Toothbrushing for People with Special Needs

Leaflet: Looking after teeth for children with extra needs (pdf)

Leaflet: Looking after teeth for adults with extra needs (pdf)

There are a range of brushes that can help people with reduced dexterity. An electric one does most of the work for the user. A thickened handled brush, or one that is adapted (e.g. by placing a ball over the end), can make brushing easier. Similarly a special brush like the Collis Curve (pictured) can help a person with limited dexterity or a carer to brush the teeth.

toothbrushes

Assisting with toothbrushing

This is an invasive process and can be uncomfortable for someone. Permission needs to be obtained, if the patient is competent, and an explanation provided of what is going to happen. Whilst the most important time to brush the teeth is before bedtime, it may be easier to assist brushing the teeth at a time when the person is more relaxed during the day e.g. watching television or listening to music.

  • Good head support must be provided for adequate, comfortable brushing for the person. It should be comfortable for carer/parent also. This might mean having the person sitting on a chair, wheelchair, on the bed or in the case of children sitting on the lap.
  • When brushing someone else’s teeth the carer should ideally be positioned behind the person, slightly to one side. This will give better access and vision into the mouth while gently supporting the head. Brushing when standing in front of someone will make it difficult to see and have access as most people will tend to ‘bow’ their heads down during brushing, resulting in the carer/parent bending and twisting over the person in order to brush.
  • It may be necessary to gently draw back the lips and cheeks with thumb, forefinger or toothbrush to gain access to the teeth and gums.
  • Everyone involved in the person’s oral health should be consulted e.g. the individual, parents, carers and the dental team.
  • The same order of brushing each time will ensure that each area of the mouth is brushed and none missed. However, if co-operation is very limited, in extreme circumstances it would be more suitable to brush a different area of the mouth each day. For example, brush the upper right hand teeth ensuring ALL surfaces in this area are brushed thoroughly in the morning and then brush the lower right hand teeth before going to bed. The next day’s focus should be on the left hand side of the mouth. In these extreme circumstances a tooth-brushing chart should be used by carers/parents to ensure no teeth are missed. A thorough brush of all surfaces of the teeth (inside, outside and biting surfaces) once every two days is better than an inadequate brush everyday where due to very limited co-operation many of the surfaces of the teeth are consistently missed.
  • Encourage the person being assisted to do as much brushing as they are capable of themselves. The toothbrush may need adapted to enable the patient to do this. (see the samples of toothbrush above.)
  • If teeth are loose more care is needed around these to ensure thorough cleaning.
  • All cares should wear latex free gloves when assisting people with tooth brushing and the gloves should be changed for each individual.

Problem solving

  • If the person bites or grinds on a toothbrush this can make brushing someone’s teeth difficult. Allowing the person to ‘bite’ on a large toothbrush in the opposite side to which you want to brush will ‘prop’ the mouth open, enabling access. This may require two people to assist.

brushing

  • Some people will find it easier to brush their teeth and allow their teeth to be brushed when watching in the mirror.
  • An active tongue and/or a tight lip may push the toothbrush away from the teeth and gums. As above gentle retraction of the lip, cheeks and tongue may be required. This can be done using a toothbrush or fingers wrapped in a flannel. Care must be taken to make sure the carer is not accidentally bitten. The use of hard plastic finger guards can be helpful.
  • Starting brushing at the back of the mouth first and moving forward can reduce gagging or retching.
  • If the person has excess saliva and tends to suffer from drooling use fluoride toothpaste on a dry toothbrush and push the paste into the bristles. The alternative is to use a non-foaming toothpaste like “Biotene”.
  • Gums bleed when the teeth are not brushed effectively and plaque is left on the teeth and gums. If gums are bleeding it is therefore an indication that more brushing in this area is required. Overtime bleeding will reduce if the brushing is maintained. If gums continue to bleed see a dentist.
  • Some medication and systemic diseases can cause a dry mouth, leaving the person more prone to gum disease and dental decay. Medications should NEVER be stopped. Ask your dentist for advice on preventive measures such as saliva substitutes.

Adapted from Karen Bellis: A Healthy Mouth – Oral healthcare for people with PMLD

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