You are seeing an established 5-year-old patient with a developmental disability. He hasn’t been to a dentist yet, and his father asks if his teeth and gums look OK. How do you assess the patient’s oral health, counsel on caries risk and prioritize referral to a dentist given his unique health care needs? What should you address in your anticipatory guidance?
The AAP addresses these and other topics in the updated clinical report Oral Health Care for Children and Youth With Developmental Disabilities. The report, from the Section on Oral Health, Council on Children with Disabilities and Section on Anesthesiology and Pain Medicine, provides evidence-based information on the unique aspects required for proper care. It is available at https://doi.org/10.1542/peds.2024-067603 and will be published in the August issue of Pediatrics.
As a group, children and youth with developmental disabilities (CYDD) are more likely to have unmet oral health care needs than typically developing children. The oral health needs of this population are increasing because CYDD are more likely to live longer into adulthood than in previous decades.
Oral health risk factors
While CYDD make up a heterogenous population, they share many of the same oral health factors and needs. The clinical report highlights these needs and provides literature-supported guidance on assessing unique caries risk factors and barriers to care.
CYDD are reported to have more oral disease indicators, including more plaque, poorer gingival health and poorer oral hygiene than other children. Risk factors inherent to their underlying condition such as behavioral challenges, sensory sensitivities and neuromuscular defects can make home hygiene and dental visits challenging.
Additional factors related to the management of their condition, including the use of medications dosed in syrups for palatability, diminished salivary flow because of medication leading to xerostomia and use of fermentable carbohydrate-containing foods for behavioral rewards and/or to promote weight gain, can increase caries risk. Social drivers of health exacerbate these risks.
Oral health risk assessments in a medical home may guide counseling and prioritize dental referrals.
Oral health findings
The clinical report also includes descriptions of other oral health findings commonly seen in children with developmental disabilities. It describes malocclusions and their potential treatments; management of dental trauma; maladaptive behaviors such as bruxism and self-injurious behaviors; and common adaptive behaviors such as chewing on objects and sialorrhea.
The report aims to aid pediatric clinicians on assessment and control of dental pain in CYDD. It highlights special considerations for dental treatment rendered under sedation or general anesthesia, which many of these patients may need.
Coordinated care between medical and dental homes is essential to meet the oral health needs of CYDD. The report offers guidance and resources on how to partner together for optimal outcomes.
Recommendations
Recommendations to promote oral health (prevention, early detection and treatment) for CYDD in primary and specialty care settings are as follows:
- Assess dental and periodontal health at least annually.
- Use structured screening instruments such as the AAP Oral Health Risk Assessment Tool to assess and identify risk factors consistently.
- Provide anticipatory guidance on oral hygiene, diet, habits, trauma prevention and malocclusion; recommend use of fluoridated toothpaste; assess community water fluoridation; apply fluoride varnish as appropriate; determine sources of fermentable carbohydrates and aim to reduce consumption; and consider transition to adult dental care as part of the adolescent health care transition.
- Advocate for a dental home by 1 year of age for every CYDD, and communicate individuals’ intellectual and functional inabilities with their dental providers.
- Encourage families to access preventive dental care.
Additional recommendations are highlighted in the report for primary care providers and specialists to reduce barriers to receiving oral health services, for dentists and dental anesthesiologists caring for CYDD, and for hospital administrators and leaders.
Dr. Sarvas is a lead author of the clinical report and an associate member of the AAP Section on Oral Health.
