Dental

Tooth decay is one of the most common diseases of childhood (15). Tooth decay and poor dental hygiene in children with disabilities is related to swallow­ing problems, drooling, and gastroesophageal reflux.

Dental health of children with cerebral palsy (CP) compared to children with other disabilities is most frequently described in the literature. The incidence of dental caries in children with CP is similar to the gen­eral population, although the quality of the caries is different. The size of the carious lesions is greater than what is seen in typical children (16-18). Periodontal disease is more prevalent in children with CP com­pared to their typical peers, likely due to the presence of gingival hyperplasia from phenytoin administration (19). Malocclusion and developmental enamel defects were also more common in children with CP (20-24). Erosion of primary and permanent teeth has been attributed to chronic gastroesophageal (GE) reflux. The severity of erosion has been correlated with the duration of the GE reflux disease, frequency of vomit­ing, pH of the acid, and the quality and quantity of saliva (25-28). Despite the fact that children with CP don't participate in high-risk activities as frequently as their able-bodied peers, dental trauma is more com­mon (29,30).

There is little information about dental problems for children with spina bifida. An important issue that must be addressed at each visit is to ensure that the dental office or operating room provide a latex-free environment (31). Families may need to remind the dentist and hygienist of the child's risk for an aller­gic reaction to latex. Latex-free gloves must be avail­able to reduce the risk of an allergic reaction. Boys with Duchenne muscular dystrophy (DMD) can have malocclusion with anterior and posterior open bites, which are associated with lip incompetence, mouth breathing, and macroglossia. Deteriorating oral mus­cle function as the child gets older is associated with increased plaque and calculus formation and gingival inflammation, but not necessarily with the presence of dental caries (32,33). Boys with Duchenne muscular dystrophy have a greater risk of malignant hyperther­mia when anesthesia is used for dental care (34,35).

Routine examinations and cleaning to maintain optimal dental hygiene should be performed by a den­tist comfortable in the care of children with special needs. Some of the dental care may need to be accom­plished under anesthesia in order to obtain the maxi­mum benefit. Combining dental procedures with other necessary procedures, such as a brainstem auditory evoked response (BAER), local intramuscular injec­tions with phenol or botulinum toxin, or certain ortho­pedic procedures, may limit the exposure to anesthetic agents. The American Academy of Pediatrics Policy Statement on oral heath care states that children with special health care needs be referred to a dentist as early as 6 months of age and no later than 6 months after the eruption of their first tooth, or 12 months of age (whichever comes first) (36). Visits will provide the dentist with the opportunity to provide specific educa­tion to the family to allow for optimal dental care.