Developmental Disabilities & Oral Health

Health Challenges:

• Mental capabilities will vary from person to person and may have an impact upon how well someone can remember and follow directions in a dental office and at home.
• Behavior problems can complicate oral health care. For example, anxiety caused by a developmental disability may make someone uncomfortable during treatment.
• Mobility problems may require a person to use a wheelchair, mobility scooter, or a walker to move around. Mobility issues can also make lifting and manipulating objects more challenging, impacting self-care. Access to the dental operatory and chair may require special arrangements and assistance with patient transfer. Longer appointment times may be needed.
• Neuromuscular problems can affect the mouth. Some people with disabilities have persistently rigid or loose chewing muscles, or have drooling, gagging, or swallowing problems that complicate oral care.
• Uncontrolled body movements can jeopardize safety and the ability to deliver oral care.
• Cardiac disorders are common in people with developmental disabilities such as Down syndrome. Consult a cardiologist to determine the need for pre-treatment antibiotics.
• Gastroesophageal reflux sometimes affects people with central nervous system disorders such as cerebral palsy. It may cause difficulty lying on their back, and teeth may be sensitive or display signs of erosion.
• Seizures accompany many developmental disabilities. Patients may chip teeth or bite the tongue or cheeks during a seizure.
• Visual impairments and hearing loss or deafness may also be present in people with developmental disabilities, leading to communication difficulties while being treated in the dental office.
• Latex allergies may be more likely in people with developmental disabilities.

Oral Health Problems:

• Tooth decay is common in people with developmental disabilities. This may be due to poor oral hygiene, and teeth may be crowded or malformed, making them more difficult to keep clean. Dental sealants are effective in children and adults to prevent decay.
• Periodontal (gum) disease occurs more often and at a younger age in people with developmental disabilities. Difficulty performing effective brushing and flossing may be an obstacle to successful treatment and outcomes.
• Malocclusion occurs in many people with developmental disabilities, which can make chewing and speaking difficult and increase the risk of periodontal (gum) disease, dental caries, and oral trauma.
• Damaging oral habits such as teeth grinding and clenching, food pouching, mouth breathing, and tongue thrusting can be a problem for people with developmental disabilities.
• Oral malformations may cause enamel defects, high lip lines with dry gums, and variations in the number, size, and shape of teeth.
• Delayed tooth eruption may occur in children with developmental disabilities such as Down Syndrome. Children may not get their first baby tooth until they are 2 years old.
• Trauma and injury to the mouth from falls or accidents may occur in people with seizure disorders or cerebral palsy.
• Prescription drugs may cause dry mouth, swelling of the gums, or other changes that make it more difficult to achieve and maintain oral health.

Helpful Tips

For Caregivers

Taking care of someone with a developmental disability requires patience and skill. As a caregiver, you know this as well as anyone does. You also know how challenging it is to help that person with oral care. It takes planning, time, and the ability to manage physical, mental, and behavioral concerns. Oral care isn't always easy, but you can make it work for you and the person you help.

• Brush every day. Depending on whether the person you care for is able to brush their teeth, you may need to take on the job of brushing their teeth yourself. Or, modify the toothbrush to accommodate physical limitations to allow the person to continue brushing his or her own teeth.
• Floss regularly. Some people with developmental disabilities may find flossing a real challenge. You may need to do the flossing for them or obtain aids such as floss holders or floss picks.
• Visit a dentist regularly. Disease prevention, early detection, and treatment are important for maintaining good oral health. It may take time for the person you care for to become comfortable at the dental office. Contact your dentist to plan a "get-acquainted" visit with no treatment provided. This might help to familiarize the person you care for with the office and the exam routine before a real visit.

For Dental Professionals

Providing oral care to patients with developmental disabilities requires adaptation of the skills you use every day. Most people with mild or moderate developmental disabilities can be treated successfully in the general practice setting.

As a dental professional you also need to be aware of the different needs – behavioral, physical, emotional and cognitive – that a patient with developmental disabilities may have. Learning appropriate skills and techniques to meet the unique oral health needs of people with developmental disabilities will help you be successful in delivering care to these patients.

Below are some general tips to help you adjust to the special oral care needs of people with developmental disabilities.

• Create a person-centered environment. It is up to you to ensure all patients are treated with respect, dignity, and empathy.
• Determine your patient's mental capabilities and communication skills. Talk with the patient and their caregivers about how the patient's abilities might affect oral health care. Be receptive to their thoughts and ideas on how to make the experience a success.
• Set the stage for a successful visit. Involve the entire dental team—from the receptionist to the dental assistant.
• Observe if physical manifestations of the disability(ies) are present. How does the patient move? Look for challenges such as uncontrolled body movements or problems with sitting in a dental chair.
• Ask if the patient has an allergy to latex before you begin treatment. Latex allergies can be life threatening and may be more common among patients with developmental disabilities.

Additional Resources

• MedlinePlus: Developmental Disabilities and Oral Health
  The National Library of Medicine's collection of links to government, professional and non-profit/voluntary organizations with information on developmental disabilities and oral health.
• Special Care Dentistry Association
  An organization of oral health professionals and other individuals who are dedicated to promoting oral health and well-being for people with special needs.
• Developmental Disabilities Nurses Association
  A specialty organization that provides education and support for nurses who care for people with intellectual and developmental disabilities.
• Dental Education in the Care of Persons with Disabilities (DECOD)
  This clinic at the University of Washington School of Dentistry provides dental care for people with developmental and acquired disabilities.