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Jakarta Post

Oral health for Down syndrome and autistic children

As we celebrate World Oral Health Day on March 20, World Down Syndrome Day on March 21 and World Autism Day on April 2, it may be worth paying closer attention to the condition of people, notably children, diagnosed with these impairments

Stella Lesmana (The Jakarta Post)
Jakarta
Sun, March 20, 2016

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Oral health for Down syndrome and autistic children

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s we celebrate World Oral Health Day on March 20, World Down Syndrome Day on March 21 and World Autism Day on April 2, it may be worth paying closer attention to the condition of people, notably children, diagnosed with these impairments.

Autistic individuals '€” a neurodevelopmental disorder characterized by impaired social interaction and abnormalities in communication '€” usually take medication that causes oral problems, such as reduced saliva, gum inflammation and dental caries.

Their restricted routines and repetitive behavior present difficulties when they arrive in a new place, such as a dental surgery. The smells, the lights and movement of a dental chair and the sound of drills can frighten them terribly. Most autistic individuals, meanwhile, suffer from sensory processing difficulties that cause an overreaction to sensations or stimuli.

As a dentist myself, I once gave a dental-health education session about how to brush teeth properly for a special school for children with intellectual disabilities in South Jakarta. I found that most of them did not brush their teeth in a proper way; some children could not even brush their teeth by themselves. Even for this supposedly simple task, educating them how to brush their teeth took a week, with the children showing improvements day by day.
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It may be a simple task, but all parents should be taught to help brush their children'€™s teeth in the correct way.

This shows the importance of healthcare personnel and others treating children with intellectual disabilities not with discrimination, but with limitless patience and immense attentiveness.

My experience showed that efforts to promote oral health for Down syndrome children in front of their parents in Jakarta received exciting responses. Some of the parents lacked awareness about oral health because they did not know that the impairment would somehow impact on their children'€™s oral condition.

Studies have revealed that more than 90 percent of Down syndrome patients aged under 30 have periodontal diseases and the incidence of bone loss was found to be twice that of mentally handicapped patients without Down syndrome.

Individuals with Down syndrome, which occurs once in around 1,000 births, have nine major dental characteristics: Underdeveloped maxilla, enlarged tongue, fissured tongue, tongue thrusting, missing teeth, malocclusion, microdontia (smaller size of the teeth), hipersalivation (drooling) and high arch palate. They demonstrate a lower prevalence of dental caries (tooth decay) but have a higher prevalence of diseases related to the periodontal or the supporting tissue of the teeth including gums and bone.

It may be a simple task, but all parents should be taught to help brush their children'€™s teeth in the correct way from the very first teeth emerging. When the children can grip the toothbrush, teach them how to brush the teeth correctly. Most importantly, allow them to brush the teeth by themselves, with the parents providing assistance only when necessary.

While this issue is important for normal children, it is even more crucial for Down syndrome and autistic children: The parents or caregivers should patiently teach the steps to brush the teeth very slowly, supervise them every night and control their dietary habits. Remember that children with Down syndrome and autism need good supervision from their closest persons because they are more susceptible to dental caries and periodontal diseases.

I also advise parents to take their children to the dentist at a very early age so children can be familiar with the dental surgery situation. This will help children regard the dentist'€™s surgery as a '€œhappy place'€, not a frightening one, so by the time they complain of a toothache they will not imagine a dentist as someone who will inflict more pain on them.

Parents'€™ support is important. They should talk of positive things about dentists at home, not saying things that discourage them from going to dentists like '€œif you cry now, the dentist will come to pull out your teeth'€.

The earlier parents take their children to a dentist, the more they will understand the importance of oral health and its preventive treatment for their and their children'€™s oral health. Dentists are not people to fear.
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The writer is a dentist who graduated from the University of Indonesia'€™s School of Dentistry and is currently taking a specialty in pediatric dentistry.

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