Oral health factors in 500 Chinese children with special needs show high caries prevalence and associations with hygiene.

Oral health is a vital component of overall well-being, yet children with special health care needs (CSHCN) are disproportionately affected by dental diseases due to physical, cognitive, behavioral, and systemic factors. A retrospective cross-sectional analysis was conducted on clinical records of 500 CSHCN aged 2–17 years, collected from pediatric dental clinics and special care centers in Nanjing, China. Lifestyle, nutrition, oral health, and socio-demographic data were extracted. Caries experience (dmft/DMFT), gingival condition, plaque accumulation, malocclusion, and dental hygiene were assessed. Chi-square tests and one-way ANOVA explored associations between clinical diagnosis and oral health outcomes. Multiple logistic regression identified factors independently associated with dental caries. The results comprised 62% males and 76% urban residents. Neurodevelopmental disorders predominated (ASD 26%, ID 18%), followed by cerebral palsy (17%) and Down Syndrome (8%). Caries prevalence was high (77%), with a mean dmft of 3.46 ± 2.15 and DMFT 2.38 ± 1.80. Gingivitis was observed in 72.6% and poor oral hygiene in 52.2% of children. Malocclusion affected 44% of participants, and only 21.4% had a dental visit in the past year. Oral hygiene practices were suboptimal: 56% brushed once daily, 40% received assisted brushing, and 42% used fluoridated toothpaste. Regression analysis identified poor oral hygiene (AOR = 2.85, p  Special needs children have increased rates of dental cavities, gingivitis, plaque accumulation, and malocclusion, as well as poor oral hygiene and limited preventive care. Dental caries risk is associated with oral hygiene practices, sugar intake, and fluoride use, suggesting the need for targeted preventive measures, caregiver education, and improved CSHCN-specific dental services.