This Report contains:
*Dental Care with Kyle House, D.D.S.

DENTAL CARE
In my opinion this was the most informative presentation I attended at the Get-Together! A lot of the other stuff I at least knew something about, or had some idea of what was going on. But Dental care is something I have chosen to ignore up to this point (and not just Julia's dental care either...)!! HOWEVER as a disclaimer, I will say that I did not take any notes during this presentation so everything here is from memory (except the biographical stuff on Dr. House, which I stole from the schedule). Julia was eating or something so I didn't have a free hand to take notes.

First off let me give you some info about Kyle House. He is Chief of Pediatric Oral Medicine and Dentistry at Scott and White Clinic and Hospital in Temple, Texas. He currently serves as an Associate Professor at the Texas A&M Medical school, where he teaches Pediatric Dentistry in the Advanced General Dentistry Resident Program. He apparently specializes in special needs kids.

Kyle (he was the kind of dentist you'd call by his first name) made some very good points. He said that many parents of special needs kids tend to put aside dental care, thinking it is less important than seizure control for instance. Or maybe parents have the feeling that the kids spend enough time at the doctors, do they really need another one? How important are teeth in the greater scheme of things with a child who has a disability, or a child with a shortened life expectancy?

Very important, as it turns out. Okay, what causes tooth decay? Bacteria. The way to get rid of bacteria is tooth brushing. This is ESPECIALLY important to our kids!! You see, the more bacteria in the mouth, the more chance this bacteria will get into the lungs in the event that the child aspirates. This could cause more pneumonias. Also if there is always more bacteria present in the mouth, and the child aspirates a lot (even tiny amounts), it could result in a hard-to-treat chronic lung infection or recurring pneumonias. So bacteria control and keeping the teeth clean is very crucial indeed!! I'd never looked at it that way! It makes perfect sense!

One very important point he made was that ALL pediatric dentists undergo at least a little training in special needs kids. Also, if you ever call a dentist and they say anything like "we don't take those kids" or try to make you find a different dentist for your special needs child, that is AGAINST THE LAW. You don't want to make a doctor MAD who is about to stick sharp implements in your child's mouth, but make sure they understand you KNOW they can't just say no.

There are two organizations he mentioned where you can get help. One was the American Academy of Pediatric Dentists and I've forgotten the name of the other one but I will try to find it out. Bob found a website for the AAPD.

http://www.aapd.org/

On the website there is a question and answer section for parents of kids with special needs, and a way to search for ped dentists in your area. Kyle also recommended starting with a local organization like your early intervention program, or asking parents of other special needs kids in your area for a recommendation of one they've been to. Word of mouth is best. (No pun intended) :-)

Kyle suggested of course brushing and flossing your child's teeth. Since a lot of kids with special needs are also oral defensive, this can be a problem. He showed pictures of several different dental tools which other parents had adapted to fit their needs. A few were special handles so that the child could hold the toothbrush themselves. One was just a gob of aluminum foil wrapped around the handle, and then the child gripped it and it formed to the shape of their hand. The same can be done for your OWN hand so you can grip the brush better to brush your child's teeth. Another ingenious thing someone had done was rig up the suction machine to a toothbrush, so that the extra saliva and stuff didn't go down and gag the child!! They sort of taped it up the back of the toothbrush and then rigged it up to the middle of the bristles. He also showed several types of dental implements, including the mechanical brushes which provide a sort of stimulation that sometimes works with our kids. There are also little finger brushes that slip on the end of a finger. But watch out for your finger, these kids like to bite!! There are also gizmos which you can wrap the floss around and then stick the gizmo in their mouth instead of using your fingers (he was ALL FOR anything that allowed you to keep your fingers out of harm's way!). And the handy washcloth, which works well on the itty bitty ones. He said that the toothbrush is just a tool. If you find something that works better, please use it. It is better to use a washcloth and get 90% of the bacteria than to feel like you have to fight with a toothbrush, and only end up getting 50% anyway.

He recommended Colgate Total and Crest Multi-Care as the best toothpastes on the market today. They have all the stuff for tartar control and cleaning. He also recommended Listerine (although it might sting) and said you could just apply a little with a wash cloth, the child doesn't need to swish it around. Same with a product called ACT for kids, a flouride wash. Apply it after the last meal and let it work all night. I bought some of that yesterday to try on Julia, and it is Bubble-gum flavor, very sweet. I used it on myself last night, to see if it tingled or anything. Nothing except sweet bubblegum flavor. I haven't tried it on Julia yet (hopefully after her
midnight snack tonight).

He said if you get your teeth brushed in 20 seconds, you didn't do a good enough job. It should take about 5 seconds per tooth, and you should go tooth by tooth rather than back and forth like you are probably doing. Also if your child only has only a few teeth (like my Julia) you shouldn't ignore the gums. Brush them just as if there were teeth there.

He also said positioning is important. Instead of standing in front of your child and trying to brush their teeth, get above and behind them like a dentist does. That is the way you can see into their mouth the best (that is why dentists do it that way). Also, you might try brushing your husband's or wife's teeth as practice...it will give you a really good idea of what things you are doing might be painful or uncomfortable!! Then of course have them brush yours too so you can know what it feels like for someone to do that.

On the subject of positioning, he said one very important thing when your child is being seen by their dentist is comfort. If your child is very comfortable in their wheelchair or special stroller, try to find a way for them to stay in it rather than being moved into the big dental chair. Those chairs may not provide enough support for our kids. The more relaxed they are, the better. Also for many of them, their chair is sort of a "comfort zone" and so they will naturally feel better in it. He said you can lock the back wheels, and have the dentist pull the chair backward onto his lap with the handles firmly on each side of his legs, so the child is in the proper position. Of course someone should always be there to assist and make sure nobody falls!!

About oral defensiveness, he said you just have to slowly work up to it. If the child tolerates you for 5 seconds at a time, do one tooth, then walk away and let them rest for a minute, then come do another tooth. (Comment from Sandy...that is nice in theory, but who has the time to spend 45 minutes twice a day brushing teeth???) Also he said start as early as possible with the babies, before they have teeth even, just getting them used to the feel of something in their mouths and you won't have as big a problem with the defensiveness as they get bigger.

Someone asked a question about tooth grinding. He said it is possible to get plates (I'm not sure that is the right word) if the teeth have been ground down enough. This is a permanent solution though, because it requires part of the tooth being cut away. Also he said to be SURE you get stainless steel plates, or the plates themselves will wear down from the grinding. Insist on it, not a lot of dentists use them.

Someone asked how to brush the child's teeth when the gums bled a lot. He said in his opinion, when gums bleed that is a sign you aren't doing a good enough job in that area. They should toughen up over time and if a certain area bleeds, then brush it especially well for a while. Of course some of the drugs cause thinning of the blood (dilantin?) so that could cause gum bleeding too.

Someone else asked about the thickening of the gums which is common with some of the medicines like Dilantin. He said the kids can have surgery to have some of the gums cut away. I can't remember what else he said about that (Linda, was it you he was answering? If so, let us know more about what he said about that question).

Also he said one reason a lot of our kids have late tooth eruption is because the teeth just wait to be pushed through the gum, rather than a "normal" child who would be chewing on things and helping the tooth go through faster.

He is willing to give out his email address (which I don't have handy but will try to send in the next couple of days). He will be happy to answer any dentistry questions you have about your child, just give him a couple days because there are several special kids' organizations who use him in this way. If anyone has that email address, send it to me. Also I know Cyntha asked him some more specific questions, and he looked at Heather, so Cyntha might be able to add some good information.

Seems like there was a lot more, and I'm sure I'll think of it later, but if so, I'll do an addendum!!

Love,
Sandy "Scoop" Merritt
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