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.
Getting Started
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.
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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.
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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.
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Use your voice and body to communicate that you care. Give positive feedback often
to reinforce good behavior.
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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.
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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.
Top
Three Steps to a Healthy Mouth
Like everyone else, people with developmental disabilities can have a healthy mouth
if these three steps are followed:
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Brush every day.
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Floss every day.
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Visit a dentist regularly.
Top
Step 1. Brush Every Day
If the person you care for is unable to brush, these suggestions might be helpful.
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Angle the brush at the gumline and brush gently.
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First, wash your hands and put on disposable gloves. Sit or stand where you can see
all of the surfaces of the teeth.
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Be sure to use a regular or power toothbrush with soft bristles.
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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.
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Brush the front, back, and top of each tooth. Gently brush back and forth in short
strokes.
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Gently brush the tongue after you brush the teeth.
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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.
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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.
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The same kind of Velcro® strap used to hold food utensils is helpful for some people.
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Others attach the brush to the hand with a wide elastic or rubber band. Make sure
the band isn't too tight.
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Make the toothbrush handle bigger.
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You can also cut a small slit in the side of a tennis ball and slide it onto the handle
of the toothbrush.
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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.
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Guide the toothbrush.
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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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A power toothbrush might make brushing easier. Take the time to help your client get
used to one.
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Top
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.
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Use a string of floss 18 inches long. Wrap that piece around the middle finger of
each hand.
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Grip the floss between the thumb and index finger of each hand.
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Start with the lower front teeth, then floss the upper front teeth. Next, work your
way around to all the other teeth.
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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.
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Adjust the floss a little as you move from tooth to tooth so the floss is clean for
each one.
Try a floss holder.
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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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Top
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.
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If the person you're helping is in a wheelchair, sit behind it. Lock the wheels, then
tilt the chair into your lap.
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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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Top
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.
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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.
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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.
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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.
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Be on time.
Top
Remember ...
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.
Other booklets in this series:
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Continuing Education: Practical Oral Care for People With
Developmental Disabilities
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Practical Oral Care for People With Autism
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Practical Oral Care for People With Cerebral Palsy
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Practical Oral Care for People With Down Syndrome
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Practical Oral Care for People With Mental Retardation
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Wheelchair Transfer: A Health Care Provider's Guide
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ACKNOWLEDGMENTS
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
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Mae Chin, RDH, University of Washington, Seattle, WA
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Sanford J. Fenton, DDS, University of Tennessee, Memphis, TN
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Ray Lyons, DDS, New Mexico Department of Health, Los Lunas, NM
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Christine Miller, RDH, University of the Pacific, San Francisco, CA
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Steven P. Perlman, DDS, Special Olympics Special Smiles, Lynn, MA
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David Tesini, DMD, Natick, MA
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For additional copies of this booklet, contact
National Institute of Dental and Craniofacial Research
National Oral Health Information Clearinghouse
1 NOHIC Way
Bethesda, MD 20892-3500
(301) 402-7364
www.nidcr.nih.gov
nohic@nidcr.nih.gov
This publication is not copyrighted.
Make as many photocopies as you need.
NIH Publication No. 04-5191
Printed May 2004
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