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Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program
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Other Concerns

Tooth Eruption
Tooth eruption may be delayed, normal, or advanced in children with special health care needs.

Delayed eruption is more common in children with Down syndrome and hypothyroidism.

Malocclusion and Crowded Teeth

Malocclusion: An abnormality in the coming together of teeth.

Malocclusion and crowded teeth occur more often in children with abnormal muscle tone (eg, cerebral palsy), mental retardation, and craniofacial abnormalities.

Crowded teeth are more difficult to clean, thereby increasing the risk of dental caries and periodontal disease.

Dental Anomalies
Teeth may vary in shape, size or number.

Dental anomalies are a cosmetic concern and may increase the risk for caries.

Gingival Hyperplasia

Hyperplasia: An abnormal or unusual increase in the elements composing a part (as cells composing a tissue).

hyperplasia usually occurs in children taking anti-epileptic medications for seizures, especially phenytoin.

Medications causing hyperplasia:

  • Phenytoin
  • Calcium channel blockers (nifedipine)
  • Cyclosporin A

Chronic gingivitis from poor hygiene can also trigger or exacerbate medication induced gingival overgrowth.

In addition to the cosmetic concern, gingival hyperplasia puts children at risk for:

  • Poor oral hygiene
  • Impaired tooth eruption
  • Difficulty with chewing
  • Severe gingivitis.
Gingivitis: Inflammation of the gums.

Treatment includes:

  • Meticulous hygiene
  • Discontinuing the offending medication
  • Gingivectomy if severe

Trauma to the face and mouth occurs more frequently in children with seizures, developmental delays, poor muscle coordination, and abnormal protective reflexes.

Some children with special needs exhibit self-injurious behavior, which may damage oral structures.


Bruxism: The habit of unconsciously gritting or grinding the teeth especially in situations of stress or during sleep.

Bruxism is more common and often more severe in children with cerebral palsy or severe mental retardation.

Bruxism may lead to enamel loss and difficulty with chewing or tooth sensitivity.

Children with suspected bruxism should be referred to a pediatric dentist for evaluation. (Refer to Chapter 8: Oral Habits for more information and treatment options.)

Fast Facts
Examining for tooth anomalies, malocclusion, and unusual patterns of eruption is important in children with special health care needs.
The presence of gingival hyperplasia or bruxism should prompt referral to a pediatric dentist for evaluation.
Oro-facial trauma is more common among children with special health care needs.

Chapter Photo Gallery
View the Chapter 7 Photo Gallery.
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