1. THE DISABILITY EXPERIENCE CONFERENCE Oral Health Online Tutorial for Children with Special needs James Lin (3 rd year dental student) Amir Boules (3 rd year dental student) Richard Rubin, DDS MPH (faculty mentor) School of Dental Medicine University of Pittsburgh

2. POOR ORAL HEALTH: QUALITY OF LIFE ISSUES May lead to severe systemic diseases, infection, and pain Poor oral health care may lead to decreased: Proper nutrition and feeding habits (selection of food) Self-esteem Concentration for work, school and play Speech ability -Taste Social contact and interaction Sleep

3. EXAMPLE: AUTISM SPECTRUM DISORDER (ASD) Dental cavities (treated and untreated) are more prevalent in children with ASD than in the general population Difficult to recognize and perform preventive measures Difficult to treat due to behavior management and sensory disorders. Special considerations Sedation, time involvement, financial hardship

4. PURPOSE OF ORAL HEALTH TUTORIAL: IMPROVE ORAL HOME CARE To help non-dental healthcare providers and families recognize signs of early caries and understand the importance of oral home care in individuals with special needs and the associated challenges. Offer solutions for better oral home preventive care, medications, and feeding challenges Not all children with ASD tolerate the same things Provide a user-friendly, photographic online tutorial

5. CHALLENGES IN PREVENTIVE CARE (I): RECOGNITION OF EARLY DECAY (TUTORIAL) This stage, called white spots stage, can be reversed!

6. DETECTION IS KEY! Early detection of caries can save the patient from being in pain. Best stage for prevention is during the white spot lesion stage Discoloration of enamel near gum line Darker stained areas combined with rough chalkiness on tooth surface This stage, called the White Spots stage, can be reversed.

7. CHALLENGES TO PREVENTIVE CARE (II): BRUSHING TEETH: FROM THEIR PERSPECTIVE 1.Toothbrush as a foreign object in their mouth 2.Sensitivity to toothpaste or toothbrush 3.Anxiety towards toothbrushing

8. SOLUTIONS FROM THEIR PERSPECTIVE 1. Routine and desensitization tell-show-do distractions (songs, stories, counting #1-5) Rewards 2. Flavored toothpaste, softer toothbrush fruit instead of the strong mint flavor toothbrushes with softer bristles 3. Predictability Location time (frequency, duration, time of day)

9. CHALLENGES IN PREVENTIVE CARE (III): COORDINATION OF TOOTHBRUSHING MOVEMENTS Children with ASD have a wide spectrum of functionality Difficulty holding the toothbrush and learning brushing motions

10. SOLUTION: USE A MODIFIED TOOTHBRUSH Modified toothbrush handle Add tennis ball to handle Wrap tape around the handle Modified toothbrush head Surround® Toothbrush has unique heads and multiple sides of bristles

11. CHALLENGES IN PREVENTIVE CARE (IV): MEDS MAY CAUSE DRY MOUTH CAVITIES

12. SOLUTION FOR: DEALING WITH XEROSTOMIA Discuss alternative medications with your childs physician that do not include xerostomia as a side effect If medication with xerostomia as a side effect is unavoidable, it is even more crucial to exercise proper oral care preventive measures Application of Fluoride varnish by dentist

13. CHALLENGES (V): PROPER FEEDING & NUTRITION Children with ASD tend to have stomach or digestive problems Vomiting, diarrhea, upset stomach Brought on by unhealthy and frequent snacking (junk food and sweets) Subject to: Nutritional deficiencies (food selectivity/restricted diets) Acid reflux/acid erosion of teeth

14. SOLUTION TO: PROPER FEEDING & NUTRITION BRAT diet: Bananas, Rice, Applesauce, Toast Short term, 2-3 days Plain foods are easier to keep in stomach May add yogurt if child had digestive problems Hardens stool to decrease diarrhea Replaces lost potassium from vomiting Consult a nutritionist for recommendations

15. ALWAYS REMEMBER TO REINFORCE POSITIVE OUTCOMES WITH REWARDS Social rewards verbal praise positive facial expressions Non-social rewards Stickers Prizes favorite TV show Rewards junk food & sweet drinks