By Barks, Lee; Lord, Debbie
The Exceptional Parent , Vol. 32, No. 12
Oral Health-An important part of any regimen
To a person with disabilities, oral healthcare may cause pain rather than a sense of well being. Instead of the normal sensation of tooth brushing, these stimuli may feel like burning, cold, searing pain, or some other sensation. The person naturally defends him- or herself. The natural response of many parents is to "be kind" to their child, do what is comfortable and hope for the best. Many say, "We just do the best we can."
The child who is orally hypersensitive may gag at the sight of a toothbrush, vomit, and engage in a battle royal at oral hygiene time. Sometimes compounding the problem, use of some medications like Dilantin can cause overgrowth of the gums, resulting in extra trapping of bacteria and plaque below the gumline. Without treatment, this accelerates and worsens infection and decay.
Good oral healthcare measures are an important part of any regimen.
Over time, even if some brushing takes place, some mouth areas may be avoided, and gingivitis, bleeding, then periodontal disease with bone loss, caries (cavities), and sometimes abscesses develop. Tooth mobility (loosening of teeth) develops. At this point, either teeth shed (fall out), or dental acute care takes place.
For the child or young person with oral pain and hypersensitivity, dental acute care can be extremely trying. Sometimes it is difficult to find someone who will prescribe sedation without general anesthesia, and this can further delay care. Medicaid and most health insurance often deny coverage of the expenses involved.
Another outcome for some children and young people is that as teeth are lost oral control of food and fluids decreases. Teeth are needed to provide the structural support to initiate a normal swallow. When they fall out or are pulled, keeping food and fluid moving in the right direction may no longer be possible. The child may begin to experience increased respiratory secretions, coughing, some aspiration, and their voice quality may seem like they are underwater.
Respiratory infections like bronchitis or pneumonia may occur. In some cases, there is a refusal to eat, weight loss, and continual crying.
Oral Motor Therapy and Normalizing Sensation at Home
For children who are orally defensive, this decline is preventable and even reversible, if it has already begun, with consistent, therapeutic oral hygiene. Actually more appropriate stimulation, not less, is needed, and there is hope. Begin with an evaluation from an occupational therapist or a speech pathologist. Following the evaluation, the development of an appropriate program depends on many factors. One of the most important factors is the child's medical status. For the infant or child who is ill or in a coma, direct work is not possible or appropriate.
However, early stimulation and involvement by an appropriate therapist (one who is trained in oral motor therapy) may be beneficial to the family before any direct work actually begins. During illness or hospitalization, pleasant sensory input into the mouth area may be appropriate.
Treatment usually may begin once the child is medically able to maintain a level of brief periods of conscious awareness. …