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Research Finds Numerous Reasons for Poor Oral Health in Children With Special Needs

Preventive care is not enough when it comes to this patient population.

A recently published study finds that even though children with special healthcare needs tend to receive preventive dental care more frequently than those without such needs, they are significantly more likely to experience poor oral health. The researchers indicated that the problem may actually stem from sociobehavioral issues. This finding runs counter to a commonly held belief that prevention is the key to maintaining oral health.1

But, as the National Institute of Dental and Craniofacial Research points out, people with developmental disabilities—ranging from autism spectrum disorders (ASDs) and cerebral palsy to Down syndrome and other cognitive disabilities—face a unique set of challenges in simply accomplishing daily activities. Such individuals may require extra help in maintaining oral health.2

Myriad Causes

Previous research on children with ASDs determined that poor oral health was likely due to cariogenic diets and the taking of medications sweetened with sugar and medications causing xerostomia, in addition to poor oral hygiene practices. But, it appears the problem runs deeper.

A South African study found that oral health problems in children with ASDs likely arise from a broad range of factors, including medication regimens, poor food choices, problems with manual dexterity, and unusual oral habits such as bruxism and tongue thrusting. Behavioral difficulties such as head banging, picking at lips, self-removal of teeth or tooth buds, and pica—the craving to chew on nonfood items, such as gravel—are also key contributors. The researchers also observed that impacted children also prefer soft foods, which, rather than swallowing, get saved at the back of their mouths for long periods.3 Medication side effects, such as xerostomia, overgrown gingiva, toothaches, changes in salivation, prolonged bleeding and altered taste, and motor disturbances, may affect good oral care practices.

Another study on children with ASDs found the main factors contributing to compromised oral health were a combination of mental, physical, and behavioral challenges, as well as congenital abnormalities of oral facial development and medication side effects.4

What Can Be Done

Dental hygienists are typically well prepared to help parents/caregivers and young patients learn how to take better care of their teeth with education and the recommendation of oral health aids based on patient needs. In the case of patients with special needs, plenty of oral aids are available to make oral care easier. 

Specially designed toothbrushes may be beneficial in helping patients overcome some challenges. Toothbrushes with extra soft bristles, tapered bristles, and bi-level bristle designs can boost the success of oral hygiene regimens. Additionally, toothbrushes with fun designs that appeal to children may improve compliance. Soft picks and interdental brushes are key for those who will not tolerate traditional floss.


  1. Burgette JM, Chi DL. Behavior and social determinants of oral health in children with special health care needs. Pediatrics. Pediatrics. 2021;148:e2021050886.
  2. National Institute of Dental and Craniofacial Research. Developmental Disabilities and Oral Health. Click here.
  3. Naidoo M, Singh S. The oral health status of children with autism spectrum disorder in KwaZulu-Nata, South Africa. BMC Oral Health. 2018;18:165.
  4. Ningrum V, Bakar A, Shieh TM, Shih YH. The oral health inequities between special needs children and normal children in Asia: a systematic review and meta-analysis. Healthcare (Basel). 2021;9:410.
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