Special Needs

Down Syndrome

Dental Management For Children With Down Syndrome

The dental care of the child with Down Syndrome presents a challenge to the patient, the parent and the provider. With over 250,000 children affected in the United States, Down Syndrome (DS) accounts for more than 5% of all special needs patients.   Dr Cara and her team are highly skilled in working with children who have unique mental and dental challenges.  At Children’s Dentistry we view it as a privilege that parents allow us to be the dental care provider for the most special child.

Good behavior in the dental office is learned. But in a patient population with delayed learning, this can be a challenge. We need to start early. The first dental visit should occur at 12-18 months of age. We want to provide parents with information about growth and development of the oral cavity. We would like to establish the optimal fluoride intake. We want to talk about dietary practices, the ins and outs of bottle and breast-feeding and the use of pacifiers. We need to practice excellent home care for dental hygiene and utilize techniques that are quick and effective.

The absolute best technique for building tolerance for dental care in the dental office is building tolerance for dental care at home with a parent. An experience created only twice a year will never gain acceptance. We suggest parent’s brush and floss their child’s teeth twice a day. While standing and facing an appropriate level sink let the child brush with your assistance while standing behind them, facing the same direction. Initially, no toothpaste is necessary or non-fluoridated toothpaste can be used.  Up until about age 3-4, no fluoridated toothpaste is recommended. The second brushing of the day should occur with your child’s head in your lap while you are seated on your bed or the floor. With just a damp toothbrush, you can easily visualize and clean all surfaces of the teeth while they are recumbent.  Reach Flossers (commercially available pre-loaded floss with handle) can then be used to floss all the inter-proximal surfaces (in between surfaces) of the teeth while they are lying down. This will closely simulate the posture that will be employed in the dental chair for all dental procedures. The vulnerability of laying supine frightens a child who is not used to it on a daily basis. Being able to lie in a parent’s lap is a big, big step!

If your child fights you on this, it may take a two-parent approach initially. The two parents sit knee to knee on straight chairs or stools with the child sitting on one parent’s lap, straddling and facing that parent. Then, the child can lay his head in the other parent’s lap. The first parent holds the child’s hands on his stomach while the second parent does the brushing or flossing. Remember, no toothpaste while lying down! You want to be quick and effective with good visibility.

The first dental exam in the dental office is often done in the lap-to-lap manner, with the dentist playing the part of second parent. If your child has experienced this at home daily, the dental exam will be well tolerated.

We also recommend using one of the inexpensive mechanical toothbrushes because the noise is very similar to the noise of our dental equipment. This will help desensitize your child to the sounds of dentistry. Let them be involved in the selection of these brushes. If your child clenches his teeth together, just slide your finger along the sides on the teeth, inside the cheek. Go all the way to the last tooth to the gum pads, which have not grown teeth yet. Bend your finger at the first knuckle in towards the tongue. This will make the mouth open and your finger will not get bitten. Your child needs to learn to not bite you before they can learn not to bite the dental providers. Nothing will replace brushing and flossing while laying down in effectively building dental tolerance. Realize that your child may be resistant, even combative, but persevere. You can do it!

Click on the image at the right of the screen to view an slideshow about how much fun our kids have when they visit us.

Dental Development

The eruption of both baby and permanent teeth is often delayed in 75% of children. Children may be 4-5 years of age before baby teeth are fully erupted and the initial eruption of permanent teeth may be delayed until 8-9 years old.  Sometimes teeth may come in an irregular sequence – baby molars may precede incisors.

Missing teeth have been reported in up to 50% of the patients. Due to the possibility of missing permanent teeth, baby teeth must be kept in excellent condition.  Dr Schroeder may recommend seeing your child every 3 or 4 months if hygiene is a challenge for you or your child.

Dental Management for Children with Autism

Daily life with a special-needs child presents many unique challenges, one of which is dental care management.   Our goal is to assist you in maintaining good oral health for your child.  We want to make this a positive experience for both you and your child.

• Children with autism need sameness and continuity in their environment. A gradual and slow exposure to the dental office and staff is recommended.
• We offer parents and children the opportunity to tour our dental office prior to the first appointment, so that the child may ask questions, touch equipment, and get used to the office. We also recommend bringing comfort items, such as a blanket or a favorite toy.
• You know your child best.  Therefore, we ask for suggestions from the parent or caregiver on how best to interact with the child. 
• We will approach the autistic child in a quiet, non-threatening manner.
• We also use a “tell-show-do” approach to providing care. We explain the procedure before it occurs. Our assistants will show the instruments that will be used.
• We will invite your child to sit alone in the dental chair to become familiar with the treatment setting.
• Autistic children often will want to know what’s going to happen next. It is important to explain things in a way that will make sense to them – our staff is trained to do this.
• It is also important to tell the autistic child where and why you need to touch them, especially when using dental or medical equipment.
• We also know to talk in direct, short phrases. Autistic children take everything literally – so it is important to avoid words or phrases with double meanings.
• Once the patient is seated, we begin with a cursory examination using only our fingers.
• Next, we would use a toothbrush, or possibly a dental mirror to gain access to the mouth.
• We always praise and reinforce good behavior, and try to ignore poor behavior.
• We invite the parent or caregiver to hold the child’s hand during the dental examination.
• Some autistic children can be calmed by moderate pressure, such as by using a papoose board to wrap the child. One the other hand, “light” touch (such as by air from the dental air syringe) can agitate them. For instance, you are more likely to have problems wrapping a blood pressure cuff around the arm than by inflating it!
• Some children will need sedation or general anesthesia so that dental treatment can be accomplished.   If this is the case Dr. Schroeder has on staff at Central Washington Hospital and may discuss this option with you.