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Oral health care in children with swallowing difficulties fact sheet

Oral health care in children with swallowing difficulties

Children with special needs, including those with dysphagia (difficulty swallowing), are at greater risk of poor oral health care which can impact their overall health and wellbeing. An oral health care plan is essential for these children to ensure good oral hygiene and to reduce their risk of lung infections if they inhale saliva, fluids or plaque. Even if a child does not eat or drink orally, they still need to maintain good oral health care.

Tips for good oral health care in children with special needs

  1. Ask for a referral to an oral health care practitioner early in your child’s life to develop an individualised oral health care plan.
  2. Follow the general guidelines for oral health care where possible using the Oral Health Care in Children fact sheet.
  3. If your child does not tolerate children’s toothpaste, try this step by step guide in the following order:
    1. Brush their teeth with a soft toothbrush dipped in diluted sodium bicarbonate (discuss with your healthcare professional first).
    2. Consider using chlorhexidine gel or mouthwash (discuss with your healthcare professional as this is not intended as a long-term option).
    3. Use a soft toothbrush with sterile water which will still remove plaque and help reduce the number of bacteria in the mouth while you work towards a long-term option.
    4. Please note the use of the above strategies, including the use of mouthwashes, are not appropriate for new born babies or young infants that have not yet developed teeth.
  4. If your child has difficulty opening their mouth try:
    • Brush their teeth using a double or triple-headed toothbrush (e.g. Surround or Collins Curve) with either toothpaste, diluted sodium bicarbonate or cold sterile water (as appropriate).
    • A bite stick can help keep your child’s mouth open during tooth brushing.
    • A flossette can make flossing easier to do, especially for harder to reach places.
  • If your child is at high risk of inhaling (aspirating) saliva or liquids and is unable to safely spit out toothpaste or secretions; try:
    • Brushing teeth with a fluoride or low-foaming toothpaste, e.g. Biotene Dry Mouth Toothpaste or many specific toothpastes for children.
    • Ensure they are positioned as safely as possible while cleaning their mouth, e.g. lie them on their side or place them in their most supportive seating with their head tilted forward.
    • Brush their teeth with a suction toothbrush system (discuss with your health care professional as this will require access to a portable or home suction system).
  • If your child does not like having their mouth touched:
    • Establish a routine for brushing and flossing teeth (morning and night), using the same technique and the same setting.
    • Use positive reinforcement for good tooth brushing behaviours.
    • Consider using water during tooth brushing at first and then work your way up to mild or unflavoured tooth paste, as tolerated.
    • Seek advice from your oral health care professional if you are still having difficulty (dentist or speech pathologist).

Who needs dental review or specialist referral?

All children should see a dentist by their first birthday. Children with special needs, including those with dysphagia, should regularly see a dentist as they are at increased risk of poor oral health.

Children will be referred to the Queensland Children’s Hospital Oral Health clinic for review and an oral health management plan if they are identified at high risk of poor oral hygiene, or need specific products or equipment prescribed.

Contact us

Speech Pathology Department (7a)
Level 7, Queensland Children’s Hospital
501 Stanley Street
South Brisbane 4101
t 07 3068 2375
e LCCH-SPEECH@health.qld.gov.au

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

Resource No: FS340. Developed by Speech Pathology and Children’s Oral Health Service, Children’s Health Queensland. Updated: January 2019. All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.

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