Download Providing Oral Hygiene

Oral Health Care for
Individuals with
Developmental Disabilities
Tools and Techniques for Providers
and Caregivers
Modifications may be required
due to:






Limited ability to understand
Behaviors that may interfere with treatment
Lack of control over muscle movements and
position
Adaptive devices (such as wheelchairs and
gastric or breathing tubes)
Multiple medications
Complex medical conditions
Importance of Oral Health Care



Key component of general health and well
being
Affects behavior and behavioral changes
Also affects:






Appearance
Speech
Comfort
Chewing
Nutrition
Breath
Healthy Gums
Coral Pink Gums
Knife edged papillae
Normal pigmentation
Unhealthy gums
Gingivitis
Puffy, red gums
Periodontitis
Swollen, shiny, red gums and gum loss
Unhealthy gums






Bleed easily
Are puffy or swollen
Are very red
May shrink away from the teeth making the
teeth appear longer
May be draining pus
Usually appear covered with plaque and food
particles
What Causes Gum Disease?

Poor oral hygiene and failure to remove bacterial
plaque and food debris from teeth and gumlines.

Oral bacteria

Medications that :



Cause dry mouth (lack of saliva)
Cause gum overgrowth
Have high sugar content that promote plaque build up
Healthy Teeth
Three Steps to a Healthy Mouth
1. Brush every day - twice a day
2. Floss every day – at least once a day if
possible.
3. Visit a dentist regularly
Providing Oral Hygiene

Make Home Care Routine

Same time


Every day after breakfast and before bedtime
Same place





Bathroom
Kitchen table and chair
Bed (elevate head of bed 30 degrees)
Bean bag chair
Wheelchair
Positioning Yourself
Tips for homecare:
 Stand behind the person.
 Additional support may be gained from
standing against a wall.
 Use one arm to cradle the person’s head
against your body.
 Use the other arm and hand to brush the
person’s teeth.
Illustrations
Providing Oral Hygiene





Make sure soft bristle tooth brush, tooth
paste and floss are easy to reach.
Change toothbrush every three months or
more frequently as needed.
Have a cup or basin available for rinsing and
spitting if possible.
Have a towel available.
Provide adequate lighting and a mirror.
Providing Oral Hygiene

Use “tell, show, do” method:







Tell:
Show:
Do:
person what will happen
what you are going to do.
begin oral hygiene
Be creative: have a favorite toy or music available to
comfort person
A person with impaired senses may benefit from
smelling, tasting, and touching toothpaste, brush
and dental floss.
Acknowledge good behavior with positive feedback
Allow time to adjust to dental care and develop trust
when working in and around their mouth.
Brushing


Let the person try to brush by themselves
first.
Use the hand over patient’s hand technique
to guide the toothbrush.
If assistance is needed…







Wash hands and/or put on disposable gloves.
Sit or stand where you can see all of the teeth.
Place pea-sized amount of toothpaste on brush if
tolerated by person. If not use water or nothing at all.
Brush front, back, top, and gumline of each tooth in
short back and forth strokes.
Gently brush the tongue
Rinse with plain water or wipe with gauze sponge.
Be an active observer and check for unusual changes.
Adapting toothbrushes

Make the handle easier to hold with Velcro, a
tennis ball, bicycle grip, tape etc.
Toothbrush handle
enhanced
with tennis ball
Plak-vac toothbrush
for swallowing difficulties
Collis Curve
3 brushing surfaces
Adapting toothbrushes

Power toothbrushes may make cleaning easier.

Take time to help the person get used to using the
power brush.
If person is sensitive to toothpaste try different
toothpaste flavors such as bubble gum or grape.

Flossing




Cleans between teeth where a toothbrush
can’t reach.
Flossing is a tough job that may take a lot of
practice.
Many types are available: waxed, unwaxed,
flavored, or tape.
If you have trouble try using a floss holder
Flossing





Wash hands and/or put on disposable gloves.
Use a string of floss about 18 inches long.
Wrap the floss around the middle finger of
each hand.
Grip the floss between the thumb and index
finger of each hand and work gently between
the teeth until it reaches the gums.
Do this for every tooth one side at a time.
Rinsing




The dentist or hygienist may recommend a
special rinse.
Fluoride rinses help to prevent cavities.
Antibacterial mouth rinses may help to fight
gum disease.
For persons with swallowing problems a
cotton swab, damp gauze, or toothbrush may
be used.