|Dental care for children with Cerebral Palsy|
The experts below agree that beginning early is best for your child when it comes to dental care. Details are offered on several ways to proceed and useful interventions for special situations. There are actions to avoid, outlined below. Included are a number of links to related sites with detailed additional information.
“Start oral hygiene in the first year even before the child has teeth. Begin by just wiping the inside of the child’s mouth with a moist cloth – this will get him used to having his mouth cleaned. Toothbrushing should start by age 18 months and can be initiated with soft brushes. Brushing should include the gums and tongue as well as the teeth.
The first visit to the dentist should be between the ages of 18 and 2 months. At this time, the dentist will review the oral hygiene program you are using and will help you resolve any frustrations you may have. Usually x-rays will not be taken until later, but the main goal of the first visit is for the dentist and the dental hygienist to understand how your child will react in the dental office and what his special needs are.
Toothbrushing is the most important daily activity in maintaining oral hygiene, and it needs to be established early. Brushing should not be a struggle for the parent or the child. Find a time of day when your child is usually in a good mood, and try to do it at the same time every day. Then you can provide some reward for the child’s behaving well. Eventually, brushing becomes an accepted part of the daily routine. Although it is advisable to leave the child with a clean mouith overnight, brushing when the child tolerates it best will provide the greatest opportunity for success in the long run.
If your child has problems of head and trunk control, you need to position him so that you can control his posture. This is usually done in the best seating system the child has, such as his wheelchair. Choose a soft multifluted nylon brush and use both circular and up-and-down motions. If the child will not tolerated a toothbrush, use a cotton-tipped swab or a soft washcloth that has been soaked with a mildly abrasive toothpaste or with an antiseptic solution. Eliminate gagging by watching where you are brushing and avoiding areas that trigger the gagging.” (Cerebral Palsy: A Complete Guide for Caregiving: 327)
“Children with CP may be more susceptible to tooth decay than their non-disabled peers. This is because the natural, self-cleaning which is facilitated by saliva (especially at night) may be disrupted. In addition, debris which usually gets moved away by the motion of the tongue may not be cleared so effectively if a child’s tongue is less mobile.
Regular brushing of teeth is vital. You should start to clean your baby’s teeth as soon as they appear in the mouth. When brushing your child’s teeth try to develop a technique which is three teeth at a time in a circular or ‘mini-scrub’ motion. Pay particular attention to the inner surfaces and the small, difficult-to-clean spaces between the teeth and the biting surfaces of the teeth at the back of the mouth. Using a battery operated toothbrush might help to make teeth cleaning easier.
Dental treatment can be very distressing for a young child. It is better to prevent the need if at all possible. In some areas there are specialist dentists who are trained in special needs. Ask your consultant, your GP or your regular dentist for advice on this. (The Cerebral Palsy Handbook: p. 105)
“Once the child starts to develop teeth, this process can be carried out with a small toothbrush. If a baby’s rubber toothbrush is available, many young children will enjoy munching on this. This may also provide a good practice for developing chewing skills. If the child finds it too difficult to tolerate a toothbrush, then it is preferable to continue tooth-cleaning with a finger, and with the possible introduction of a small amount of toothpaste.
The toothbrush is used in a pattern similar to the finger in gum massage. Oral control is usually necessary to ensure that the child’s head is held in a stable, upright position, maintaining elongation of the back and the neck. Treat the mouth in four sections. When brushing the upper jaw, brush the teeth from top to bottom, and from the back to the mouth to the front. When brushing the lower jaw, brush the teeth bottom to top, and again, from the back of the mouth to the front. After each section, remove the brush, allowing the child enough time to spit out any excess water or toothpaste, and to do several relaxed breaths before beginning the next section. Toothbrushing is a very stimulatory activity, and most children will need time to get used to it. It should not cause gagging, and if it appears to be doing so, then it is wise to use a finger instead of brush for a while.” (Children with Cerebral Palsy: p. 180)
“A good program of oral and dental care should begin early. Even before your child gets any teeth, you can use a child’s toothbrush or your finger to massage and stimulate his gums. This will keep the gums healthy and prepare your child for later toothbrushing. Once teeth erupt – usually beginning around six months of age – you should clean them regularly. You can do this with a washcloth wrapped around your finger or with a small soft toothbrush and a small amount of toothpaste (not essential). In addition to cleaning the outer surfaces of your child’s teeth by brushing, it is also important to clean the surfaces between the teeth with dental floss. Many parents find flossing easier if they use a floss holder. If you child has oral tactile defensiveness, see the previous section for tips on desensitizing his mouth.
When your child is young, you may find it simplest to clean his teeth while he is lying across your lap on his back. This makes it easier to keep him still, and also gives you a better view of his mouth. Usually it is enough to clean your child’s teeth thoroughly once a day – preferably in the evening so your child does not go to bed with food particles on his teeth.
A hazard you should know about if your child is still nursing is the “nursing bottle syndrome.” Nursing bottle syndrome refers to the very early rapid decay of teeth that sometimes occurs when children are given a bottle at bed- or nap-time. To avoid this problem, never let your child fall asleep with a bottle in his mouth.
Once your child has the motor skills to begin brushing his own teeth, you may need to get him a toothbrush with an adapted handle to help him maintain his grasp. Remember, too, that electric toothbrushes can provide some of the finer movements your child cannot do himself.” (Children with Cerebral Palsy: p. 130-131)
“If your child can walk to the bathroom, allow her to brush her own teeth. If not, you will need a spit cup or emesis basin so she can spit out the contents of her mouth after she brushes her teeth in bed.” (Cerebral Palsy: A Complete Guide for Caregiving: p. 322)
“The primary care physician should inform the dentist about which type of oral sedation has been successful in other situations where sedation is needed (our experience has been that restraints without other sedation are not effective).”
“Dentistry has become an important part in the multi-disciplinary approach in providing health care for patients with cerebral palsy and the severe handicapping conditions that frequently accompany this neuromuscular disorder.”
“Managing the preventive, restorative, and surgical aspects of dental treatment involve an early (by age 1) and regular oral health evaluation and the establishment of a customized oral health care plan.”
“HMS proudly announces support from Proctor & Gamble to widely distribute the school's video, Your Smile: Dental Care for Children with Cerebral Palsy.”
“The information presented in this module is intended to provide the institutional dental staff with the appropriate knowledge needed to modify treatment and preventive procedures to best meet the needs of the person with cerebral palsy.”
“More than 90% of children with cerebral palsy have oral motor dysfunction. The severity of oral dysfunction makes it difficult for some cerebral palsied children to be adequately nourished.”
“Many people with cerebral palsy have problems with oral health and finding understanding dentists. This page is set up as a place to record problems and (hopefully) some solutions. If you say where you are in your submission, that will help all of us.”
“It is often very difficult for people with cerebral palsy to clean their teeth...”