Dental care for children with illness and disability

ALL children need a "dental home" for preventive advice and supervision - a place to go to in an emergency and for routine treatment where they feel comfortable and relaxed.

Children have very varied dental needs depending on their age, ability to co-operate, dental health and also their medical health. Tooth decay can cause a number of problems to children's general health. For children who already have health problems, dentistry can be more complicated. Early dental visits are important for all children but especially for those who are compromised in relation to dentistry due to medical reasons, intellectual or physical disabilities.

Dental decay can have effects on a child's general health and wellbeing. The types of problems caused by decay can be divided into acute - meaning severe and short term - versus chronic where they continue for months or years. Acute dental infection often leads to pain, swelling and suffering for children. A dental abscess can cause a child's face to swell. In a child a swelling can progress to cause breathing difficulty or blood poisoning and is potentially life threatening.

Chronic or longer term dental infection has been shown to affect growth and physical development. It is not fully understood if it is because of the chronic inflammation or the effect of sleep loss that children's growth is held back. When decay and infection is treated, the improvements in health and growth are measurable. There is very good quality research to support this.

Children with disabilities such as autism are especially vulnerable. A routine check-up that might sound very easy for another child could mean a huge trauma for a child with an autistic spectrum disorder. The prevention of tooth decay in these children can be made very difficult as these children often favour restrictive diets as and in many cases parents feel relieved if they eat anything at all. Keeping teeth clean for these children can be a huge struggle for parents. Having a filling or an extraction might never be something that a child with autism could tolerate. There is one huge priority for these children and that is to ensure they require as little dentistry as possible. This means excellent preventive care and regular visits to ensure these children avoid dental problems at all costs.

Children with heart defects are another vulnerable group. To have a heart defect or what is sometimes called a "murmur" or "hole in the heart" can have important implications for dental care. Some defects can increase the risk of harmful bugs and bacteria collecting on surfaces of the heart. Luckily it is rare but, this type of infection is very serious and kills up to 30 per cent of people who get it. Up to recently, dentists would give these patients an antibiotic before treatment to prevent bacteria travelling from the mouth via the blood to the heart defect. Antibiotics are no longer recommended but it is thought that the long term effect of poor dental health is a greater threat to heart health. Dental infection carries a more serious health risk for these children than for the rest of the population. It is very important that children with heart problems avoid dental problems and, therefore, they require high quality, regular dental care.

Children with diabetes react differently to stress and infection. A dental abscess in a diabetic child can cause problems in a number of ways. Having a sore mouth can prevent a child from eating. Going to the dentist can be stressful. Coping with an infection can place demands on a child's blood glucose uptake in a way than can upset their diabetic control, causing them to become ill. Avoidance of dental problems is the best solution and this starts with early visits and regular dental check-ups.

Children with Down Syndrome sometimes find it harder to communicate and may not always be able to take care of their teeth on their own. Their immune systems don't always fight disease as well as the rest of us, so they are more prone to gum infections. These children often have missing teeth or don't develop teeth at the usual times. There is a higher risk of leukaemia in these children and the mouth can sometimes be the first place for signs of a serious disease. Sometimes these children have a heart problem as well, which further adds to the need for them to have a high standard of dental health.

Dental problems for healthy children are extremely common and can often require specialist care and services to treat them effectively. It is very important that vulnerable children, who are medically compromised or have intellectual or physical disabilities, are protected from poor oral health. This starts with having a high quality dental home from a young age.

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