Introducing Brushing in Autistic Children

Oral health in children is a very important aspect that must never be neglected. Children are not equipped to perform this complex task, and parents therefore step in to perform it till the child reaches an age when he can do it himself. While it can be difficult for any child to get used to the process of brushing and oral hygiene, it is particularly distressing and challenging for a child with Autism Spectrum Disorder.

Autism Spectrum encompasses a wide variety of neurodevelopmental conditions, characterized by difficulty in communication, socializing and interaction across multiple contexts. It is also accompanied by repetitive behavioral patterns, impaired functions in certain cases with heightened skills in others.

Given the nature of this condition and the fact that autism is often detected within the first year of birth, it becomes essential to handle these kids, and their special needs using a softer, more considerate approach. Autistic children are hypersensitive, do not allow anyone to touch their mouths, are oftentimes unresponsive and also non co-operative. Brushing and other oral tasks when introduced gently will enable them do their tasks themselves.

Below are a few tips that will make it easier to introduce brushing to autistic children-

• To begin with, choose the right kind of toothbrush. Since there are many sizes, colors and styles, it is important to choose a brush that is just the right size for the mouth, and also one in a color that the child will love.
• Since the children experience heightened sensitivity which makes them uncomfortable, it helps to touch the brush to the child's lips or inside of the mouth for a few days to desensitize them.
• Giving the same instructions repeatedly, such as 'open mouth wide', 'show your teeth', ensures they get used to the them as a daily practice.
• It also helps when parents set an example. Brushing, gargling and flossing can become a shared activity which the child will come to learn and love.
• Brushing the teeth of an autistic child works when there are a repetitive set of procedures to follow. This will familiarize them as well as help them open up to the ritual over time.

Below are a set of steps that can be followed for brushing the child's teeth;

1. Stand behind the child with their head resting on the front of your chest

2. Put a small pea sized amount of paste on the brush

3. Use the brush as you would on your own teeth

4. Follow this 6 step procedure for brushing

- Brush the bottom back teeth inside, out and top 5 times

- Brush the top teeth inside and out 5 times

- Brush bottom front teeth inside, out and top 5 times

- Move to the opposite teeth and brush bottom teeth inside and out 5 times

- Brush the top front teeth inside and out 5 times

- Brush the top back teeth inside  and out 5 times

5. Although brushing is normally done in the bathroom, it is advisable to brush the teeth of autistic children wherever they seem comfortable. It could be either on a couch or on their bed and gradually progressed into the bathroom.

Just as with every other activity, getting the child to look after their teeth independently is the ultimate goal of a parent. When it comes to autistic kids, it needs a little more effort and attention.

Do read our next blog to understand how to ensure how teeth brushing can be made a regular task in such children.

Oral Injuries and Their Treatment in Children

Besides tooth caries and misaligned teeth, very few children make it through to childhood without mouth injuries. The appearance of teeth in children brings with it a whole set of problems. While some are predictable, some others aren't. 

Mouth injuries, even the most gory ones need immediate and good treatment to avoid any permanent kind of damage. While home treatment often suffices, medical intervention is required in certain extreme cases. Below is all what you need to know to differentiate between the two.

How they happen?

Besides scraped knees and head bumps, cuts and bleeding on lips and inside of the mouth is very common in children. Mouth tissues are soft, and often a fall or hit pushes them against hard bones of the jaw or even the teeth. In addition, slip ups, tumbles, crawling are all activities where a child's mouth is exposed, leading to cuts and bruising.

How to treat them?

Oral injuries in children look much worse than they actually are. Because the mouth and areas in the face and head are suffuse with blood vessels, even a tiny cut can cause excessive bleeding, with the exact location becoming difficult to pinpoint. Often mouth injuries are minor and the crying bouts of the child are more out of fear than actual injury.

The below steps will help you handle any kind of mouth injury in a calm manner, reduce bleeding, minimize the pain and prevent infection.

• Stop the Bleeding - If the bleeding is from the outer lip or tongue, apply gentle pressure on the area with a clean moist cloth for a while. If inner lip bleeds, press the area gently against the child's teeth/gums.
• Distract the child during cleaning- Sing, talk or soothe the child in whichever way you can. Any treatment needs a child to sit still.
• Keep the area cool - Numbing the pain and reducing the swelling are first priority. Apply an ice pack or frozen veggies on the area. Sucking a Popsicle is also a great idea.
• Painkiller - These should be given only when the child is unable to bear the pain for long, usually under advice from the pediatric dentist
• Change diet temporarily - Although often superficial, lip cuts or injuries can be very painful. It is better to change the diet for children to liquid or semi-solid till the wound heals. Softer diets help healing faster and don't tend to irritate. Chilled treats such as Popsicle or ice cream, and a mouth rinse after food will take care of dental hygiene too for a while.

When is a pediatric dentist intervention necessary?

• When bleeding is very heavy, continuous and uncontrolled, and doesn't stop despite applying pressure and ice.
• When the cut is too deep or too wide
• When a rusted or dirt filled object has caused the wound
• When there is dirt or mud in the wound
• When a puncture wound caused due to pen/pencil gets into the roof of the mouth, or hurts deeper tissues of the jaw
• When the wound is caused by bite of an animal
• If there is suspicion of bone injury, swelling of the jaw, locked jaw, broken or impacted tooth
• Any inflammatory changes such as redness, swelling, pain, fever that lasts for more than a day

It is very common for children to have mouth injuries, almost like a rite of passage in childhood. The right kind of treatment immediately, with moral support and without anxiety will help them recover faster.

For more advice on oral injuries or to get treatment for the same, reach out to Dr.Premila of Small Bites Dental Clinic at Indiranagar by contacting her at 080 4125 6715.

Braces in Children & Their Different Types

It is common to see children nowadays with braces. Some kids can't wait to get it at the earliest, while parents themselves often feel that their children may require them for reasons as varied as misaligned teeth, or for an aesthetic look.

Regardless of the reasons for wanting them, there is a clear purpose to getting your child's teeth fitted with braces, and why it should be done at a particular age. 

Below are a few details on them and their purpose;

WHY BRACES

MISALIGNED TEETH

Children may need braces for any one of the following reasons;

* Overlapping, overcrowded or crocked teeth, also called as 'bad bite' or malocclusion. Malocculsion occurs whenever the upper and lower jaws have a major difference in size, where the upper is bigger than lower (called an overbite) or lower bigger than upper (called an underbite)

* Tooth decay, accidents and thumb sucking habits

* Inherited misalignment

Not all parents realize when braces have to be put, and it is often the pediatric dentist who can advise during routine checkups if braces are required. Depending on severity of the problem and the child's age, he or she will be further advised to meet with an orthodontist to get braces fitted out as per the requirement.

TYPES OF BRACES

Braces work by correcting teeth alignment, putting pressure on developing teeth to move into a particular position. This is best done during the growth period of a child, since the jaw and muscles are still malleable. There are different kinds of braces, and the doctor decides what is apt for the child based on the lifestyle and age.

1. Wire and rubber bands - Braces like these have been used for teeth alignment since years. These traditional braces have bands or steel ties holding wires between teeth brackets

2. Damon braces - These braces do not have steel/rubber ties but brackets hold the braces in place

3. Clear braces- These braces are clear/transparent and can hold themselves in place like a mouthguard

These braces either can be inserted temporarily, wherein removable braces can be removed and cleaned as and when required. These provide gentle pressure to the teeth.

Other times, teeth are very misaligned, and therefore need to be guided more accurately. This is when fixed braces are inserted. They cannot be removed and inserted as and when one likes. These are the bracket and band braces which are stuck to the teeth, with a flexible wire joining the brackets and allowing the teeth to move.

Functional braces on the other hand, use the movement of the jaw to align the teeth, and are are fitted only in certain conditions.

Braces are made from all types of materials' metal, ceramic and even medical grade plastic.

To know whether your child really needs to be fitted with one, bring him to us at the earliest. Dr.Premila will be able to assess the teeth, and decide the plan of treatment accordingly.

To book an appointment, please visit http://www.smallbites.in/

5 Books That Prepare Your Child For Their First Dental Visit

The high backed chairs, plenty of equipment, unfamiliar space and a doctor poking around inside your mouth....this can be so very intimidating for most of us adults. Imagine what it can do to our kids?

Visiting a pediatric dentist for the first time is a new experience for little ones. They don't know what is being done, and despite parents being there, can resist the experience of a new person handling them from such close quarters.

It is very important for parents, and for us doctors to make them familiar with a few things before their first visit or during subsequent ones. While we take care of them inside the clinic, using the most gentlest way to handle their fears, as parents what you can do, is make the entire process less stressful for them.

Books we have found, are one of the ways to make things more relatable. When a child understands how his teeth work, what is happening in his mouth, through pictures and illustrations, he knows what to expect. It is also a great way to communicate to kids in their own language.

Here are 10 children books, for different ages that explain about dental health, pediatric dentist visit and some of the procedures in ways that will make them understand, relate and reduce stress.

1. Dentist (First Time)

Author, Illustrator: Jess Stockham

Age Group: 2+

First time at a dentist's can be a very nerve wracking experience. This book is part of a series of 'First Time' which rather than telling a story, shows different children experiencing treatment, and the general interaction with a dentist. There is a waiting room, a scene which shows teeth being counted, a look at the equipment, step by step on how a child undergoes dental fillings.

The text is conversational, brightly illustrated, helps children see different situations, and understand procedures.

2. Harry and the Dinosaurs say 'Rahhhh'

Author: Ian Whybrow

Illustrator: Adrian Reynolds

Age Group: 3+

Harry and all his dinosaurs have a dental appointment and everyone is nervous - especially T-Rex who has many teeth. With Harry's reassurances and a special button that makes him grow big, T-Rex lets Dr.Drake examine his teeth.

The illustrations are simple, funny and text easily understandable. It will help relieve the anxiety of this important life lesson for the little ones.

3. Dentist Trip (Peppa Pig)

Author: Lady Bird

Age Group: 3+

Peppa, George and Mr. Dinosaur visit the dentist to get their teeth checked. Although George is nervous, he does get through the procedure while having fun in the process. The story is one among a series revolving around Peppa and her family, and the challenges they face. 

The book has very relatable characters, great illustrations and a simple explanation, which helps kids connect. Since the characters are also favorites among kids, it makes it easier to connect with them.

4. Open Wide

Author, Illustrator: Laurie Keller

Age Group: 3+

32 students (8 incisors, 4 canines, 8 premolars and 12 molars) are taken through a class on how to care for teeth through questions and quizzes. Mr.Flossman, their teacher, peppers their classes with fun facts, and plenty of questions on tooth care.

The book has wonderfully vivid illustrations, is hilarious full of interesting facts and connects all the different procedures that happen during a checkup.

5. How Many Teeth?

Author: Paul Showers

Illustrator: True Kelley

Age Group: 3+

One of the oldest books (30 years), teaching kids about taking care of their teeth, the books starts from the basics, explaining to kids the number of teeth they have, what happens when baby teeth fall off and big teeth come in. The book relates their growth to the fall of the teeth.

Illustrations are older but very familiar with our childhood, text simpler and the book is very engaging. The relation of teeth with growth is simple and easily explained.

Books are the best way to teach kids about life. When it comes to their teeth, there is no better thing than books to make them relate to what their teeth go through. 

Do let us know if there are any other books related to dental health in kids that you may know of. It will help us and other parents add more to their list.