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Special-needs children need early oral care

SINGAPORE — The worst case of tooth decay paediatric dentist Terry Teo ever saw in a child was in a five-year-old with autism who was brought into the clinic with a mouthful of rotting teeth. All 20 baby teeth had to be extracted due to severe decay and infection.

SINGAPORE — The worst case of tooth decay paediatric dentist Terry Teo ever saw in a child was in a five-year-old with autism who was brought into the clinic with a mouthful of rotting teeth. All 20 baby teeth had to be extracted due to severe decay and infection.

“The boy was in immense pain but could not communicate it, so he would hit himself repeatedly,” said Dr Teo, who is with The Dental Studio, a Singapore Medical Group clinic. This extreme example is what could possibly happen when oral-health requirements are unmet in children with special needs, said paediatric dental experts interviewed by TODAY.

Studies show that this group of children tend to have their first dental visits delayed for up to four years, said Dr Teo. Local experts note a similar trend here: While most children start seeing him at an average age of three, those with special needs only do so at about the age of six, said Dr Teo.

Children with special needs make up about 5-10 per cent of the patients seen by the paediatric dentistry team at National University Hospital (NUH). They include children undergoing chemotherapy and on long-term steroid medications for chronic kidney disease, as well as those with behavioural issues from conditions such as autism.

Most children with special needs seen at the centre have their first dental visit at about four to five years old when dental problems arise, causing pain or discomfort, noted Dr Betty Mok, senior consultant at the Discipline of Orthodontics and Paediatric Dentistry at NUH.

Ideally, a child’s first dental visit should be scheduled when they are one, or — at the latest — by the time all of their baby teeth are out, at around the age of two-and-a-half to three, ­according to Dr Mok, who is also a senior lecturer at National University of Singapore’s Faculty of Dentistry. This also applies to children without special needs.

“Patients with special needs generally have a host of other health issues to deal with, which may be of higher priority than seeking dental treatment,” said Dr Mok.

Dr Teo added that delays in dental care could also be due to a lack of awareness among parents here, who do not know where to turn for their children’s dental issues. Paediatric dental specialists are trained to treat children with special-needs conditions, who are often at a higher risk of dental problems due to their health or ­behavioural issues, said Dr Teo.

 

DO NOT DELAY DENTAL CARE

 

For this group of children, putting off that trip to the dentist can have dire consequences.

“For example, a child receiving cancer treatment may have lowered immunity. Should any oral ­infection occur, such as an abscess from a decayed tooth, it could lead to a potential systemic infection and ­adversely affect the child’s recovery process,” warned Dr Teo.

Children with special needs, particularly those with developmental disabilities, may also have damaging oral habits such as tooth grinding and lip/cheek biting that require professional help.

One of the most serious cases ­encountered by NUH paediatric dentists was a child with extensive ulcers all over her tongue and lips caused by a compulsive biting habit.

“A variety of measures was employed, ­including smoothening the front teeth and (using) mouth guards. But the habit persisted and she finally bit off the end part of her tongue. To prevent further trauma, her upper and lower front teeth had to be removed,” shared Dr Mok.

Moreover, scheduling a routine check-up before any dental problems arise is less likely to be traumatic for the child, said Dr Mok.

“In some cases, brushing the child’s teeth may be a twice-daily struggle for the caregiver due to lack of cooperation. An early dental visit also gives parents a chance to learn appropriate preventive measures such as tooth-brushing techniques,” she added.

With some patience and the right dentist, it is possible to help a child with special needs get used to — or even ­enjoy — their dental visits.

Despite having oral sensory issues, Ethan Ong, 5, and Vikram Ramani, 11, who have autism, are both free of cavities and like dental checkups. The trick, said Vikram’s ­father, Sriram Venkataramani, is to start them young on routine dental ­checkups.

Added Ethan’s mother, ­Deniece Ong: “My son used to be very fearful of clinics so I was a bit worried before his dental visit. But preparing him by using pictures and role-play helped ease his fears. It also helps that he has a fantastic paediatric dentist who has experience treating children with special needs.”

 

Tips for a tears-free first dental visit

1. Start early

Don’t wait until a dental problem arises and your child is in pain to avoid making the first dental visit a negative experience.

2. Prep your child

You may do this by reading a book about dental visits or role-play “dentist and patient” with your child. Using pictures to breakdown the visit into simple steps is especially helpful for children with autism.

3. Schedule the dental appointment at the right timing.

Set aside enough time to reach the clinic earlier so that you and your child can settle down before seeing the dentist. Also, avoid making an appointment during your child’s nap time.

4. Communicate with the dental team

Let them know what behaviour strategies work for your child, his level of tolerance and what he is particularly sensitive to.

5. Stick to a regular dentist

This helps the dental team build rapport with your child.

Source: Dr Betty Mok, senior consultant at Discipline of Orthodontics and Paediatric Dentistry at NUH

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