THE DISABILITY EXPERIENCE CONFERENCE Oral Health Online

Tutorial for Children with Special needsJames Lin (3rd year dental student) Amir Boules (3rd year dental student) Richard Rubin, DDS MPH (faculty mentor)School of Dental MedicineUniversity of Pittsburgh

POOR ORAL HEALTH: QUALITY OF LIFE ISSUES

• May lead to severe systemic diseases, infection, and pain• Poor oral health care may lead to decreased:

Proper nutrition and feeding habits (selection of food)Self-esteemConcentration for work, school and playSpeech ability-TasteSocial contact and interaction Sleep

EXAMPLE: AUTISM SPECTRUM DISORDER (ASD)

• Dental cavities (treated and untreated) are more prevalent in children with ASD than in the general population

• Difficult to recognize and perform preventive measures• Difficult to treat due to behavior management and sensory

disorders.• Special considerations

Sedation, time involvement, financial hardship

PURPOSE OF ORAL HEALTH TUTORIAL:IMPROVE ORAL HOME CARE• To help non-dental healthcare providers and families

recognize signs of early caries and understand the importance of oral home care in individuals with special needs and the associated challenges.

• Offer solutions for better oral home preventive care, medications, and feeding challengesNot all children with ASD tolerate the same things

• Provide a user-friendly, photographic online tutorial

CHALLENGES IN PREVENTIVE CARE (I): RECOGNITION OF EARLY DECAY (TUTORIAL)

This stage, called “white spots” stage, can be reversed!

DETECTION IS KEY!

• Early detection of caries can save the patient from being in pain.

• Best stage for prevention is during the “white spot lesion” stage

Discoloration of enamel near gum line Darker stained areas combined with rough chalkiness

on tooth surface This stage, called the “White Spots” stage, can be

reversed.

CHALLENGES TO PREVENTIVE CARE (II):BRUSHING TEETH: “FROM THEIR PERSPECTIVE”

1. Toothbrush as a foreign object in their mouth2. Sensitivity to toothpaste or toothbrush3. Anxiety towards toothbrushing

SOLUTIONS “FROM THEIR PERSPECTIVE”1. Routine and desensitization tell-show-do distractions (songs, stories, counting #1-5)Rewards2. Flavored toothpaste, softer toothbrush fruit instead of the strong mint flavor toothbrushes with softer bristles3. PredictabilityLocation time (frequency, duration, time of day)

CHALLENGES IN PREVENTIVE CARE (III): COORDINATION OF TOOTHBRUSHING MOVEMENTS

• Children with ASD have a wide spectrum of functionality• Difficulty holding the toothbrush and learning brushing

motions

SOLUTION: USE A MODIFIED TOOTHBRUSH

• Modified toothbrush handleAdd tennis ball to handleWrap tape around the handle• Modified toothbrush headSurround® Toothbrush has unique heads and multiple sides of bristles

CHALLENGES IN PREVENTIVE CARE (IV): MEDS MAY CAUSE “DRY MOUTH”CAVITIES

SOLUTION FOR: DEALING WITH XEROSTOMIA

• Discuss alternative medications with your child’s physician that do not include xerostomia as a side effect

If medication with xerostomia as a side effect is unavoidable, it is even more crucial to exercise proper oral care preventive measures

Application of Fluoride varnish by dentist

CHALLENGES (V): PROPER FEEDING & NUTRITION• Children with ASD tend to have stomach or digestive

problemsVomiting, diarrhea, upset stomachBrought on by unhealthy and frequent snacking (junk food

and sweets)• Subject to:

Nutritional deficiencies (food selectivity/restricted diets) Acid reflux/acid erosion of teeth

SOLUTION TO: PROPER FEEDING & NUTRITION• BRAT diet: Bananas, Rice, Applesauce, Toast

Short term, 2-3 daysPlain foods are easier to keep in stomachMay add yogurt if child had digestive problemsHardens stool to decrease diarrhea Replaces lost potassium from vomiting

• Consult a nutritionist for recommendations

ALWAYS REMEMBER TO REINFORCE POSITIVE OUTCOMES WITH REWARDS• Social rewards

verbal praisepositive facial expressions

• Non-social rewardsStickersPrizesfavorite TV show

• Rewards junk food & sweet drinks