Taking care of someone with a developmental disability requires patience and skill. As a caregiver, you know this as well as anyone does. You also know how challenging it is to help that person with dental care. It takes planning, time, and the ability to manage physical, mental, and behavioral problems. Dental care isn't always easy, but you can make it work for you and the person you help. This booklet will show you how to help someone brush, floss, and have a healthy mouth.
Everyone needs dental care every day. Brushing and flossing are crucial activities that affect our health. In fact, dental care is just as important to your client's health and daily routine as taking medications and getting physical exercise. A healthy mouth helps people eat well, avoid pain and tooth loss, and feel good about themselves.
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Location. The bathroom isn't the only place to brush someone's teeth. For example, the kitchen or dining room may be more comfortable. Instead of standing next to a bathroom sink, allow the person to sit at a table. Place the toothbrush, toothpaste, floss, and a bowl and glass of water on the table within easy reach.
No matter what location you choose, make sure you have good light. You can't help someone brush unless you can see inside that person's mouth. Positioning your body lists ideas on how to sit or stand when you help someone brush and floss.
Behavior. Problem behavior can make dental care difficult. Try these ideas and see what works for you.
- At first, dental care can be frightening to some people. Try the "tell-show-do" approach to deal with this natural reaction. Tell your client about each step before you do it. For example, explain how you'll help him or her brush and what it feels like. Show how you're going to do each step before you do it. Also, it might help to let your client hold and feel the toothbrush and floss. Do the steps in the same way that you've explained them.
- Give your client time to adjust to dental care. Be patient as that person learns to trust you working in and around his or her mouth.
- Use your voice and body to communicate that you care. Give positive feedback often to reinforce good behavior.
- Have a routine for dental care. Use the same technique at the same time and place every day. Many people with developmental disabilities accept dental care when it's familiar. A routine might soothe fears or help eliminate problem behavior.
- Be creative. Some caregivers allow their client to hold a favorite toy or special item for comfort. Others make dental care a game or play a person's favorite music. If none of these ideas helps, ask your client's dentist or dental hygienist for advice.
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Three Steps to a Healthy Mouth
Like everyone else, people with developmental disabilities can have a healthy mouth if these three steps are followed:
- Brush every day.
- Floss every day.
- Visit a dentist regularly.
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Step 1. Brush Every Day
Angle the brush at the gumline and brush gently.
If the person you care for is unable to brush, these suggestions might be helpful.
- First, wash your hands and put on disposable gloves. Sit or stand where you can see all of the surfaces of the teeth.
- Be sure to use a regular or power toothbrush with soft bristles.
- Use a pea-size amount of toothpaste with fluoride, or none at all. Toothpaste bothers people who have swallowing problems. If this is the case for the person you care for, brush with water instead.
- Brush the front, back, and top of each tooth. Gently brush back and forth in short strokes.
- Gently brush the tongue after you brush the teeth.
- Help the person rinse with plain water. Give people who can't rinse a drink of water or consider sweeping the mouth with a finger wrapped in gauze.
Get a new toothbrush with soft bristles every 3 months, after a contagious illness, or when the bristles are worn.
If the person you care for can brush but needs some help, the following ideas might work for you. You may think of other creative ways to solve brushing problems based on your client's special needs.
Make the toothbrush easier to hold.
The same kind of Velcro® strap used to hold food utensils is helpful for some people.
Others attach the brush to the hand with a wide elastic or rubber band. Make sure the band isn't too tight.
Make the toothbrush handle bigger.
You can also cut a small slit in the side of a tennis ball and slide it onto the handle of the toothbrush.
You can buy a toothbrush with a large handle, or you can slide a bicycle grip onto the handle. Attaching foam tubing, available from home health care catalogs, is also helpful.
Try other toothbrush options.
A power toothbrush might make brushing easier. Take the time to help your client get used to one.
Guide the Toothbrush.
Help brush by placing your hand very gently over your client's hand and guiding the toothbrush. If that doesn't work, you may need to brush the teeth yourself.
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Step 2. Floss Every Day
Flossing cleans between the teeth where a toothbrush can't reach. Many people with disabilities need a caregiver to help them floss. Flossing is a tough job that takes a lot of practice. Waxed, unwaxed, flavored, or plain floss all do the same thing. The person you care for might like one more than another, or a certain type might be easier to use.
- Use a string of floss 18 inches long. Wrap that piece around the middle finger of each hand.
- Grip the floss between the thumb and index finger of each hand.
- Start with the lower front teeth, then floss the upper front teeth. Next, work your way around to all the other teeth.
- Work the floss gently between the teeth until it reaches the gumline. Curve the floss around each tooth and slip it under the gum. Slide the floss up and down. Do this for both sides of every tooth, one side at a time.
- Adjust the floss a little as you move from tooth to tooth so the floss is clean for each one.
Try a floss holder.
If you have trouble flossing, try using a floss holder instead of holding the floss with your fingers.
The dentist may prescribe a special rinse for your client. Fluoride rinses can help prevent cavities. Chlorhexidine rinses fight germs that cause gum disease. Follow the dentist's instructions and tell your client not to swallow any of the rinse. Ask the dentist for creative ways to use rinses for a client with swallowing problems.
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Positioning Your Body: Where To Sit or Stand
Keeping people safe when you clean their mouth is important. Experts in providing dental care for people with developmental disabilities recommend the following positions for caregivers. If you work in a group home or related facility, get permission from your supervisor before trying any of these positions.
If the person you're helping is in a wheelchair, sit behind it. Lock the wheels, then tilt the chair into your lap.
Stand behind the person or lean against a wall for additional support. Use your arm to hold the person's head gently against your body.
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Step 3. Visit a Dentist Regularly
Your client should have regular dental appointments. Professional cleanings are just as important as brushing and flossing every day. Regular examinations can identify problems before they cause unnecessary pain.
As is the case with dental care at home, it may take time for the person you care for to become comfortable at the dental office. A "get acquainted" visit with no treatment provided might help: The person can meet the dental team, sit in the dental chair if he or she wishes, and receive instructions on how to brush and floss. Such a visit can go a long way toward making dental appointments easier.
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Prepare for Every Dental Visit: Your Role
Be prepared for every appointment. You're an important source of information for the dentist. If you have questions about what the dentist will need to know, call the office before the appointment.
- Know the person's dental history. Keep a record of what happens at each visit. Talk to the dentist about what occurred at the last appointment. Remind the dental team of what worked and what didn't.
- Bring a complete medical history. The dentist needs each patient's medical history before treatment can begin. Bring a list of all the medications the person you care for is taking and all known allergies.
- Bring all insurance, billing, and legal information. Know who is responsible for payment. The dentist may need permission, or legal consent, before treatment can begin. Know who can legally give consent.
- Be on time.
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Brushing and flossing every day and seeing the dentist regularly can make a big difference in the quality of life of the person you care for. If you have questions or need more information, talk to a dentist.
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The National Institute of Dental and Craniofacial Research thanks the oral health professionals and caregivers who contributed their time and expertise to reviewing and pretesting the Practical Oral Care series.
Expert Review Panel
- Mae Chin, RDH, MEd, University of Washington, Seattle, WA
- Sanford J. Fenton, DDS, University of Texas, Houston, TX
- Ray Lyons, DDS, FADPD, DABSCD, New Mexico Department of Health, Los Lunas, NM
- Christine Miller, RDH, MHS, MA, University of the Pacific, San Francisco, CA
- Steven P. Perlman, DDS, MScD, Boston University, Boston, MA
- David Tesini, DMD, MS, Sudbury, MA
This booklet is one in a series on providing oral care for people with mild or moderate developmental disabilities. The issues and care strategies listed are intended to provide general guidance for caregivers on how to manage various oral health challenges common in people with developmental disabilities.
Other booklets in this series:
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This publication is not copyrighted. Make as many photocopies as you need.
NIH Publication No. 12-5191
NIH...Turning Discovery Into Health