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Oral care for persons with disability Q&A with Dr Karve




WHY IS ORAL CARE FOR PEOPLE WITH DISABILITY SUCH A COMPLICATED TASK?

Oral care is a complex task because it requires coordination, memory, good muscle control and fine mo


tor skills. In persons with special needs, changes in muscle tone, dexterity, posture, compromised vision, taste aversion and a strong gag reflex can make independent oral care difficult. Also, if a toothbrush is used incorrectly, it can cause physical damage to the mouth plus psychological damage to the person having their teeth brushed. It is natural for a person with a developmental disability to resist anything that has caused them pain, therefore they will resist toothbrushing if there is a history of abuse or trauma to the mouth or teeth.


WHY IS IT IMPORTANT THAT CARERS GET IT RIGHT?

The mouth is an important part of the body, and a healthy mouth and teeth are key to communication, speech, swallowing, nutrition and overall health. So, attempting daily oral care is a must. Plus, people with a disability are more at risk of things like dental disease, misaligned or missing teeth, over-crowding, tooth grinding, weak tooth enamel, gum problems – the list goes on. They may also have difficulty swallowing, which can cause aspiration risks; they may drool or even have a dry mouth, which can lead to dental decay. And of course, some may have a greater risk of


falling causing trauma to the mouth.Ultimately carers need to attempt to get this right because even small problems in the mouth such as tooth decay may require a general anaesthetic to rectify (elaborate here on what that entails if appropriate).


WHAT ARE SOME THINGS YOU NEED TO CONSIDER WHEN YOU BRUSH SOMEONE ELSE’S TEETH?

Approach, Routine, Location, Positioning, Tools (what is a good order here?)

The main aim of toothbrushing is to remove food debris and plaque, encourage saliva flow and introduce fluoride to the teeth.


Where should carers start in establishing a routine?

Ideally, oral care should be undertaken twice daily, after breakfast and after dinner. Establishing a routine with storyboarding or with the use of a video, song or timer can also help.


Where is the best place to brush/floss someone’s teeth?

Traditionally oral care is done in the bathroom as it provides adequate space, good lighting and a mirror which is very helpful for the person whose teeth are being brushed as it offers visual feedback so they can see what is going on and gain a better understanding of what is happening to them. This might not be the right fit for every person, I know some that prefer to brush in the shower or even on the couch while watching TV.


How important is positioning?

may mention something about asking your dental practitioner the best way for your situation


What are some basic rules for what you should use to brush or floss someone’s teeth?

For effective toothbrushing, you will need a toothbrush with a small head and soft bristles or an electric toothbrush, fluoride containing toothpaste. If basic brushing is tolerated well, we can also try for a mouthwash, which can be brushed onto the teeth if the person cannot swish and spit. Interdental cleaning with floss, floss sticks or interdental brushes, but please never use a toothpick or pin to clean in between teeth as these can lead to injuries/trauma/tooth damage.


WHAT DO YOU DO WHEN THE PERSON DOESN’T WANT TO DO IT?


What are some brushing aides that can help people with heightened tactile defence, taste aversion or aspiration risk?


They might need modification of the standard products. Your dental practitioner may recommend:

  • Plaque disclosing aids

  • Altering the grip to a wide handle

  • Electric toothbrush

  • Three sided or curved surround toothbrushes

  • Tooth brush which can attach on to a suctioning device

  • Using a mouth prop or bite block to hold the mouth open

  • Low foaming toothpasteFlavour free toothpaste


Are there any aides that carers should avoid?

Do not use foam swabs as they can dislodge and be aspirated

HOW IMPORTANT IS DIET?

Frequent dietary sugars are especially harmful to oral health in persons with special health needs.


WHEN SHOULD WE GET A DENTAL CHECK-UP?


Followup questions:


What if I can’t afford to go to a private dentist?

Are there any oral-health services I can use?


Who can I see for a checkup?

OHT, Hygienist, Special Needs Dentist etc

WHAT IS A CARE PLAN?

WHAT SHOULD I BE LOOKING OUT FOR GOING FORWARD?


Monitor for signs of underlying pain, infection or oral disease

Followup questions:

What does infection or oral disease look like?


WRAP UP

I think it is important to include in the wrap-up that we encourage people to try for routine but be flexible. Re-iterate that the main aim of toothbrushing is to remove food debris and plaque, encourage saliva flow and introduce fluoride to the teeth, so even if you get a brush in their mouth for a couple of seconds, it’s better than nothing. What is non-negotiable however is the use of fluoride (toothpaste, drinking water), plaque removal (somehow) and protection from aspiration risk (reduce sugar load too?)


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