Children with special health care needs are at increased risk for developing caries for the following reasons:

1. Diet. Many children require prolonged or frequent feedings or a special diet that is cariogenic. Medications containing sugar that cannot be timed with meals are additional sugar exposure to the teeth.

2. Xerostomia. Decreased saliva production increases the risk of caries and is usually secondary to a medication.

3. Gastroesophageal Reflux Disease and vomiting. More common in this population, regular acid exposure to the teeth can cause enamel wear and increase the likelihood of dental decay.

4. Difficulties performing oral hygiene. This is more common in children who exhibit the following conditions:

		Neuromuscular conditions or cognitive disability. Many children remain dependent on a caregiver to perform proper oral health hygiene.
		Oral aversion and behavioral concerns. Children who cannot cooperate with regular oral hygiene practices are at risk for dental decay and infection.
		Difficulty swallowing and oral motor hypotonicity. Uncoordinated chewing may leave more food in the mouth, and a weak, uncoordinated tongue may not be able to adequately clean all oral surfaces. Gagging on the toothbrush, paste, or saliva may inhibit complete brushing of all surfaces, and an inability to spit may result in the swallowing of toothpaste.

5. Gingival hyperplasia and crowding of the teeth. Both interfere with the cleaning of oral surfaces.