Transcript Presentation - University of Pittsburgh

THE DISABILITY
EXPERIENCE
CONFERENCE Oral Health Online
Tutorial for Children
with Special needs
James Lin (3rd year dental student)
Amir Boules (3rd year dental student)
Richard Rubin, DDS MPH (faculty mentor)
School of Dental Medicine
University of Pittsburgh
POOR ORAL HEALTH: QUALITY OF LIFE ISSUES
• May lead to severe systemic diseases, infection, and pain
• Poor oral health care may lead to decreased:
Proper nutrition and feeding habits (selection of food)
Self-esteem
Concentration for work, school and play
Speech ability-Taste
Social contact and interaction
Sleep
EXAMPLE: AUTISM SPECTRUM DISORDER (ASD)
• Dental cavities (treated and untreated) are more prevalent
in children with ASD than in the general population
• Difficult to recognize and perform preventive measures
• Difficult to treat due to behavior management and sensory
disorders.
• Special considerations
Sedation, time involvement, financial hardship
PURPOSE OF ORAL HEALTH TUTORIAL:
IMPROVE ORAL HOME CARE
• To help non-dental healthcare providers and families
recognize signs of early caries and understand the
importance of oral home care in individuals with
special needs and the associated challenges.
• Offer solutions for better oral home preventive care,
medications, and feeding challenges
Not all children with ASD tolerate the same things
• Provide a user-friendly, photographic online tutorial
CHALLENGES IN PREVENTIVE CARE (I):
RECOGNITION OF EARLY DECAY (TUTORIAL)
This stage, called “white spots” stage, can be reversed!
DETECTION IS KEY!
• Early detection of caries can save the patient from
being in pain.
• Best stage for prevention is during the “white spot
lesion” stage
 Discoloration of enamel near gum line
 Darker stained areas combined with rough chalkiness on tooth
surface
 This stage, called the “White Spots” stage, can be reversed.
CHALLENGES TO PREVENTIVE CARE (II):
BRUSHING TEETH: “FROM THEIR PERSPECTIVE”
1. Toothbrush as a foreign object in their mouth
2. Sensitivity to toothpaste or toothbrush
3. Anxiety towards toothbrushing
SOLUTIONS “FROM THEIR PERSPECTIVE”
1. Routine and desensitization
 tell-show-do
 distractions (songs, stories, counting #1-5)
 Rewards
2. Flavored toothpaste, softer toothbrush
 fruit instead of the strong mint flavor
 toothbrushes with softer bristles
3. Predictability
 Location
 time (frequency, duration, time of day)
CHALLENGES IN PREVENTIVE CARE (III):
COORDINATION OF TOOTHBRUSHING
MOVEMENTS
• Children with ASD have a wide spectrum of functionality
• Difficulty holding the toothbrush and learning brushing
motions
SOLUTION: USE A MODIFIED TOOTHBRUSH
•
Modified toothbrush handle
Add tennis ball to handle
Wrap tape around the handle
•
Modified toothbrush head
Surround® Toothbrush has unique heads and multiple
sides of bristles
CHALLENGES IN PREVENTIVE CARE (IV):
MEDS MAY CAUSE “DRY MOUTH”CAVITIES
SOLUTION FOR: DEALING WITH XEROSTOMIA
• Discuss alternative medications with your child’s physician
that do not include xerostomia as a side effect
 If medication with xerostomia as a side effect is unavoidable,
it is even more crucial to exercise proper oral care preventive
measures
 Application of Fluoride varnish by dentist
CHALLENGES (V): PROPER FEEDING &
NUTRITION
• Children with ASD tend to have stomach or digestive
problems
Vomiting, diarrhea, upset stomach
Brought on by unhealthy and frequent snacking (junk food
and sweets)
• Subject to:
Nutritional deficiencies (food selectivity/restricted diets)
Acid reflux/acid erosion of teeth
SOLUTION TO: PROPER FEEDING &
NUTRITION
• BRAT diet: Bananas, Rice, Applesauce, Toast
Short term, 2-3 days
Plain foods are easier to keep in stomach
May add yogurt if child had digestive problems
Hardens stool to decrease diarrhea
Replaces lost potassium from vomiting
• Consult a nutritionist for recommendations
ALWAYS REMEMBER TO REINFORCE POSITIVE
OUTCOMES WITH REWARDS
• Social rewards
verbal praise
positive facial expressions
• Non-social rewards
Stickers
Prizes
favorite TV show
• Rewards
junk food & sweet drinks