PERSONAL TOUCH: As a parent, you are the best advocate for your child every day. Knowing what is important to a dental team prior to the visit improves oral health.

BY JUNE SADOWSKY, DDS, MPH AND DAVID FRAY, DDS, MBA

The form that appears on the following page, developed at the University of Texas Health Science Center (UT Health) School of Dentistry at Houston, informs and prepares families for dental visits. Please share it with your dentist and dental team to understand clearly the needs of your adult child with Intellectual and Developmental Disabilities (IDD). More in depth information facilitates better planning for future appointments.

We recently received the following message from a mom of an adult daughter: "Thank you so much for calling about my daughter's dental situation. I'm sending you some pictures of her smile and x-rays. The first pictures are from 2017 and 2018 showing her smile. She had an extra tooth at that point. We had tried to get the hospital dental clinic to deal with that extra tooth all her life, but they wouldn't. It got a visible cavity after she turned 17 and the children's hospital program would no longer see her.

We tried several different dentists and finally found a doctor who agreed to do something. In December of 2018, we took her in for surgery thinking he would pull the extra tooth, and came out with not only that done, but also four root canals. Now the front teeth are crumbling and look black. What do I do?"

A lack of thorough communication leads to misunderstanding and different expectations that could be anticipated and discussed with the family, prior to treating a patient that is combative and not verbal. Postponing treatment may lead to much bigger problems. Communicating with pictures is very helpful. As a parent, you are the best advocate for your child every day. Knowing what is important to a dental team prior to the visit improves oral health. Your feedback as parents to improve this form is welcome.•

ABOUT THE AUTHORS:

June Sadowsky DDS, MPH is Professor, University of Texas Health Science Center at Houston (UT Health) School of Dentistry. David Fray DDS, MBA is Associate Professor, University of Texas Health Science Center at Houston (UT Health) School of Dentistry.

DENTAL VISIT PRE-APPOINTMENT FORM

• Name ______________________________________
• Care Provider ________________________________________
• Guardian _________________________________________________________________________________________
• Plan for Shaping Behavior:
• a. Methods being learned:
• Always Needed
• ABA Therapy
• Sometimes Needed
• BCBA
• Always Cooperative
• Modeling
• Other
•  
• b. Circle or write the type of prompts for communication cuurently effective:
• Physical (hand-over-hand brushing)
• Physical Cue (touch)
• Pointing
• Social Story
• Verbal
• Other
•  
•  
• Prevention Plan
• a. Xylitol: 5-minute exposure 3x/day Form being used
• b. Fluoride Varnish: Applied 2x/year Next time:
• c. Fluoride Rinses: Applied 3 times in 1-week x/year. Next time:
• d. High concentration fluoride toothpaste or gel:
• e. Chlorhexidine: Person rinses and empties mouth
• Prevident 5000 Rx How and when to apply:
• Care provider uses swab technique
• f. Special diet? Decrease exposure to sugar/starches How?
• g. Home Care:
• Brushing x/day
• Electric
• Manual
• Interproximal
• Professional Visit and Recommendations
• a. Last dental cleaning appointment
•   Flossing x/week Who?  How?
• Date: ____________
• Last treatment date:___________________
• b. Dental checkup result or treatment recommendations:   
• c. What works best at home to achieve oral health care? 
• d. What health care visits are most successful and why?
• Our types of payment and coverage: 

Oral care is essential in one's daily care regimen. All people need daily thorough oral care and it is vital to overall health. The complications from poor oral health include:

Pain and discomfort that may lead to dehydration and/or poor nutrition

• Increased risk of:
• • Bacteremia
• • Septicemia
• • Respiratory tract infection
• • Pneumonia
• • Cardiovascular problems for those with an existing heart defect

Decreased saliva production may lead to xerostomia and tooth loss

Bad breath from the accumulation of plaque/debris may have social psychologica impact

Despite evidence that poor oral health results in unnecessary illness, there may be no desire to make oral hygiene a daily routine. Many may lack the information to assess accurately another's oral health status. Each person caring for another with intellectual disabilities must become knowledgeable of oral care and make hygiene assessment routine.

Primary Assessment Questions Help identify where problems may occur.

• Primary Assessment Questions Help identify where problems may occur.
• Teeth are clean without debris Yes No
• Moist oral tissues and tongue Yes No
•  Saliva is adequate or "ropey"  Yes  No
• Lips are dry and/or cracked Yes No

This assessment tool is modified for individuals with intellectual and developmental disabilities and their families. Please circle the number that best describes the patient's oral health.

• Teeth or denture cleanliness
• 1. Clean and free from debris, no odor
• 2. Plaque: the soft white stuff that is localized debris
• 3. Generalized plaque and food debris which indicates poor oral hygiene
• 4. Rank odor and many visible cavities

• Gingiva/ gums
• 5. Pink, moist, firm, does not bleed ever
• 6. Red or swollen with slight bleeding on brushing
• 7. Tender and depressible; bleeds easily with brushing
• 8. Bleeding or ulcers are visible

• Tongue
• 9. Pink with large papillae (the little bumps). Looks normal
• 10. Coated with a white coat that can be brushed off
• 11. Shiny or pebbly look that is reddened and hurts to brush
• 12. Fissured or cracked tongue that appears dry and is painful to touch

• Cheeks
• 13. Pink, moist and smooth
• 14. Red or coated
• 15. White areas
• 16. Ulcers or bleeding

• Lips
• 17. Pink, smooth, intact
• 18. Dry/cracked
• 19. Bleeding
• 20. Ulcers

• Hard / soft palate or roof of mouth
• 21. Pink and moist
• 22. Coated with moist secretions
• 23. Coated with dry secretions
• 24. Coated with a crusty layer

• Saliva
• 25. Present and watery
• 26. Thick (stretches like a rope)
• 27. Insufficient (hard for person to spit)
• 28. Absent (really dry mouth)

• Airway/throat area
• 29. Breathes normally
• 30. Uses humidifier/nebulizer/ frequent infections
• 31. Mouth breather and front teeth do not touch/ or has Disordered Sleep Breathing
• 32. Artificial airway/ intubated/ feeding tube/ treated for Obstructive Sleep Apnea

Add the numbers of each answer. If the number is greater than 20, a dental visit may be an immediate need. Schedule regular appointments with your dentist and physician.

• Oral care regimen:
• • Small-head, soft toothbrush or a battery-operated toothbrush used gently.
• • A pea-sized amount of fluoride toothpaste – twice daily. More if you have cavities.
•   • For anyone having trouble swallowing they should have a suction toothbrush (Cutler and Davis, 2005).
• • Foam swabs should not be used especially those with lemon-glycerin because it is a weak acid and can damage tooth surfaces. Use a fluoride mouthwash daily. • Flossing is difficult to do. Use a foam or rubber mouth prop. Floss the back teeth first.
• • Learn how to make oral home care fun. Don't force it and encourage the person to use a dry brush or an interdental brush frequently every day.