As previously mentioned, children with special health care needs may not be able to fully cooperate with oral hygiene practices. This may be the result of gagging, oral defensiveness, or behavioral issues. In addition, children with special health care needs may have difficulty tolerating fluoride liquid, toothpaste, varnish, sealants, or other caries prevention strategies. Daily home preventive dental care may have to be tailored to meet the specific needs of the child, and this is often best addressed by the dental health professionals involved in caring for the child.

Caregivers should be encouraged to discuss their concerns with the pediatric dentist and the occupational or speech therapist who works regularly with the child. They may be able to help the family with techniques to optimize oral care.

If there are concerns about swallowing toothpaste, families should minimize the amount of toothpaste used (less than a pea-sized amount) or use a
non-fluoridated toothpaste. If gagging is triggered by toothpaste, the teeth should be brushed with plain water.

For older patients with limited dexterity, consider an electric or battery-powered toothbrush, extending the brush handle with a tongue depressor, widening the brush handle (ie, wrapping it with a sponge), and using a mouth prop for brushing. For additional suggestions on toothbrush adaptations, flossing tips, and brushing positions, review Special Smiles: A Caregivers Guide to Good Oral Health for Persons with Special Needs.