A Caregivers Guide to Good Oral Health for Persons with Special Needs Steven P. Perlman, DDS, MscD Clive Friedman, DDS Sanford J Fenton, DDS, MDS i A Guide to Good Oral Health for Persons with Special Needs TABLE OF CONTENTS Introduction 1 You’re Not Healthy without Good Oral Health 1 Creating a Personal Oral Hygiene Program 2 Patient Skills Evaluation Checklist 2 Oral Hygine Checklist 4 Good Oral Hygiene...Step by Step 5 Brushing…Step by Step 5 Rinsing…Step by Step 6 Flossing…Step by Step 7 Adapting a Toothbrush 9 Different Positions for Brushing 11 In a Wheelchair 11 Sitting on the Floor 12 On a Bed or a Sofa 12 In a Beanbag Chair 13 Lying on the Floor 13 Some Common Dental Problems 14 Oral Health Considerations during Growth & Development of a Child 18 Special thanks to Ann S. Smith, DDS, BSN and H. Barry Waldman, DDS, MPH, PhD. This Guide was originally prepared in 1995 by Special Olympics Special Smiles and Boston University with an unrestricted grant from Colgate Oral Pharmaceuticals. © Special Olympics, Inc., 2008. All rights reserved. 1 A Guide to Good Oral Health for Persons with Special Needs INTRODUCTION You’re Not Healthy without Good Oral Health For the millions of people worldwide with intellectual and developmental disabilities, dental care is often not a top priority and takes a back seat to more pressing medical issues. However, maintaining good oral health should be a priority for everyone. In the words of former United States Surgeon General C. Everett Koop, “You are not a healthy person unless you have good oral health. Oral health is part of general health and it can affect your overall health and your quality of life.” It is well documented that oral disease — tooth decay, periodontal disease, tooth loss, oral cancer — is one of the most widespread of all chronic health conditions. Unlike the common cold, which left untreated will resolve itself, oral disease can lead to complications that can be difficult and expensive to cure. The good news is that dental disease is much easier to prevent than to treat. Dentistry has made great strides in the last decade and research proves that proper oral hygiene and regular visits to the dentist can prevent many dental diseases. This guide is designed to help you develop and maintain a complete oral hygiene program for the person with special needs. These pages are devoted to easy-to-follow instructions on proper brushing, rinsing and flossing techniques, as well as suggestions for alternate positions for these activities. You will also find important information about common dental problems, including oral health considerations during the growth and development of a child with special needs. This guide does not take the place of routine visits to the dentist. With regular cleanings and check-ups, everyone can have a beautiful and healthy smile. © Special Olympics, Inc., 2008. All rights reserved. 2 A Guide to Good Oral Health for Persons with Special Needs CREATING A PERSONAL ORAL HYGIENE PROGRAM This personal oral hygiene evaluation and program checklist will help to evaluate the level of ability the person with special needs has in maintaining his or her oral hygiene. The following pages will help to develop a regular and realistic individualized oral care program. Take this form to your dentist or dental hygienist. He or she will complete it with you and talk with you about how best to help the person with special needs take care of his or her oral health. Patient Skills Evaluation Checklist Date: _________________________________ Patient: _______________________________ Caregiver: ____________________________ 1. Classification of Cleaning Skills (please check one): ❑ Patient requires significant assistance ❑ Patient has some dexterity but insufficient cleaning techniques ❑ Patient can effectively brush with little assistance ❑ Patient requires virtually no assistance 2. Current Patient Brushing Method (please check one): ❑ Scrub Brush ❑ Bass ❑ Vibration ❑ Circular ❑ Roll ❑ Electric 3. Does the patient use toothpaste? ❑ Yes ❑ No If yes, type of toothpaste used (e.g., tartar control) ____________________________________________________ © Special Olympics, Inc., 2008. All rights reserved. 3 A Guide to Good Oral Health for Persons with Special Needs CREATING A PERSONAL ORAL HYGIENE PROGRAM 4. Rinse (please check one): ❑ Patient rinses with chlorhexidine ❑ Patient rinses with fluoride (please specify) ____________________________________________________ ❑ Patient rinses with alternate rinse (please specify) ____________________________________________________ ❑ Patient unable to rinse; caregiver uses swab technique with chlorhexidine ❑ Patient is unable to rinse; caregiver uses swab technique with alternate rinse (please specify): ______________________________________________________ ______________________________________________________ 5. Floss (please check one): ❑ Patient is able to floss ❑ Patient is able to floss with finger holder ❑ Patient is unable to floss; caregiver assistance needed ❑ Patient is unable to floss; no flossing technique currently used 6. Fluoride (please check one): ❑ Liquid ❑ Gel © Special Olympics, Inc., 2008. All rights reserved. 4 A Guide to Good Oral Health for Persons with Special Needs CREATING A PERSONAL ORAL HYGIENE PROGRAM Oral Hygine Checklist Regimen Patient Caregiver Toothbrushing ❑ ❑ M o n❑ i❑ t o r A c t i v i t y T o o❑ t ❑ h b r u s h M o d i f i c a t i o n E l e ❑ c ❑ t r i c T o o t h b r u s h T o o❑ t ❑ h p a s t e W a ❑t e❑ r F l u ❑ o ❑ r i d e R i n s e F l u ❑ o ❑ r i d e G e l C h l❑ o ❑ r h e x i d i n e R i n s e C h l❑ o ❑ r h e x i d i n e B r u s h i n g C h l❑ o ❑ r h e x i d i n e S w a b R e d❑ ❑ D y e P r o g r a m S a l ❑ i ❑ v a S u b s t i t u t e F l o ❑ s ❑ s R e i ❑ n ❑ f o r c e r s ( e . g . , f o o d , T V , b o o k ) S t u p❑ p❑ o r A r m❑ ❑ H e a❑ d❑ H a n❑ d❑ V e r❑ b ❑ a l I n s t r u c t i o n s P o s❑ i ❑ t i o n o f C a r e g i v e r O ( t M h I e r P : a _ s _ t _ e _ , _ _ x _ y _ l _ i _ t _ o _ l _ _ g _ u _ m _ , _ _ e _ t _ c _ . _ ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ A d d i t i o n a l C o m m e n t s / I n s t r u c t i o n s : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ © Special Olympics, Inc., 2008. All rights reserved. 5 A Guide to Good Oral Health for Persons with Special Needs GOOD ORAL HYGIENE…STEP BY STEP The most important part of maintaining good oral health is a person’s daily oral hygiene and diet. Brushing, rinsing, a healthy diet and, if possible, flossing, will not only enhance a person’s smile and self-esteem but also can avoid problems in the future. Everyone, regardless of their ability, should brush or have their teeth brushed at least twice each day. Flossing and rinsing are equally important. However, as you may know, for persons with special needs, these tasks can be difficult. The following instructions will help to make oral hygiene easier. They provide information on the following techniques; ways to adapt a toothbrush and positions to enhance brushing. Brushing…Step by Step 1. Place toothbrush bristles at the gum line at a 45-degree angle to the gums. Press gently and use short strokes vibrating back and forth, or light scrubbing motion. Reposition brush vertically to clean inside upper and lower surfaces of front teeth. 2. Start with upper teeth, brushing outside, inside, and chewing surfaces. Do the same for lower teeth. Be sure to brush each tooth. © Special Olympics, Inc., 2008. All rights reserved. 6 A Guide to Good Oral Health for Persons with Special Needs GOOD ORAL HYGIENE…STEP BY STEP 3. To freshen breath, brush the tongue too, since it can harbor many bacteria. 4. For persons with limited dexterity, there are alternate methods of brushing. Using the “roll” method, turn their wrist slightly. With the filaments of the brush remaining flexed, follow the contours of the teeth. Another method is the “circular” method. With teeth closed, place the brush inside the cheek with tips lightly touching the teeth. Use a fast, wide, circular motion with little pressure. Have your dentist or hygienist recommend the best method and instruct you on how to perform it. Rinsing…Step by Step 1. Take recommended dose of a fluoride rinse (usually a capful) and swish it around mouth for 60 seconds, and expectorate (spit), taking care not to swallow the rinse. For full fluoride protection, do not eat or drink for 30 minutes after rinsing. 2. If the patient is unable to rinse without swallowing, as in Step 1, use a cotton swab or toothbrush to place a little fluoride rinse on teeth. Your dental professional may also recommend a prescription fluoride gel treatment. © Special Olympics, Inc., 2008. All rights reserved. 7 A Guide to Good Oral Health for Persons with Special Needs GOOD ORAL HYGIENE…STEP BY STEP If a person gags or cannot expectorate (spit), brush with a fluoride rinse instead of toothpaste. First, brush without the rinse. Then pour a little rinse into a cup, dip the toothbrush into it, and brush. If a chlorhexidine gluconate product is prescribed, use a sponge applicator (available in many medical supply stores) or a toothbrush/, dip into the chlorhexidine, and rub on the teeth and gums. Flossing…Step by Step Flossing is an important activity, but takes a high degree of manual dexterity. Many persons with special needs may not have the ability to floss. It is, however, an activity that can be done for the person. 1. Take a piece of floss, approximately 18 inches long, and wrap it around the middle finger of each hand. You can also tie the ends together in a circle. 2. With the floss gripped firmly between the thumb and index finger of each hand (hold an approximately half-inch section taut for more control), work the floss gently between the teeth until it reaches the gum. © Special Olympics, Inc., 2008. All rights reserved. 8 A Guide to Good Oral Health for Persons with Special Needs GOOD ORAL HYGIENE…STEP BY STEP 3. Curve the floss into a C-shape around the tooth. Slide it up and down the side of the tooth. Remove the floss carefully, and repeat the process for each tooth. While flossing, make certain not to injure the gums — keep your movements controlled and gentle whenever the floss is in contact with the gums. 4. Floss holders are available to help with coordination. © Special Olympics, Inc., 2008. All rights reserved.