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Oral Health

By: Katherine A. TeKolste, MD, FAAP, Developmental Pediatrician,

     Member, Interdisciplinary Children's Oral Health Promotion (ICOHP) project

Introduction

Children with special health care needs are at higher risk than the general population for oral health problems. 

• Routine self-care may be difficult or impossible for a child, e.g. due to motor disability such as seen in spastic quadriplegia or due to cognitive or behavioral impairment. 
• The underlying disease may impact oral health, such as with cleft lip and palate or leukemia. 
• The treatment of a chronic disorder may lead to secondary oral health problems, such as gingival hyperplasia with anticonvulsants, methotrexate, immunosuppressants and calciuim channel blockers.

In surveys of the special needs population, parents and families identify dental care as the most common unmet health care need for their children.

How Can the Primary Health Care Provider Help Optimize Oral Health?

• Emphasize prevention
  • Reinforce the importance of daily oral care
  • Provide handouts and brochures on how to maintain oral hygiene
    • Great resources at: http://www.doh.wa.gov/PublicHealthandHealthcareProviders/
      HealthcareProfessionsandFacilities/PatientCareResources/
      OralHealth/OralHealthPromotionCards.aspx
  • "Innoculate against cavities" by reviewing fluoride exposure and supplementing when indicated
  • Review diet and feeding practices for behaviors and habits that create a high risk for developing caries or gingivitis
  • Review medications and dosage regimens to minimize oral health side effects

• Monitor interactions of oral and systemic health; Recognize implications of poor oral health relative to overall health across the lifespan - Further information

• Link patients with dental providers and reinforce the importance of dental health maintainance
  • Finding Dental Care
    • Access to Baby and Child Dentistry (ABCD) Programs in Washington State
      • Program sites
      • Program information
    • WithinReach (formerly Healthy Mothers Healthy Babies) - 1-800 322-2588
    • Finding a Pediatric Dentist - national list from American Academy of Pediatric Dentistry
• Address oral health on the community level whenever possible
  • General oral health promotion
  • Local water fluoridation
  • Access to dental care

Helpful Resources:

For the Health Care Provider:

• Oral health information at the American Academy of Pediatrics
• Oral Conditions in Children with Special Health Care Needs
• Promoting the Oral Health of Children with Developmental Disabilities and Other Special Health Care Needs. Proceedings of the 2001 UW Conference
• Practical Oral Care for Individuals with Developmental Disabilities
• Bright Futures: Oral Health Toolbox
• Dental Home Resource Center - American Academy of Pediatric Dentistry
• Oral Health Sheet for Medical Professionals: Children with Traumatic Brain Injury

For Families:

• Dental Care for Children with Special Health Care Needs - from the Center for Children with Special Needs
• Dental Care Every Day: A Caregiver's Guide
• 10 Simple Ways You Can Protect Your Baby's Smile
• A Guide to Good Oral Health for Persons with Special Health Care Needs - from the Special Olympics, Special Smiles
• Dental Health Guidance for Parents and Caregivers of Children with Traumatic Brain Injury

Further Information:

Fact Sheet - Challenges and Opportunities

Information on unmet oral health needs, oral health and general health/well-being, barriers to care, and opportunities for care. 

www.mchoralhealth.org/PDFs/SHCNfactsheet.pdf

Tip Sheet - Strategies for Improving the Oral Health System of Care for Children and Adolescents with Special Health Care Needs

Approaches for health professionals planning, developing and implementing state and local efforts to ensure access to care.

www.mchoralhealth.org/PDFs/SHCNtipsheet.pdf

Resource Guide: Oral Health Services for Children and
Adolescents with Special Health Care Needs. National Maternal and Child Oral Health Resource Center, Washington, DC. 2005.

List of journal articles, materials and federal agencies and national organizations that may serve as resources for ensuring optimal oral health care.

http://www.mchoralhealth.org/PDFs/SHCNResGuide.pdf

Case Study: ABCD, ABCD"E", Kids Get Care - Washington State Oral Health Initiatives. 

Report from the W.K. Kellogg Foundation.  Community-based Oral Health Programs: Lessons from Three Innovative Models.
www.wkkf.org/knowledge-center/resources/2005/11/Community-Based-Oral-Health-Programs-Lessons-From-Three-Innovative-Models.aspx