Children with learning disabilities are affected by the same dental problems as other children, the chief ones being tooth decay and gum disease. However, the resulting chewing problems, swollen or bleeding gums and broken or decayed teeth can add further difficulties to a child who already has a disability.
TOOTH CLEANING AND PLAQUE
First teeth (milk teeth) are as important as ‘permanent’ teeth. They contribute to successful eating, appearance and speech, and they guide the permanent teeth into their correct positions. It is therefore important to begin cleaning teeth as soon as they appear. At first, cleaning can be done with gauze wrapped around a finger; from the age of one, a small toothbrush can be used. Most children lack sufficient manual dexterity to clean their teeth effectively until they are at least seven years of age; some individuals with a learning disability, especially those with severe disabilities or uncontrolled movements, will need to have their teeth cleaned for them through adulthood. However, the time spent in doing this will be repaid many times over by the improvement in oral health.
One of the main causes of tooth decay and gum disease is plaque, a colourless film of bacteria which forms on teeth. The bacteria in the plaque act upon the sugar in food or drink to produce acids which can dissolve tooth enamel and create cavities. In gum disease, the plaque forms products which cause inflammation of the tissues which hold the teeth in place. Since plaque is normally colourless, a disclosing solution (in liquid or tablet form) which stains plaque on the teeth is a valuable aid to effective cleaning, and it can also be used to assess whether an individual needs assistance to clean his/her teeth.
The brushing technique most commonly recommended for plaque removal is to use a short back-and-forth scrubbing motion with the bristles at the junction of the gum and teeth. The inside, outside and chewing surfaces of the teeth should be cleaned, and dental floss should be eased gently up and down between the teeth. If thorough cleaning has not been carried out in the past, some bleeding of the gums may occur until they become healthier; if bleeding continues over a long period, a dentist should be consulted.
In some cases, a child’s hand movements can be guided during brushing, with the child standing in front of you, supporting the chin and helping to keep lips out of the way. An electric toothbrush may also be useful if the child has sufficient dexterity to control it. Only a pea-sized amount of fluoride-containing toothpaste should be used. The toothbrush may be modified by bending the handle or by anchoring the brush in a ‘bicycle grip’ to make it easier to hold. Where a child has uncontrolled movements, tongue spatulas taped together to make a ‘tooth chair’ may be used to help keep the mouth open.
Another way of decreasing the harmful effects of plaque on teeth and gums is to ensure a well-balanced diet free of sugar-rich foods. Good eating habits need to be established early. Teeth can be severely damaged if a nursing bottle containing fruit juices or even milk is regularly given after the age of one year. Sugary snacks produce acid which damages teeth; such ‘treats’ should be restricted to mealtimes and should never be used as rewards during behaviour training. Healthy snacks include fruit, crisp raw vegetables, sandwiches, breads, yoghurts, low-fat cheese and plain popcorn. Cereals are an excellent energy provider, but sugar-coated varieties should be avoided. Milk, water and sugar-free squashes are recommended, and diet drinks in moderation.
ORAL HEALTHCARE IN IRELAND
Patients with no state entitlement, or who choose to do so, have their dental treatment provided by dentists in private practice. There are two schemes for adults entitled to state treatment by dentists in general practice.
The Department of Social, Community and Family Affairs Dental Benefits Scheme (DSW) applies to employees who make full PRSI contributions, and their spouses. The scheme covers free examination, diagnosis and X-ray investigations, with reduced fees for fillings, dentures and more complicated treatments. Over 30 per cent of eligible adults receive care under the scheme each year.
The Dental Treatment Services Scheme (DTSS) is administered by the Department of Health and Children for adult medical card holders. Routine dental treatment under this scheme will be extended to all adults (over 16 years) with medical cards before the end of this year. An emergency service is available at the point of delivery and routine care is available on application to health boards. The range of treatments available includes examination, X-ray investigations, fillings, extractions, oral surgery, dentures, periodontal (gum) treatments, and root fillings. Treatment is free to the patient; the dentist claims the full cost from the health board.
The Department of Health and Children has included persons with a mental handicap and persons in long-stay institutions among specific target groups who have special difficulties gaining access to oral health care. Provision of dental services for these groups is intended to complement, rather than to replace, existing services within the Children’s Dental Service and the DTSS. The Public Dental Services have the responsibility of identifying the specific target groups, determining and prioritising their oral health needs and implementing oral health care programmes, with a multidisciplinary approach and under the direction of the thirty Principal Dental Surgeons in the eight regional health boards. Queries regarding the provision of dental services to people with disabilities may be made by contacting the local Health Board Dental Clinic.