Children with hypoxic-ischemic encephalopathy (HIE) may require additional oral and dental care, especially in situations where there is bruxism (teeth grinding), seizures, cerebral palsy, or intellectual/developmental disabilities. Dental care is one of the most common unmet needs of individuals with disabilities, and access to care may be limited, especially for children with cerebral palsy, autism, or intellectual/developmental disabilities (I/DD).
Why Might Children with Disabilities Experience Oral Health Issues?
Children with disabilities are often at risk for developing cavities (caries) due to:
- Diet (caused by prolonged or frequent feedings)
- Insufficient saliva production (due to certain medications)
- Limitations in performing oral hygiene (such as neuromuscular or cognitive disability that inhibits teeth brushing)
- Oral aversion and behavioral difficulties
- Difficulty swallowing and oral motor hypotonicity
- GERD and chronic vomiting
- Use of medicine containing sugar
- Dysphagia (which can leave food in the mouth)
- Weak tongues can inhibit the cleaning of oral surfaces
- Gagging may inhibit complete brushing of the teeth
- An inability to spit may cause toothpaste swallowing.
- Malocclusion/teeth crowding (which is more common with I/DD or cerebral palsy)
- Crowding makes teeth harder to clean, increasing risk of periodontal disease and cavities.
Detecting Oral Health Issues in Kids with HIE
Parents of children with HIE or other disabilities should watch out for:
- Gingival hyperplasia (gum enlargement), especially if the child is prescribed antiepileptic medications for seizures such as phenytoin, calcium channel blockers or cyclosporin A
- Gum redness and swelling (a sign of gingivitis, also known as gum disease)
- Periodontal disease (gum infection)
- Trauma to the head and face (which is more common in children with seizures, developmental delays, poor muscle coordination, or abnormal protective reflexes), which can damage oral structures
- Bruxism (teeth grinding, especially during sleep or in times of stress)
- Malocclusion (‘bite’ misalignment, which can cause abnormal facial shape, drooling and biting/chewing difficulty)
- Tooth decay and/or cavities (caries) due to excessive drooling (sialorrhea) or due to acid from reflux or vomiting
Creating a Daily Preventative Care Regimen to Prevent Tooth Decay
Because children with special needs may have unique health concerns, parents should speak to a dental or other medical professional (such as an occupational or speech therapist) to see how they can tailor daily preventive care regimens to their child.
Some suggestions parents may receive:
|Type of Oral Care||Concern||Possible Solution|
|Brushing teeth||Toothpaste swallowing||Use only a small amount of toothpaste (a ‘smear’) or use non-fluoridated toothpaste|
|Brushing teeth||Brushing triggers gagging||Brush teeth with fluoride mouthwash|
|Brushing teeth||Limited dexterity||Use electric/battery-powered brush or extend brush handle with tongue depressor or widden brush handle with wrapping or use a mouth prop|
|Going to the dentist||Child cannot tolerate or does not cooperate with routine cleanings, restorative procedures, or minor oral surgery||Ask for a referral to a pediatric dentist or a specialist with training in sedation (local anesthesia, nitrous oxide sedation, oral conscious sedation or general anesthesia)|
|Screening for Oral Problems||Oral examination may be more difficult||Primary care physician should complete examination checklist or refer to a dental professional comfortable with treating children with special healthcare needs. Children with special healthcare needs are considered ‘high risk’ and should be referred to a dentist by age 1 year.|
|Insurance Coverage||Children’s dental care not covered by insurance||Many children with special healthcare needs qualify for Medicaid, which can help qualify them for the Early and Periodic Screening and Diagnostic and Treatment (EPSDT) program.|
In some situations, it may not be possible to brush, floss and rinse regularly throughout the day. If rinsing with water is not an option, caregivers should use a disposable applicator swab to clean the mouth, and continue scheduling regular dental appointments for cleaning, fluoride treatment and sealants.
Dental Care Specialists for Kids with HIE and Special Needs
You should consult with your child’s physicians to determine what best meets their individual needs. However, there are several dental care professionals that may help a child with special needs:
- Dentists (who provide cleaning, fillings, minor surgery, and fluoride or sealant treatment)
- Orthodontists (who treat malocclusions and improve tooth positioning)
- Periodontists (who treat infections, plaque, and gingivitis)
- Cosmetic dentists (who improve the aesthetic appearance of teeth)
Other professionals the child may see include dieticians (who can provide advice regarding meal plans that minimize tooth decay) and speech-language pathologists (SLPs), who can help a child control their facial muscles to improve chewing and swallowing ability.
How Do I Find a Dentist Who Can Help My Child with Special Needs or HIE?
Not all dentists are well-equipped to address the unique health concerns of individuals with disabilities. Dental practitioners with experience in serving individuals with disabilities can often be difficult to find, and there are often barriers to oral health care, including barriers to building accessibility, financial availability (due to the costliness of restorative work), and lack of insurance coverage. However, there are several organizations devoted specifically to dental professionals with disability-related training, and parents can check to see if there is a dentist near them that can help keep their child’s teeth healthy:
- The Special Care Dentistry Association and SCDA Care Locator
- Dental Lifeline Network: Dedicated to helping individuals with disabilities find dental care
- Find a State Oral Health Program
- Grottoes of North American: Dental Care for Kids with Special Needs (USA)
- Find a Dentist: USA and Canada
These medical professionals have experience in addressing special healthcare needs, which can include handling breathing difficulties, reducing aspiration risk, doing wheelchair transfers, controlling seizures and acid reflux, sedation, pharmaceutical interactions, and the control of involuntary movements, shaking and seizures – topics that do not always apply with traditional dental practice. They can also provide specific advice to caregivers regarding daily health maintenance routines.
To learn more about ways to help maintain your child’s oral health, please see the following resources:
- [Resource Guide] South Carolina Department of Health and Environmental Control: Oral Health for Families with Special Health Care Needs
- Oral Health Care For Children With Special Health Care Needs: A Guide for Family Members/Caregivers and Dental Providers
- [Powerpoint download] Protecting All Children’s Teeth: American Academy of Pediatrics
- A Caregiver’s Guide to Good Oral Health for Persons with Special Needs
- Practical Oral Care for People With Cerebral Palsy
- Colgate Oral Care Center: Dental Health Care For Children With Special Needs
Paying for Special Needs Dental Care
Some insurance plans provide dental health insurance coverage, while other do not. Most dental clinics have payment plans and dental care packages that can help families save money, but it is best to inquire about pricing prior to receiving services.