Just as it is important for a child to have a well-established “medical home,” it is also beneficial for the child to have a “dental home.” The American Academy of Pediatric Dentistry describes a dental home as “the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way. Establishment of a dental home begins no later than 12 months of age and includes referral to dental specialists when appropriate.” So, a dental home—like a medical home—is a model that ensures highest quality of care for your child.
At the Dentist
The process of establishing a dental home can begin with your local pediatric dentist. It may be helpful to meet with the dentist prior to your child’s first appointment to discuss your concerns with the dentist and/or hygienist ahead of time. Explain to them what works with your child and what doesn’t. Ask if they are willing to “customize” the appointment to your child’s ability and needs. For example, if your child is sensitive to bright lights, you could request permission for her to wear sunglasses during dental exams. Also, inquire as to whether they have received training on the unique oral health issues that may occur in children with special health care needs.
The next step is to prepare your child for the dental exam. You may want to visit your local library and check out picture books of children’s experiences going to the dentist. Or create your own book with your child’s photographs, waiting in the waiting area, sitting in a dentist chair, getting her teeth “counted” by the dentist etc.
Another tip worth mentioning is that you should be aware of your own feelings and experiences around dentists. If you are using terminology like “yank,” “pull,” “drill,” and other similar words, you might be passing along your fears to your child. Instead, be honest (and insist the dentist do the same!) about when a procedure may be uncomfortable and when it will not.
Of course, most oral health care is managed outside of the dentist’s office. Many dentists recommend the “2 by 2” method—brushing for 2 minutes twice each day, plus regular flossing. However, establishing good oral health care habits at home can be challenging for a child with special health care needs. Below are some tips to manage the process.
For some children brushing teeth can be difficult. You may want to start by using the toothbrush to touch your child’s lips or just inside the mouth. You may also want to show and teach them how to “open wide” so that this direction is understood.
It is important that the brush is the right size for your child’s mouth and that it has soft bristles. Pick the color, style, and type that work best for you and that your child likes. A child who gets to pick our his toothbrush and toothpaste may be more cooperative with brushing.
You can enlarge the toothbrush handle for the child to hold with a sponge, piece of Styrofoam, rubber ball, bicycle handle grip or similar items. You can lengthen the toothbrush handle with a piece of wood or plastic to aid those with limited shoulder movement. There are also products available for purchase at home healthcare stores and website.
If squeezing the toothpaste tube is difficult for your child, a possible adaptation is to purchase a toothpaste dispenser. Some require no batteries, and administer just the right amount directly onto the brush with a simple push of a button.
There are many different kinds of toothpaste available as well. Since mint can be strong flavor and might be bothersome to your child, you might try some other kid-friendly flavors like strawberry, watermelon, or bubble gum. There are also baking soda-based flavorless toothpastes available online. Another option is to try using a diluted fluoride mouthwash on a toothbrush. And finally, there are some toothpastes that are designed for those with sensitive teeth; inquire with your dentist as to whether this alternative is right for your child.
- Stand behind your child with her head leaning against you.
- Put a pea size amount of toothpaste on the brush. You can brush without paste as well; just rinse the brush frequently.
- Guide the brush as if you were brushing your own teeth.
- Sometimes counting each tooth slowly as you brush may help.
- Most people brush in the bathroom, but you may want to try brushing your child’s teeth in another part of your home where they may feel more comfortable.
- You might also try brushing your child’s teeth in different positions. Lying on a beanbag in a well-lit area can provide a comfortable, sensory-friendly alternative. Another option is a recliner. This strategy may also make your child more comfortable at the dental appointment when the dental chair that leans back.
- Introduce flossing as soon as possible in small steps, building upon each success.
- It might be useful to use a timer so that the individual can see when the task will be over.
- Once a manual toothbrush has been mastered then a power brush can be introduced, which will help to do the brushing. This will also help prepare them for the “power” toothbrush in the dental office.
- Some individuals benefit from visual supports and schedules. A link to a visual schedule is provided in the resources section, or you can take photographs of your child during each step of the process for a more personalized approach.
For information on covering the cost of dental care, there is a Sunny Start fact sheet on the topic at http://fvindiana.org/Files/SS/FS_DentalCare.pdf.
Click here for a Visual Schedule for "Brushing Teeth."
Pediatric dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants, and children through adolescence, including those with special health care needs. The Find a Pediatric Dentist directory of the American Academy of Pediatric Dentistry contains the contact information of pediatric dentists.