hygiene as compared to the general population. This is so because of their weak muscular control, poorly developed teeth and jaws, inability to understand instructions, undeveloped or underdeveloped motor skills and manual coordination.
One of the main causes of dental issues is the common problem of the inability to draw out problematic foods stuck in the mouth. The cross-cutting impact of poor general health, along with these factors, can also lead to poor oral hygiene. Special care dentistry is a new field of dental practice that provides oral health care and treatment for persons with disabilities.
With more than 26 million persons with disabilities in India, it is unfortunate that the sensitisation of dental graduates to this problem is inadequate. There is a need for profound modifications in the programme structure and content of dentistry as a large number of dental graduates go through this demanding course of study. Even though the attitude of dental graduates towards those with special needs is dependent upon a number of factors, exposure to a curriculum related to special care patients is indispensable.
While interning at a dental clinic, I met Sahil*, a young boy with Down Syndrome who had come for dental treatment. The key aspect in the process of his treatment is his comfort with the dental chair. Sahil was restless and fearful; and when everything else failed, his extreme anxiety had to be managed with sedation.
While sedation is a failsafe method of dealing with cases of extreme behaviour, what I took away from the experience was a lack of awareness of alternative methods that a doctor might adopt to manage such behavioural challenges. The lack of discussion of alternative methods is a product of a lack of exposure to prepare and sensitise the service providers for such eventualities.
The herculean task of making a child with special needs follow an oral hygiene routine rests on maintaining a good homecare routine. At home, parents and caregivers can help children with special needs to establish a regimen of oral health. Using a soft brush to brush the teeth twice a day may help in warding off dental problems.
Consult a dentist regarding the initiation of and the appropriate method to use fluoride toothpaste to prevent tooth decay and caries. It is also a good practice to avoid sugary and sticky food as that leads to acid formation in the mouth that not only lowers the pH value of the mouth but also hastens the process of tooth decay. Establishing healthy habits such as rinsing the mouth after each meal is an important preventive strategy that can help ensure good oral hygiene. Regular check-ups with a special care dentist twice a year can prevent dental problems. After all, prevention is better than cure.
Apart from preventive strategies, recommendations for a better oral healthcare experience for the child and service provider might involve scheduling prior appointments and informing the doctor of the needs of the child. A case can also be made for sensitising parents to the oral health needs of their wards with disabilities. It is worthwhile to invest in a medical consultation for the safe delivery of oral health care. Establishing effective modes of communication between the dentist and the patient, and behavioural guidance for safe treatment of the patient are important steps in getting the care that a person with challenges might need.
First and foremost, it is imperative to find a dentist who can open a clear communication channel with the child and be the saviour that the caregiver is looking for. A dentist who is understanding and equipped to deal with the behavioural challenges of children with intellectual and developmental disabilities is an important resource that every parent and/or caregiver requires. One needs to acknowledge that children with special needs need special care to maintain good oral health and these tips could help to move in the right direction.
About the Author: Dr Prakamya Arora is an intern at the Amrit Foundation of India. She is pursuing MBA in Healthcare from IIHMR, Delhi. She is an Oral Professionalist who believes in spreading smiles and working hard. Her aim is to open an NGO for the unprivileged.
*Name changed