Kaden was born with a lymphatic malformation, the medical term for an abnormal growth of lymph vessels in his head and neck. His enlarged tongue makes it difficult to get to all the areas a toothbrush should effectively reach. Due to this condition, Kaden’s mother and his nurses use Toothette swabs in conjunction with a squirt bottle to clear out his mouth six times each day.

“We can’t get to his teeth really well because the tongue just kind of fills the whole space,” mom Kimberlee Lee said. “We realized we can’t leave food in his mouth at all, ever. He gets food stuck on the roof of his mouth because he can’t move his tongue around.”

Dental care for Kaden’s sister, Joslynn Lee, also requires a degree of finesse and patience. A rare genetic disorder caused strokes that left 7-year-old Joslynn autistic and developmentally delayed with behaviors more aligned with a 3-year-old child. She bites, squirms and resists whenever it’s time to brush her teeth.

Kimberlee says Joslynn responds better when she can watch her reflection in the mirror. And their routine involves music; Kimberlee sings a special toothbrushing song to both distract and calm her wiggly daughter. Singing also helps Joslynn make a connection to the purpose of the toothbrush.       

February is National Children’s Dental Health Month, an occasion to promote awareness of the importance of oral health to overall health. This includes the best oral care practices at home and while at the dentist office. Routine dentistry can be challenging for many children, and even more so for children like Joslynn and Kaden who face extra medical hurdles.

The various sensations that even a routine dental procedure entails – sounds, tastes, tickly tools and bright lights – can be overwhelming for a child with developmental or mental disorders. Patients with autism might need additional patience and care to mediate the sheer amount of sensory immersion they are experiencing all at once. Or a patient with muscular dystrophy might need specialized tools to keep her mouth open during the treatment. Or a patient with epilepsy might have chipped front teeth because of his seizures.

“Patients who have mental, developmental or physical disabilities have a harder time with communication or have difficulty cooperating for oral health practices at home. This all leads to a higher risk of dental problems,” according to Sheela Patel, D.D.S., a pediatric dentist at the Cook Children’s Renaissance Neighborhood Clinic.

“We often encounter families who put off seeing a dentist because they are fearful their child may not be able to cooperate. But it is very important -- especially for the special needs population -- for children to visit the dentist early on so prevention strategies can be created in order to address oral health issues before they cause pain or even infections,” she added.

Dr. Patel and Shawne Barron, D.D.S., M.S., both practice at the Cook Children’s Renaissance location, the only Cook Children’s neighborhood clinic that offers dentistry services in addition to general pediatric care. Dr. Patel estimates that out of the more than 50 patients treated in the dental clinic each day, typically 20%-30% of those patients have underlying medical conditions or special health care needs. The Lee family makes the drive from their home in Justin for dental services at Cook Children’s Renaissance Dental Clinic in Fort Worth.

The American Academy of Pediatric Dentistry (AAPD) reports that children with special needs tend to run a higher risk for tartar buildup, cavities, gum disease, overcrowding and tooth fractures. The AAPD cites various reasons to explain why these children often face a greater likelihood of oral health problems. Examples of complications include behavioral issues (attention deficit hyperactivity disorder, for instance); intellectual disabilities; and facial birth defects such as cleft lip or cleft palate.

“The more severe their health conditions, the more likely they are to have unmet dental needs,” according to the AAPD.

But the experts at Cook Children’s have some advice regarding strategies to ensure healthy oral care and treatment: Go to a pediatric dentist.  Communicate your child’s likes and dislikes to the clinic staff. Establish a daily brushing routine that fits your child’s needs and sensitivities. The guidance and encouragement can ultimately help keep every child’s smile as healthy as it can be.    

Children should make their first trip to the dentist between 6 months and 1 year of age, said Tonya Fuqua, D.D.S., director of Child Oral Health at the Center for Children’s Health, led by Cook Children’s. The first visit lays the foundation for a good relationship with the dentist and for healthy dental practices at home.

“I can’t tell you how to best help your child unless I meet them, I see them, I ask you questions and learn about your child and their special needs,” Dr. Fuqua said. “We as dentists want to help make toothbrushing the least invasive part of the day. We can give tips and tricks to help support a good dental routine at home with different gadgets, tools and ideas. There’s so much to offer, but a parent won’t know unless they take their child to the dentist and start early.”

 She calls the initial appointment the “happy visit” – a chance for the patient to meet the clinic staff, explore the surroundings, and maybe ride up and down in the exam chair. “The first visit should establish a positive experience for that child so that each time they come back they know that this is a safe and possibly fun place to go,” Dr. Fuqua said.

 To acquaint her patients with a few common dental items, Dr. Fuqua might send them home with mouth mirrors, gloves and masks, encouraging the family to play “going to the dentist.” Create a pretend scenario looking into each other’s mouths and using a flashlight to mimic the dental light on the swing arm above the dental chair. Having that play experience can help decrease anxiety when it’s time for an actual cleaning or checkup, she said.  

 Parents of children with special needs should be sure to update the dentist each time their child’s medication and health history change. The office will need to know any accommodations that might help the appointment go smoother, such as headphones or dimmed lighting. Dr. Fuqua recalled a patient with autism who requested a Taylor Swift playlist. “It made a huge difference,” she said.

Dr. Fuqua welcomes any favorite toy or blanket that helps soothe a child in the dentist chair. Parents may also hold their child’s hand and give words of reassurance during the dental procedures. “You have to find what makes them tick, what makes them engaged and smile, what makes that child happy,” she said.

 Alert the staff to any aversions, such as loud noises or a crowded room that could be upsetting. “You know your child best. Let the dentist know those things that trigger your child to get nervous or worked up, in order to help us know what to avoid.”

 Modifications and role playing at home can help a child with special needs warm up to going to the dentist and receiving dental care. For those with extreme sensitivity to taste and touch, Dr. Fuqua recommends limiting the stimulation. Start with a small toothbrush without toothpaste. Eventually, you can apply the toothpaste when the child is ready. Let the child brush a stuffed animal’s mouth. Read books and watch animated videos. All of these steps can start the process of making oral hygiene both fun and familiar.

 For children with dexterity impairments, a tool can be created by inserting a toothbrush into a tennis ball, making it easier to grasp. This modification not only teaches a level of independence, but also gives those children the confidence that they are capable of doing it on their own. 

 Dr. Patel and Dr. Fuqua understand that families juggling with stress and time constraints. possibly due to their child’s health challenges, might be tempted to make dental care a low priority. “It’s definitely one of those things that parents let slide because it’s just one more thing to deal with,” Dr. Fuqua said. The intense combination of medications and frequent doctor visits for the underlying health condition can be overwhelming. Even with these struggles. families should aim for brushing teeth at least two times a day (morning and before bed). Oral health impacts overall health, so it’s not something to ignore.

 The two dentists at Cook Children’s Renaissance Dental Clinic stay busy but are always accepting new patients. The clinic has seen an annual average of 5,434 dental patient visits since 2019. Depending on the medical issues, the safest way to perform dental procedures for some children is under anesthesia in the operating room. Annual dental surgeries at Cook Children’s averaged almost 1,100 in the past three years.

 Dr. Patel recommends finding a pediatric dentist who is comfortable with your child’s unique and individual needs, and can speak at his or her cognitive level. She attributes the resistant behaviors in some patients to a lack of understanding or an inability to express themselves. For a patient who is nonverbal like Joslynn Lee, the care must be extremely customized.

Kimberlee Lee says her daughter has a sensory processing disorder along with her autism. Joslynn’s desire for control makes brushing her teeth a battle. She won’t allow flossing or pulling a loose tooth.

During a dental appointment, Joslynn doesn’t understand why she has to sit still and can’t bite. As a result, she must be sedated for cleanings or other dental work, Kimberlee said.

At home, keeping little brother Kaden’s teeth clean involves the team of nurses who tend to his tracheotomy and restricted airway. The nurses collaborate with Kimberlee to sponge off his teeth and gums every time he eats. 

Unfortunately, a medication Kaden takes to control his lymphatic malformation makes him prone to mouth sores and tooth decay. At just 4 years old, Kaden has already needed several extractions and caps due to the damage to his enamel. Through all of this, he maintains high spirits at the dental office.  

“He loves the attention,” Kimberlee said. “So for the most part, he really is very cooperative. He’s happy to open his mouth. He’s excited about the little bag with the toothbrush and the new toothpaste and all the little things inside and to get the stickers at the end of the appointment.”

For parents with children who have similar needs, Kimberlee shared a few points that help dental visits go smoother for her family:

Plan ahead and bring whatever makes your child relax. Kaden prefers the iPad, and Joslynn likes fidget toys to keep her hands busy.

Offer a reward afterward as encouragement.  

Stay calm and positive. “Check your own energy and be able to show up and love and comfort for your child rather than feeding on their fear,” Kimberlee said. “When you’re scared, it ends up making everything worse.”

 Kimberlee advises parents to do their best to implement dental care at home, and be OK if it isn’t perfect.  The key is progress, not perfection.

“In the beginning of having special needs kids, I always felt like if they got a cavity or something was wrong, that it was my fault that I haven’t been taking good care enough of their mouth,” Kimberlee said. “I’m just going to have some grace, and if we have a problem, we have Dr. Patel to help us through it.”

It was reported by the American Academy of Pediatric Dentistry that sports accidents account for 10-39 percent of all dental injuries in children! These injuries can happen to a child’s face and teeth from falls, collisions, contact with hard surfaces and sports equipment. Activities such as riding a bike, skateboarding, hover boarding and jumping on a trampoline can result in injuries that affect the teeth and the face. The upper lip, gums and front teeth are more prone to injury. These teeth are subject to fracture, nerve damage, becoming loose and even falling out.

Not all sports-related injuries can be avoided, but most of them can be prevented! Wearing helmets, facemasks and mouthguards have been shown to greatly reduce the severity of dental and facial trauma. The National Federation of State and High School Associations only mandate mouthguard use for certain sports such as football, ice/field hockey, lacrosse and wrestlers wearing braces. But it is very important that proper protective equipment and mouthguards be worn for all sports that have the risk of injury (baseball, softball, basketball, soccer, volleyball, gymnastics to name just a few).

A mouthguard is made to protect the lips, gums and teeth from damage. They work by absorbing the energy from an impact and dissipating the remaining energy. There are many different types of mouthguards and if you are thinking of getting a mouthguard for your child, it is important that you visit your dentist. The best mouthguards are the ones that are custom made at the dental office. A mold is taken of the teeth and a mouthguard is made that is the right fit and comfortable for your child. If a custom mouthguard is not feasible for you, then there are many other mouthguards that are available over the counter. Even though they may not be a perfect fit, they will still provide offer some protection.

Bottom line, please protect your child’s face and teeth with the proper protective equipment while they are playing sports and having fun!

I have more than once used the "you don't want to be the kid that smells" tactic on my kids and once they are school age it usually works to get them to brush their teeth. In elementary school most kids don't care about life long health but they do care about friends and teachers. I prefer not to use star or sticker charts as I find they are more work for parents--but if this works in your family go for it.

Toddlers are another creature entirely. I suggest that parents start cleaning babies teeth early not only for health but to get them used to it. Under 1 year it can be as simple as wiping the teeth with a wet washcloth, but at 1 year I have families starry using a toothbrush. There are lots of little tricks out there to keep toddlers brushing. My favorites are singing or counting while brushing--same song every night--they love routine. Once toddlers get into the "I can do it myself now" stage, get 2 toothbrushes. Let the toddler "brush" with one and the parent can use the other at the same time to really brush. Does all of this fail sometimes--yes. I have I held my toddlers down to brush their teeth--yes. Have I skipped teeth brushing--yes.

For all kids one of the most important things a parent can do to protect the teeth is to keep kids off of sweet drinks--that means no juice--and not letting them fall asleep with a bottle or cup of milk after age 1 year.

I have seen many toddlers and young children over the years require anesthesia and surgery to repair decayed teeth. This is entirely preventable with good dental care. Please ask your pediatrician if you need help in carting for your childs teeth or contact one of the Cook Children's dentists.

Related Articles

• 5 Reasons Why Baby Teeth Are Just As Important As Permanent Teeth
• Parents, Stop Giving Your Teething Babies Homeopathic Remedies
• Protecting Your Young Athlete From Dental and Facial Trauma
• 4 teething myths every parent should know
• 5 life-saving reasons to take care of your teeth

The truth is that baby teeth DO matter! Primary teeth, or baby teeth, are very important to a child’s physical, emotional, and social development. Here are five reasons why baby teeth should be taken care of just as we take care of our permanent (adult) teeth.

1. Tooth alignment and position - The primary teeth save space for the adult teeth and guide the adult teeth into their proper position. If the baby tooth is lost early due to tooth decay, the adjacent teeth tend to drift or tip into that space. Therefore, the permanent tooth has less room to come in and can be blocked from erupting into that space.

2. Healthy permanent teeth - The permanent teeth develop very close to the roots of the baby teeth. Baby teeth are much smaller and cavities can spread very quickly through their thin enamel. If cavities are left untreated, the baby tooth can develop and infection or abscess which can hinder tooth development and cause damage to the permanent tooth underneath.

3. Proper health and nutrition - Teeth, of course, are needed for chewing. Dental pain from cavities can lead to nutritional deficiencies if the child is not able to properly chew their food. Also, if cavities are left untreated, there is a great risk of an infection forming. And this infection can spread to other areas of the body and even to the brain. This can turn into an emergency situation very rapidly and the child may need to be hospitalized. Unfortunately, there have been reported cases where children have died from a dental abscess.

4. Speech and facial development – The tongue, lips and cheeks deflect off teeth when forming sounds. The presence and proper positioning of baby teeth assist in the formation of correct pronunciation during speech. The tooth structure also provides support for the developing facial muscles and gives shape to your child’s face.

5. Concentration and self-esteem – If a child is having dental pain, it can greatly affect their ability to pay attention and learn in school. Decayed teeth can also interfere with a child’s social interactions and affect their confidence and self-esteem. This can also lead to children missing school and parents having to miss work if they have to take children into the dentist for emergency appointments.

The bottom line: Teaching your child to develop good oral care habits with their primary teeth is very important! These early habits will help them keep those permanent teeth healthy for life!

About the author

Dr. Patel is a dentist at Cook Children's Neighborhood Clinic on 2600 E. Berry Street in Fort Worth Texas, 76105. Dr. Patel received her dental degree in 2009 from University of Nebraska-Medical Center in Lincoln, Neb. She completed her pediatric residency in 2011 from the Baylor College of Dentistry in Dallas. Dr. Patel is board certified by the American Academy of Pediatric Dentistry. The Neighborhood Clinic offers a dental home for patients from 6-18 years of age the clinic and most CHIP, Medicaid, and commercial insurance plans are accepted. The staff speaks English and Spanish. To learn more, click here or call 817-347-4600.

Good dental health is critical for everyone, regardless of age. It's important to remember that the health of you and your children’s teeth and gums can have a direct impact on their overall health. While poor dental hygiene can lead to gum disease, cavities and tooth loss, the bad news doesn’t stop there.

Several studies show that the bacteria in your mouth from periodontal disease (gum disease) can contribute to various health concerns.

Here are 5 health concerns you may not have realized that are currently being studied:

1.Heart disease - People who develop gum disease as a result of poor dental health, have a higher risk of also developing heart disease. The bacteria that causes gum disease can cause inflammation as it travels through the blood stream which in turn can cause a stroke or heart attack. And those individuals who already have existing heart conditions are even more prone to developing endocarditis (an infection of the heart) which can be life threatening.

2.Respiratory disease - Scientists have found that bacteria in the mouth can be taken into the lungs and cause respiratory diseases such as pneumonia.

3.Pregnancy - New research suggests a possible link between gum disease and babies born with low birth weight or premature babies. And optimal oral hygiene during pregnancy may decrease the amount of cavity-causing bacteria that can be transmitted to the new baby.

4.Alzheimer’s - There is current ongoing research that states that the bacteria originating from gum disease can travel to areas of the brain which can trigger Alzheimer’s later in life.

5.Malnutrition - Gum disease and pain can often lead to people not getting the adequate amount of calories and protein needed to maintain a healthy diet. Therefore it is not uncommon for children and elderly to suffer from malnutrition if they are experiencing dental pain.

So make sure you take care of those pearly whites for a great smile and healthy body!

a) Nails on a chalk board.

b) 6 a.m. alarm clocks.

c) Your child’s teeth grinding.

Sorry that there’s no “all of the above.”

Around 25 percent of kids grind their teeth at some point. It most often occurs at night but can occur during the day (usually they are not conscious that they are doing it.) The most common ages are from 7-10 years and most grow out of it without any problems arising.

We don’t really know the cause of teeth grinding although it has been linked to stress and one study showed it to be more common in kids who talk in their sleep or wet the bed.

Most children do not have complications related to grinding their teeth. Some complications that have been reported are: jaw pain, headaches (more common in adults) and damage to teeth.

Treatment for teeth grinding can be very frustrating as there are no quick fixes. Since stress can be a related factor, try to have open dialogue with your children about factors that could be causing them stress. Mouth guards are not frequently used in children because they are not likely to help and making one to fit is difficult because children grow so quickly.

If the teeth grinding continues, talk with your pediatrician or dentist to see if there are new treatments available.

“Proper dental care actually begins before the baby’s first tooth appears,” said Tonya Fuqua, DDS, director for the Save a Smile program, led by Cook Children’s. “As soon as the baby’s born, it’s extremely important to make sure that parents begin wiping the child’s mouth and gums with a nice clean baby wash cloth. The cloth should be soft and easy to get wet.”

The early cleaning with the cloth removes any remaining milk from babies’ mouths and helps them become accustomed to something going in their mouth for cleaning. So when babies begin getting teeth and brushing starts, they will be used to the parents placing their hands in the mouth for brushing.

Once you see the first baby tooth, you can begin using a toothbrush. You aren’t doing a lot, but you are introducing that feel of the bristles in the mouth so that as the baby develops more teeth, he or she will be used to a toothbrush in the mouth. Make sure you are using a soft bristled, age appropriate toothbrush. As your child has more teeth, a routine should be established of brushing two times a day, the morning and at bedtime. Dr. Fuqua gave us 10 other helpful tips parents should know about when caring for their child’s teeth:

1. Know the rules of twos. You should always brush your children’s teeth twice a day – every morning and every night for two minutes, regardless of how many teeth are in his or her mouth.
2. Did you know: A baby should never be put to bed with a bottle or sippy cup filled with anything other than water.
3. When should you schedule your first dental appointment? Find a dental home and take your child to the dentist by age 1 or earlier if you notice problems.
4. How dangerous is tooth decay (cavities)? Tooth decay (cavities) are the No. 1 long-lasting disease in young children – even more than asthma.
5. Can you catch a cavity? Germs that cause tooth cavities can be passed from parent or caregiver to a child. Choosing healthy behaviors from an early age will help prevent tooth decay (cavities) and improve a child’s overall health throughout his or her lifetime.
6. How do you prepare your child for visiting the dentist? Read your child a book about going to the dentist, schedule a tour of the offices before the first visit and role play at home on what to expect for the visit.
7. How long should you supervise your child’s brushing and flossing? As general rule, keep up with your child’s brushing and flossing activity until he or she is about 9 years old.
8. Which toothbrush should you get for your child? Choose a soft or extra soft toothbrush with the right size handle and head for his or her mouth.
9. How often should a toothbrush be changed? Every 3 to 4 months, when the bristles become worn or after there has been an illness.
10. What toothpaste should you use for your child? Use a rice-sized smear of fluoride toothpaste when the first tooth appears around 6 months until age 3. Then use a pea-size amount of fluoride toothpaste.

For more information:

The Children's Oral Health Coalition is working hard in the community to educate parents on the importance of caring for their children’s mouth and the impact their children’s oral health can have on their overall health. Find dental health resources here.