Photo credit: Purchased by the National Maternal and Child Oral Health Resource to be used for this article.
Treating with children with SCHNs can be very fulfilling.

Why oral health matters for children with special health-care needs

March 5, 2024
Knowing how to approach and treat children with special health-care needs makes each appointment more comprehensive, and each patient and their family very thankful.

Each March, the National Association of Councils on Developmental Disabilities raises our awareness about including people with development disabilities in all facets of life. When National Children’s Dental Health Month ends in February, we don’t reduce our focus on young children. The ADHA asked me to lend my expertise on children with special health-care needs (SHCNs) who may face challenges with their oral health, and I’ll share resources to help oral health-care providers support them.

As it is for everyone, oral health for the SHCN population isn’t just about a pretty smile; it’s a cornerstone of overall health. Children with SHCNs are a vulnerable population, but little is known about their oral health, particularly about the prevalence and causes of tooth decay because national clinical data is not available. However, small clinical studies targeting children with specific conditions show that children with SHCNs are more likely to have tooth decay than those without SHCNs.1 We must recognize these challenges and the significance of good oral health for children with SHCNs.

Why oral health care is important

Children with SHCNs are at increased risk for physical, developmental, behavioral, and emotional conditions and may require health and related services beyond those that children typically require. Also, children with SHCNs are more susceptible to oral diseases than those without SHCNs.2

Children who are medically compromised face high risk for oral diseases, and these diseases can further jeopardize their health. Additionally, children with cognitive or developmental disabilities may not understand instructions or be able to maintain their oral health without assistance. Relying on caregivers to monitor and maintain their oral health may put them at risk for complications stemming from oral diseases.3

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These conditions can pose challenges that underscore the critical importance of oral health care for children with SHCNs:4

  • Physical and developmental issues: Delayed, accelerated, or inconsistent tooth eruption and malocclusion can adversely affect a child’s ability to chew, impede speech development, and slow overall growth and development.
  • Physical disabilities or neurological conditions: These conditions can make brushing and flossing difficult.
  • Injuries: A child may experience facial or oral trauma due to seizures, poor protective reflexes, problems with muscle coordination, or impulsive or risky behavior.
  • Oral habits: Mouth breathing, tongue thrusting, bruxism, thumb-sucking, and other oral habits can cause dry mouth, malocclusion, and cracked or chipped teeth.
  • Medications or chronic conditions: Certain medications or chronic conditions can cause dry mouth or gingival overgrowth.
  • Sensory sensitivities: Textures, tastes, and sounds associated with oral hygiene practices can trigger discomfort or aversion.

Strategies for improving oral health care

Engage with families and other health professionals: Engaging with parents, extended family members, and other health professionals involved in a child’s care is crucial for obtaining and sharing information and ultimately ensuring delivery of the best possible care.

Seek skilled experience: Most children with SHCNs can obtain care from a general dentist and their clinical staff. For those with significant behavioral challenges, complex medical conditions, or other issues, it’s best to obtain care from oral health professionals who have significant experience in providing care to this population.5

Excellent resources

Brush Up on Oral Health. This series of tip sheets provides Head Start staff with information on current practices and practical tips to promote good oral health for young children, including those with SHCNs. Much of the information is also relevant to dental hygienists.

Healthy Habits for Happy Smiles. This series of handouts provides simple tips on oral health issues for parents of young children, including those with SHCNs.

Special Care: An Oral Health Professional’s Guide to Serving Children with Special Health Care Needs. This series of modules discusses providing optimal oral health care, oral health supervision, prevention of oral diseases, and behavior guidance. The course can be taken for continuing education credits.

Each child with SHCNs experiences unique oral health challenges related to their specific conditions. Dental hygienists play an important role in meeting their needs in a comfortable and supportive environment by working with other oral health professionals, health professionals, and families to help them become familiar with the oral health risks associated with SHCNs, and by tailoring the care they provide.


1. Chi DL. Oral health for US children with special health care needs. Ped Clins North Amer. 2018;65(5):981-933.

2. Lebrun-Harris LA, Canto TM, Vodicka P, Mann MY, Kinsman SB. Oral health among children and youth with special health care needs. Pediatrics. 2021;148(2): e20200252.

3. Allareddy V, Rampa S, Lee MK, Allareddy V, Nalliah RP. 2014. Hospital-based emergency department visits involving dental conditions: Profile and predictors of poor outcomes and resource utilization. JADA. 2014;145(4):331-337.

4. Isman B, Newton RN. Oral Conditions in Children with Special Needs: A Guide for Health Care Providers. August 2016. California Connections Project.

5. Balzer J, Holt K. Strategies for Improving the Oral Health System of Care for Children and Youth with Special Health Care Needs (2nd ed.). 2022. National Maternal and Child Oral Health Resource Center.

Katrina Holt, MPH, MS, RD, FAND, is the director for the National Maternal and Child Oral Health Resource Center. She works to enhance the quality of oral health services for pregnant women, children, and adolescents, especially those from disadvantaged and underserved populations. Prior to joining Georgetown University, Katrina worked in local health departments, prenatal clinics, school-based clinics, refugee clinics, and other community programs. She’s very committed to supporting individuals with SHCNs and she has served as a volunteer for the Special Olympics for the past 20 years.