Oral health of special needs children prompts hygienist to develop school-based program

On one typical day in the dental office — amidst the sounds of ringing phones, talking people, and the printing of appointment slips — I overheard a woman at the front desk ask about a toothbrush for a special needs child. Her request immediately caught my attention because it was for a special needs child and because “toothbrush” is a key word in the love language of dental hygienists.

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On one typical day in the dental office — amidst the sounds of ringing phones, talking people, and the printing of appointment slips — I overheard a woman at the front desk ask about a toothbrush for a special needs child. Her request immediately caught my attention because it was for a special needs child and because “toothbrush” is a key word in the love language of dental hygienists.

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Upon hearing the conversation, I learned she had received a “different kind of toothbrush” from an orthodontist many years earlier. She proceeded to say, “I’ve been everywhere looking for this toothbrush, and no one seems to carry it. Can you help me?”

I found out that she worked as a teacher in a local public school’s severe and profound multiple disabilities class, which consisted of children with Down syndrome, cerebral palsy, intellectual disabilities, hearing loss, visual impairments, and seizures. Upon building rapport, I learned of the significant need to raise awareness about the many barriers that impact access to care for special needs children, as well as of the need for those barriers to be overcome. I decided to find out whether I could help to educate teachers and caregivers of special needs children about oral hygiene instruction and practices.

Many factors contribute to poor oral health problems for children with disabilities. Research has proved that over 80 craniofacial syndromes can negatively affect oral cavity development in children with special needs.(1) Limitations in performing daily oral health-care practices, such as brushing and flossing, can be challenging for both the individual and the caregiver.

Medications, malocclusion, developmental defects, poor physical coordination, and lack of appropriate knowledge about maintaining oral health can all increase the prevalence of dental diseases in disabled children.(2) Not to mention, numerous dental needs among special needs children are unmet due to limited funding for preventive programs and the resulting lack of treatment delivery.

A difference-maker continually searches and finds ways to overcome given situations.

Setting up school-based program
In order to visit the school, I needed to collaborate with parents, legal caregivers, and the public school system. After making many phone calls, doing a lot of paperwork, and acquiring the appropriate authorization, I was able to educate teaching staff and caregivers at the school about periodontal disease and oral hygiene instruction and practices.

In my program, I used “An Oral Health Professional’s Guide to Serving Young Children with Special Health Care Needs” as a visual guide for aiding in detection of dental diseases.(2) Throughout the day, oral hygiene methods were practiced twice but only with limited resources. Upon observation, I discovered that specialized prevention aids and instructions about plaque removal were needed. While teaching modified brushing techniques in the first class, I learned that over 90% percent of the children had active decay and/or moderate to severe dental disease(s) that needed immediate attention. Upon arriving in the next classroom, I found the exact same results. Improving the oral hygiene education of teachers and caregivers was a start to helping to eliminate the disparity, but stopping there was not an option.

The goal was set small, but the bar was raised high when the need became so great. To me, making a difference for those children meant looking for ways to help eliminate the financial barriers that may have prevented them from getting necessary treatment and/or products.
So my next step was to look for possible donations, but resources were limited — until a grant from a local medical and dental health board funded the purchase of preventive products for oral health care. The grant gave me the opportunity to reach more special needs children within the school setting.

After I received the funds for the prevention aids, an individualized conducive assessment was created and conducted.
Disposable mirrors, gloves, masks, and gauze were donated. In addition, the following prevention items were purchased: fluoride varnish, toothbrushes, floss, floss holders, antimicrobial toothpaste, disclosing solution, Q-tips for applying the disclosing solution, bite blocks, additional antimicrobials, extra-grip toothbrush holders, various modified toothbrushes, Spry Rain mouth spray, mouthguards, and mouth props.
The assessments included reviewing students’ health histories and medications prior to their dental screenings and determining whether they had any malocclusion or teeth with developmental defects. Reduced physical coordination, oral habits, and behavioral limitations were also taken into account. Finding out what made the children smile or what they preferred was the fun part in seeing what was needed.
The initial assessment and the specialized products took plaque control to a whole new level. We had floss, floss aids, appropriate-sized manual toothbrushes, Benedent Corporation’s three-prong toothbrushes, and powered Oral-B or Sonicare toothbrushes.

I encouraged the teachers and caregivers to use disclosing solution continuously to aid in the identification of plaque. Antimicrobial Colgate toothpaste was used for removal. I stressed the benefits of using xylitol and provided each child with Spry Rain mouth spray to aid in decreasing oral bacteria. Three to four fluoride varnish treatments were applied at three-month intervals to aid in decreasing the high risk for dental caries. Nutritional counseling and additional oral hygiene instruction were also provided. Additional adjunctive items, such as antimicrobial mouth rinse, mouth props, and mouthguards were also distributed as was appropriate to the obstacles unique to each child.

Parents were notified via phone calls if treatment was urgent, and letters were sent home for reviewing. Specialized dental professionals were contacted for referrals, and appointments were made.

Positive results

The pleasant surprise of seeing a smile
One of the most touching stories from this school program was that of a 17-year-old boy who had a moderate intellectual disability and never smiled due to severe decay on all of his anterior maxillary teeth and posterior molars. It was emotionally and physically painful for him to open his mouth or even try to eat, but somehow he managed. For fear of embarrassment, however, he didn’t say much, and it was challenging for me to gain his trust and be sensitive about his home-care situation.
Recent threats to the authorities were the reason that this child never received the treatment he so desperately required. But once positive reassurance was given to caregivers, appointments were made quickly, and strategic treatment was rendered. After a few restorations had been placed, I began to notice something different about the boy who wouldn’t smile. At each visit, he would proudly show me a tooth that had been restored, and then he would quickly close his mouth if others came near. I continued to encourage daily brushing and flossing and provided him with extra supplies to take home or put in his backpack for use throughout the day.
During my last visit before summer vacation, he came walking into the room with a countenance I had not seen before. I was greeted with a hug and a great big smile before he exclaimed, “Look, Ms. Dee, I got new front teeth!” The teaching staff told me that he continued to act like a new person — happy and smiling at everyone. As one remarked, “Who knew that his front teeth would make all the difference?” It was truly an eye-opening experience for me to share such a life-changing event with such a special person.

At the end of the school year, evaluations were performed to determine whether the prevalence of dental diseases had decreased and whether the students’ overall health had improved. The treatment and prevention aids provided were also evaluated after each visit. The results showed improvement by about 40 to 50 percent, but further care was still needed. Supplies were sent home for the summer months, and services were carried over into the next school year. By the end of the second year, the dental diseases had drastically decreased — by 90 percent overall. The program had helped to reduce the bright red, inflamed gingival tissue; the visible calculus; the severe halitosis; and the multiple carious lesions that had previously afflicted the children.

It was rewarding to see the many positive changes in the children’s oral health and to get to know them. While I was spit on and hit in the face at times (neither of which hurt me), I was also greeted with huge smiles each time I arrived and thanked with hugs and high-fives. Some remembered my name, and the visually impaired responded to the sound of my voice.

The experiences at the school made me realize how many special needs children need us, as dental professionals, to raise awareness and be more proactive on their behalf. We need to take the preventive initiative and go beyond the four corners of our respective dental offices to reach out. When I overheard the woman at the front desk ask about a toothbrush for a special needs child, it was not about me making her more aware of all the possibilities. It was completely about her and the amazing children I would meet who made me more aware of the opportunities to do something incredible and to be a “difference-maker” in the lives of others. They made all the difference to me.

Kalena Dee Humphrey, RDH, BS, is a prevention specialist who provides quality care and treatment services at a community health and dental clinic in Jay, Okla.

References

  1. National Institute of Dental and Craniofacial Research. Continuing education: Practical oral care for people with developmental disabilities. Bethesda, MD: National Institute of Dental and Craniofacial Research; 2004:1-8. http://www.nidcr.nih.gov/CareersAndTraining/ContinuingDentalEducation/PracticalOralCareDisabilities.htm.
  2. Isman B, Newton RN. Oral conditions in children with special needs: A guide for health care providers. Los Angeles, CA: California Connections Project, University of Southern California, University Center for Excellence in Developmental Disabilities, Children’s Hospital Los Angeles; 2002. http://www.first5oralhealth.org/page.asp?page_id=432 and http://www.mchoralhealth.org/specialcare/.
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