The Dentist and Medically Fragile Children

Did I ever tell you about Cody's first experience at the dentist? On second thought, maybe I should reverse that. Did I ever tell you about the dentist's first experience with Cody?

Dr. Lax, an assistant professor of pediatric dentistry at Oregon Health and Science University, works with "medically fragile" children. Cody's first visit with Dr. Lax was memorable if nothing else. Cody was tactile defensive as a child and getting into his mouth was a chore for me, let alone a stranger. Don and I knew we would need to hold Cody's arms and hands down to prevent him from grabbing, shoving, hitting or pushing the doctor's hands away. What none of us saw coming, however, was Cody's right leg shooting straight up and kicking Dr. Lax in the head.

The good news is things only got better after that! (The only thing I can think of that might be worse than a blow to the head would be throw up.) Although Cody still isn't fond of people getting inside his mouth, he is able to make it through routine cleanings without his dad holding down his arms and legs. To read about Cody's coping techniques, click here .

The following information about toothbrushing and tactile defensive people was written by Jim Bubenik, a dentist who works with special needs patients in St. Louis, MO. I think those of you who have young children with special needs may find this of interest:

TOOTHBRUSHING FOR DISABLED PEOPLE

"All people with teeth need brushing. Brushing followed by flossing is better if possible. If your child will not let you near his mouth due to fear, unfamiliarity with the brush or tactile defensiveness around the face, here is how you systematically desensitize them: Start with just some wet gauze or a washcloth wrapped around your finger and move it around the lips until the child will accept this. Use a massaging motion. Put something sweet on it to give him extra incentive if needed. When he gets accustomed to this and seems to like it (this may take quite a few sessions), start to go inside the mouth. Back teeth seem to be less sensitive than the front ones on most tactile defensive people, so start on the back ones. Be patient. Don't worry if he clenches; you are making progress and he'll open later. When this has become routine, start putting the brush in the mouth to do the cleaning. If he doesn't like the bristles on the brush, just use the other end (the handle part) to desensitize him to the feel of that. Use a soft or ultrasoft bristle brush. Heat the bristles in hot water to soften them if needed, anything to get the child to take that first step. Stop if you are gagging him. Give him an old brush with something on it to make it taste good and let him play with it and chew on it by himself before or after the tooth brushing session. Expect that this systematic desensitization program will take several weeks but it is well worth the effort. Do it at the same time and in the same place every day. Give him/her a reward after the session is over.

Mechanical (electric or sonic) toothbrushes are all right only if your child will accept something like this in the mouth and they have learned to accept a regular brush first (NOTE: Children with seizure disorders should consult their physician before using any electric or sonic toothbrush as in some cases this may trigger seizures). Use toothpaste sooner or later in this series of steps but remember it is supposed to feel and taste good, so don't use anything that will turn your child off. The only real value of toothpaste is the fluoride in it. Use only a pea-sized drop of toothpaste. My all-time favorite flavor of toothpaste for kids is Oral-B Bubble Gum Flavor. Use water or fluoride rinse if they won't use toothpaste. Don't feel bad if your child never gets accustomed to toothpaste, it is not 100% essential. Most people with significant physical or mental disabilities need someone else to brush and floss their teeth for them. This may sound funny to you but I thoroughly recommend it after seeing many disabled people show dramatic improvement in dental health when a competent person takes over this part of their self-care."

You can find more information about Dentistry for the Disabled Child and Adult on www.our-kids.org .