Children with Special Needs

Children with special health care needs are a particularly high-risk group for development of dental caries. Additional risk is due to:

  • Decreased ability to take food or fluids orally- Children with a G-tube often do not have normal oral clearance found in children fed by mouth.
  • Oral aversion- Children with autism and sensory integration concerns may have difficulty with foods of certain textures or smells, as well as aversion to oral hygiene.
  • Functional limitations in self-care- Reliance on others for oral care requires all caregivers to understand the importance of proper oral hygiene.
  • Craniofacial anomalies- Anatomic abnormalities such as cleft lip or palate may interfere with feeding, hygiene, and tooth development.
  • Chronic dental erosions – Children with special health care needs have higher rates of esophageal reflux and may display maladaptive behaviors of bruxism (teeth clenching and grinding) or biting non-food items that contribute to dental erosions.
  • Chronic medication usage- Medications created for children are often high in sugar to make them more palatable. Medications may also cause xerostomia (dry mouth) and increase gingivitis risk.

Routine habits, such as brushing and flossing may be more difficult in children with special needs and more intensive anticipatory guidance may be needed at well child visits.

Children with special needs should be seen more frequently in a dental home and have additional attention paid to their daily oral needs.

Children with special health care needs often require specialty dental care which is often more challenging to obtain. Developmental limitations and cooperation may require dental care be provided with sedation or general anesthesia.


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Frank M, Keels MA, Quinonez R, Roberts M, Divaris K. Dental caries risk among subgroups of children with special health care needs. Pediatr Dent. 2019; 41(5):3-9

Norwood KW, Slayton RL. Oral Health Care for Children With Developmental Disabilities. COUNCIL ON CHILDREN WITH DISABILITIES, SECTION ON ORAL HEALTH. Pediatrics 2013; 131: 614–619.