5.) EXTENDED feeding times >>>> INCREASED exposure of teeth to cariogenic foods >>>> INCREASED RISK of caries
Cyclic Relationship of Oral Health & Nutrition:
Oral motor dysfunction/compromised oral health >>>>DECREASED food intake >>>> POOR nutritional status
14 Problems in the oral cavity can affect the ability & desire to eat & nutritional status:
1.) Mastication
2.) Abnormal Muscle Tone
3.) Malocclusion
4.) Bruxism
5.) Gingival Overgrowth
6.) Dysphagia
7.) Prolonged Feeding
8.) Periodontal Disease
9.) Dental Caries
10.) Viral Infections
11.) Developmental Defects
12.) Delayed, Accelerated, or Inconsistent Tooth Eruption
13.) Trauma
14.) Tooth Anomalies
Malocclusion:
Malocclusion & crowding of teeth occur frequently in people with developmental disabilities
Nearly 25% of the more than 80 craniofacial anomalies that affect oral development are associated with Mental Retardation
Muscle Dysfunction CONTRIBUTES to Malocclusion, particularly in people with Cerbral Palsy
Teeth that are Crowded or out of alignment are MORE DIFFICULT to keep clean, which contributes to Periodontal Disease & Caries
REFER pt. to Orthodontist or Pediatric Dentist for evaluation & specialized instruction in daily oral hygiene
Gingival Overgrowth:
may be a SIDE EFFECT from Medications such as Calcium Channel Blockers, Phenytoin (Dilantin), Sodium, Cyclosporine
POOR oral hygiene AGGRAVATES the condition & can lead to superimposed infections
Severe overgrowth can IMPAIR tooth eruption, chewing, & appearance
REFER to oral health care provider for prevention & treatment; a preventive regimen of Antimicrobial Mouthrinses & FREQUENT appointments may be NEEDED; consider ALTERNATIVE medication if possible
Dental Caries:
They may be LINKED to FREQUENT vomiting or GI Reflux, LESS than normal amounts of saliva, medications containing sugar, or special diets that REQUIRE prolonged bottle feeding or snacking
Counsel parent/caregiver on daily oral hygiene to include: frequent rinsing with water & use of a fluoride-containing toothpaste & mouthrinse
Explain the NEED for supervising children to AVOID swallowing Fluoride
Refer to oral health care provider &/or Gastroenterologist for prevention & treatment; prescribe sugarless medications when available
Viral Infections:
Viral infections are USUALLY due to the Herpes Simplex Virus
Children RARELY get Herpetic Gingivostomatitis or Herpes Labialis BEFORE 6 months of age
Herpetic Gingivostomatits is MOST COMMON in young children, but may occur in adolescents & young adults
Viral infections can be painful & are USUALLY ACCOMPANIED by a fever
Counsel parent/caregiver about infectious nature of lesions, the need for frequent fluids to prevent dehydration, & methods of symptomatic treatment
Early, Severe Periodontal Disease:
Can occur in Children with IMPAIRED immune systems or connective tissue disorders & INADEQUATE oral hygiene
Simple Gingivitis results from an accumulation of bacterial plaque & presents as red, swollen gums that bleed easily
Periodontitis is MORE sever & leads to tooth loss if NOT treated
Professional cleaning by oral health care provider, systemic antibiotics, & instructions on home care may be needed to STOP infection
Explain that parent/caregiver may need to HELP with daily toothbrushing & flossing & that FREQUENT appointments with an oral health care provider may be NECESSARY
Bruxism:
Bruxism is a COMMON occurrence in people with Cerebral Palsy or Severe Mental Retardation
In EXTREME cases, Bruxism leads to tooth abrasion & FLAT biting surfaces
Refer to Dentist for evaluation; behavioral techniques or a bite guard/night guard may be recommended
Developmental Defects:
They APPEAR as pits, lines, or discoloration in the teeth
Very HIGH fever or certain medications can DISTURB tooth formation & defects may result
MANY teeth with defects are PRONE to caries, are DIFFICULT to keep clean, & may COMPROMISE appearance
Refer to an oral health care provider for evaluation of treatment options & advice on keeping teeth clean
Tooth Eruption:
Tooth eruption may be delayed, accelerated, or inconsistent in Children with growth disturbances
Gums may appear red or bluish-purple before erupting teeth break through into the mouth
Eruption DEPENDS on genetics, growth of the jaw, muscular action, & other factors
Children with Down Syndrome may show DELAYS of up to 2 years
Offer info about the variability in tooth eruption patterns & refer to an oral health care provider for additional questions
Trauma:
Trauma to the face & mouth occur MORE FREQUENTLY in people who have mental retardation, seizures, abnormal protective reflexes, or muscle incoordination
People receiving Restorative Dental Care should be OBSERVED CLOSELY to PREVENT chewing on anesthetized areas
If a tooth is avulsed or broken, take the patient & tooth to the dentist IMMEDIATELY
Counsel parent/caregiver on ways to PREVENT trauma & what to do when it occurs
Tooth Anomalies:
Tooth anomalies are VARIATIONS in the #, size, & shape of teeth
People with Down Syndrome, Oral Clefts, Ectodermal Dysplasia, or other conditions may experience congenitally missing, extra, or malformed teeth
Consult an oral health care provider for dental treatment planning DURING a child's growing years
Managing Diet & Nutritional Needs of People with Special Health Care Needs:
Choosing healthful foods & engaging in physical activity are IMPORTANT lifestyle habits to adopt for long-term health
Children & Adults with Special Needs should STILL practice healthful eating habits by following the Food Pyramid on the USDA's website & Dietary Guidelines for Americans
Dysphagia is a swallowing dysfunction that may lead to 2 things:
1.) INCREASED aspiration risk in children & adults with Special Health Care Needs
2.) INSUFFICIENT food intake
2 Solutions to Dysphagia:
1.) MODIFY consistency & Caloric content of foods & liquids
2.) REFER to an Occupational or Speech Therapist for feeding evaluation
National Dysphagia Diet outlines 4 Levels of food consistencies:
1.) Dysphagia puree
2.) Dysphagia mechanically altered
3.) Dysphagia advanced
4.) Regular
*Proper assessment & treatment will help optimize food & liquid intake in these individuals
Implications for Dentistry:
Dental health professionals should be aware of the oral problems commonly seen in children & adults with developmental disabilities
Be familiar with the negative consequences these may have on feeding & nutrition
An interdisciplinary health care plan is likely the MOST BENEFICIAL approach for treatment
Work TOGETHER with a specialized Registered Dietician to optimize pt's nutritional status & overall health
5 Tips for Health Care Providers:
1.) Take time to talk & listen to parents & caregivers
2.) Tell parents & caregivers to seek dental consultation NO LATER THAN a child's 1st birthday
3.) Seek advice on behavior management techniques; early intervention & familiarization with the dental team may take SEVERAL visits
4.) Evaluate & treat Orthodontic problems EARLY to LIMIT RISK of MORE COMPLICATED problems later in life
5.) Advise caregivers to AVOID serving snacks at bedtime
Author
Kymberli
ID
84327
Card Set
Ch. 20
Description
Oral & Nutritional Concerns for People with Special Health Care Needs
