Looking after our teeth – advice for people with neuromuscular conditions

Teeth care for children and youngsters with neuromuscular conditions

This information has been put together by the Neuromuscular Service at Sheffield Children’s Foundation NHS Trust and Charles Clifford Dental Hospital. We hope it will provide you with some useful information, resources and suggestions for looking after your teeth.

Why does good oral care matter?

Our teeth are essential. If we look after them and clean them, they will last for ever. The oldest teeth discovered are 450,000 years old (that’s very old!) and they were found in Italy. Did you know that there are 32 teeth in a full adult set. When we are children we have 20 teeth and our 4 wisdom teeth usually appear between the ages of 17 and 21.

Good oral care is important for everyone, but it is even more important for children and youngsters who have neuromuscular conditions. Some neuromuscular conditions affect the jaw and face muscles. For instance you might have noticed that your child experiences:

• Changes in the shape of their face, or in the movement of their facial muscles.
• A weak swallow.
• Chewing difficulties. This combined with a weakened swallow can result in food becoming lodged at the back of the mouth and throat. This can cause a feeling of choking. Food could be taken into the lungs and make your child very ill.
• Difficulty with mouth and jaw movements. Opening the mouth wide for instance, can be really hard to do.

You might want to think about

• Thinning or blending solid food at meal times.
• Cutting up food really small, so there are fewer big lumps to chew.
• Giving water following a meal to encourage the safe journey of food into the tummy.
• Using sugar free gum, which may strengthen the orofacial muscles and encourage stronger chewing. Additionally, it encourages salivary flow, neutralising the effects of acids and sugars in the diet.

It is recommended that

• Children should get dental care very early (on the appearance of their first baby teeth, at around 6 months old) and on a regular basis as they grow.
• Dental appointment duration times should be kept short.
• Children have a healthy diet. Keep sugary foods to a minimum and provide them only at mealtimes. Try healthy alternatives such as fruit.
• Teeth are brushed twice daily with fluoride toothpaste. Toothpaste should be spat out and the mouth not rinsed. This helps to keep teeth coated.
• Teeth brushing for children who are tube-fed is still important. It makes the mouth feel comfortable and clean, otherwise plaque bacteria can cause chest infections. If the feeding tube is temporary, the good habit is already in place when oral feeding starts again.

Causes of poor oral health

The two main dental diseases are tooth decay and gum disease. Frequent and or high intakes of sugar, in the form of both food and drinks, are the main causes of tooth decay. The more often sugar is taken, the greater the risk of tooth decay. Gum disease is mainly caused by the build-up of dental plaque and food debris around the teeth.

Children and youngsters with neuromuscular conditions are at greater risk of tooth decay and gum disease because

• They may be taking medicines which contain sugar and can cause tooth decay.
• Some medicines cause a dry mouth, which can put the teeth at greater risk of decay.
• Some children may not tolerate having a toothbrush in their mouth or may have a gag or choking reflex.
• Some children may tend to keep food in their mouth for a long time. They may have difficulty clearing leftover food from around their teeth and gums.
• Some children have a strong preference for sweet food and drinks, or food of a particular colour or texture, and will eat little else.
• Drooling can cause skin irritation and mouth infections.
• Some children can suffer from gastric reflux, where the acid from the tummy comes up which can then causes erosion of the tooth enamel.

Sometimes we need to think in a different way when we offer dental services to youngsters with neuromuscular conditions

• It might be hard to persuade them to accept dental treatment and some youngsters may find the dental surgery quite a frightening place.
• Tolerating the noise produced by the dental equipment can take some getting used to.
• It may be necessary to provide dental treatment under general anaesthetic.
• Transferring to sit in the dental chair may prove difficult for some youngsters.
• As the facial muscles weaken, opening the mouth wide can be hard to do.

For these reasons, it is very important to try and do all we can to prevent the need for complex dental treatment and to keep teeth and gums healthy

Special dental services in Sheffield

In Sheffield the Sheffield Teaching Hospitals NHS Foundation Trust operates the Sheffield Community Dental Service – Community and Special Care Dentistry. It is based at Firth Park Health Centre. Should children and youngsters require dental surgery this is carried out Sheffield Children’s Hospital or Charles Clifford Dental Hospital. There is a specific section of the service which is geared towards meeting the needs of children with special needs. The community dental service also operates clinics in a number of the special schools around the city. For families living out of Sheffield, local dental services will have community dental services too. Your Consultant Paediatric Neurologists Dr Ong, Dr Atherton or Dr Hart can make referrals for dental treatment, as they do for other tests and medical interventions.

Some practical ideas for teeth cleaning

• Enlarged handles on a tooth brush may help with a weak hand grasp. Handles can be lengthened and angled to assist with access to the mouth.
• An electric toothbrush may be easier. There are a wide range of products available, with varying price depending on functions.
• It may help to carry out dental care with your child if they are sitting on a stable chair, or if they are well supported in their wheelchair.

Useful products

Plastazote tubing is foam tubing which comes in a choice of bore size to fit a range of utensils. Supplied in a range of lengths, it can be cut as required, and can fit over tooth brush handles. Supplier: NRS Healthcare www.waysandmeans.co.uk telephone 0845 606 091.

Grippit 2000 is an implement holder. It will hold pens, pencils, and toothbrushes. Made from plastic, with a short cylinder, circular grip, it comes in 3 sizes. Supplier: Saracen Products Ltd www.thegrippit.com telephone 0141 336 2200.

Etac Beauty Multi Purpose Grip can be used for a variety of personal care needs including holding a toothbrush. Supplier: Etac R82

Ora Nurse toothpaste is a range of non-flavoured and non-foam toothpaste for children who are orally sensitive and dislike the taste of normal toothpaste www.oranurse.co.uk

Oral Care is a soft 100% silicone fingertip toothbrush. A gentle way to clean tiny teeth and massage tender gums. It can be cleaned in a dishwasher or in sterilising fluid. It is latex free www.oranurse.co.uk

Additional information

• ‘Teeth Matter! Caring for Your Children’s Teeth: Advice for Parents and Carers of Children with Special Needs‘ – Public Health Agency Belfast.
• livingmadeeasy.co.uk impartial website giving information on all types of daily living equipment for children and adults.