Ch. 20

  1. T/F: People with special health care needs have UNIQUE oral health & nutrition issues that may be OVERLOOKED due to MORE PRESSING medical needs.
  2. CURRENTLY in the U.S., there are approximately ___ million individuals LIVING with a developmental disability.
    4.5 million
  3. What is the MOST COMMON developmental disability in the U.S?
    Mental Retardation
  4. T/F: Individuals with developmental disabilities &/or special health care needs have INCREASED dental & nutritional risks.
  5. Individuals with developmental disabilities & special health care needs may REQUIRE an array of medical & support services: (4)
    • 1.) Prescription medications
    • 2.) Speech, physical, & occupational therapies
    • 3.) Family & Genetic counseling
    • 4.) Dental & Nutritional care
  6. Dental Care is the ___ MOST NEEDED service for approximately ___ % of the Special Needs population.
    2nd; 78%
  7. MORE THAN ___ % of children with special health care needs REQUIRED, but did NOT receive dental care.
    8 %
  8. 5 Nutrition Problems of People with Special Health Care Needs:
    • 1.) INADEQUATE caloric intake >>>> SLOW growth & POOR weight gain
    • 2.) POOR growth & development
    • 3.) INADEQUATE feeding skills
    • 4.) Side effects of medications
    • 5.) EXTENDED feeding times >>>> INCREASED exposure of teeth to cariogenic foods >>>> INCREASED RISK of caries
  9. Cyclic Relationship of Oral Health & Nutrition:
    Oral motor dysfunction/compromised oral health >>>>DECREASED food intake >>>> POOR nutritional status
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 2 Solutions to Dysphagia:
    • 1.) MODIFY consistency & Caloric content of foods & liquids
    • 2.) REFER to an Occupational or Speech Therapist for feeding evaluation
  24. 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
  25. 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
  26. 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
Card Set
Ch. 20
Oral & Nutritional Concerns for People with Special Health Care Needs