Dental Care for People With Developmental Disabilities: A Caregiver Guide

Autism, cerebral palsy, Down syndrome and other developmental disabilities can make everyday self-care harder, and that includes brushing, flossing and dental visits. The National Institute of Dental and Craniofacial Research (NIDCR) notes that people with these disabilities may need extra help to achieve and maintain good oral health. This guide is for families and caregivers. It covers the oral health problems NIDCR says are more common, home-care tips, and how to prepare for dental visits.

Why oral care can be harder

NIDCR lists several challenges, which vary widely from person to person:

• Understanding and memory. Mental capabilities affect how well someone can remember and follow directions, at home and in the dental chair.
• Anxiety and behavior. Anxiety linked to a disability can make treatment uncomfortable.
• Mobility. Wheelchairs, scooters or walkers may require special arrangements and help transferring to the dental chair, and longer appointments may be needed. Limited mobility can also make it hard to hold and handle a toothbrush.
• Neuromuscular problems. Some people have rigid or loose chewing muscles, or problems with drooling, gagging or swallowing.
• Uncontrolled body movements can affect safety during care.
• Other conditions. Heart conditions are common in some developmental disabilities, such as Down syndrome. NIDCR advises consulting a cardiologist about the need for antibiotics before treatment. Reflux, which sometimes affects people with conditions like cerebral palsy, can make teeth sensitive or eroded. Seizures can chip teeth or cause tongue and cheek bites. Vision or hearing loss can make communication harder. NIDCR also notes latex allergies may be more likely.

Oral health problems to watch for

According to NIDCR:

• Tooth decay is common. Hygiene may be difficult, and crowded or malformed teeth are harder to clean. NIDCR notes dental sealants are effective in both children and adults.
• Gum disease occurs more often and at a younger age. Difficulty brushing and flossing can make treatment harder.
• Malocclusion (a poor bite) is common. It can make chewing and speaking difficult and raises the risk of gum disease, decay and injury.
• Damaging habits such as grinding and clenching, food pouching, mouth breathing and tongue thrusting. For grinding, see teeth grinding and night guards.
• Delayed tooth eruption. In children with conditions such as Down syndrome, NIDCR says the first baby tooth may not appear until age 2.
• Injuries from falls or accidents, especially with seizure disorders or cerebral palsy.
• Medicine side effects such as dry mouth or swollen gums.

Daily care at home

NIDCR’s caregiver guide sums it up in three steps: brush every day, floss every day and visit a dentist regularly.

Brushing

Depending on the person’s abilities, you may need to do the brushing yourself. Or you can modify the toothbrush to fit their physical limitations so they can keep brushing on their own.

Flossing

Flossing can be a real challenge. NIDCR says you may need to floss for the person, or use aids such as floss holders or floss picks.

Consistency

A predictable routine can help: the same place, the same time and the same order each day. Calm, simple, one-step instructions also help. NIDCR’s caregiver guide includes positioning ideas for helping someone brush safely.

Preparing for dental visits

NIDCR notes it may take time for a person to get comfortable at the dental office. It suggests asking the dentist for a “get-acquainted” visit with no treatment, so the person can see the office and the exam routine first. Before the visit, share with the office:

• the person’s medical history and medicines
• any latex allergy
• how they communicate best and what tends to cause distress
• mobility needs, including whether they need help transferring to the chair
• any heart condition. Ask the cardiologist and dentist whether antibiotics are needed before treatment. The ADA explains that this applies only to specific high-risk heart conditions.

For tips on fear and nerves, see dental anxiety tips. Some patients may need sedation. Our dental sedation options guide explains the types.

Finding the right dentist

NIDCR states that most people with mild or moderate developmental disabilities can be treated successfully in a general dental practice. When calling offices, ask whether they have experience with your family member’s needs, whether they can schedule longer appointments, and whether the office is wheelchair accessible. You can search for dentists near you. NIDCR also points to the Special Care Dentistry Association, an organization of professionals focused on people with special needs.

Frequently asked questions

Does my family member need a special-needs dentist?

Not necessarily. NIDCR says most people with mild or moderate developmental disabilities can be treated in a general practice. More complex needs may call for a dentist with special-care experience.

What if they won’t let me brush their teeth?

Try a modified toothbrush, a consistent routine and short sessions. Ask the dentist or hygienist to demonstrate techniques and positions that work for your situation.

Are sealants worth it for adults?

NIDCR notes that dental sealants are effective in both children and adults to prevent decay. Ask your dentist whether they suit your family member’s teeth.

Sources

• NIDCR: Developmental Disabilities and Oral Health
• NIDCR: Dental Care Every Day: A Caregiver’s Guide (PDF)
• ADA: Antibiotic Prophylaxis Prior to Dental Procedures

By the Dentist Review Editorial Team.

This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.

Featured image: “Navy dentist teaching oral hygiene to children” by U.S. Navy, via Wikimedia Commons, in the public domain. Resized and compressed for the web.