The mouth, or oral cavity, is the gateway to the internal parts of our body. When oral care is not practised adequately, infectious bacteria can enter and accumulate in the mouth, resulting in tooth decay and periodontal (gum and supporting structures) diseases. 1,2 The mouth can also be a site of origin for the spread of pathogenic organisms to other body parts, causing systemic diseases (for e.g., cardiovascular diseases, diabetes, and others), especially in immunocompromised individuals and possibly those who have infections in the inner structures of their tooth or periodontal diseases. 3
Practising regular oral hygiene at home is hence crucial to maintain the long-term health of an individual. It is vital to adopt good oral care practices from an early age. This can be achieved by regular toothbrushing, use of interdental aids (for e.g., dental floss, dental/floss picks, pre-threaded flossers, tiny brushes that reach between the teeth etc) and mouthwash. However, some individuals with physical disabilities may find it challenging to perform activities of daily living, such as oral care practices, independently. 4 In turn, they may rely on their caregivers to support them in these activities. 5 In this article, we will explore some useful oral care tips for persons with disabilities and their caregivers.
Selecting a Toothbrush
It is recommended for individuals to brush their teeth at least twice a day – once in the morning and once at night after the last meal. A soft bristled, age-appropriate toothbrush is ideal. The toothbrush size and shape must fit one’s mouth, allowing them to reach all areas easily. 6
Though there are many traditional toothbrushes available in the market, electric or battery-operated toothbrushes might be easier for persons with disabilities to use.
Tips for persons with disabilities and their caregivers
1. For individuals who are not able to grasp the handle of a toothbrush, you can make the handle thicker by inserting a build-up handle to make it easier for the individuals to hold.
2. The handle of the toothbrush can also be made longer by attaching an extender such as an extended toothbrush aid or a tongue depressor, to help individuals who have difficulties in lifting their hand.
3. Consider using a universal holder strap for individuals who struggle with a weak grasp or limited hand and finger mobility.
4. Consider using an angled toothbrush. This could create a better angle for brushing
5. If the individual has difficulty keeping their mouth open, consider using a mouth prop such as a rolled-up moistened washcloth. 7
It is important to replace the toothbrush when it wears off or every three to four months (whichever is earlier) as a worn-out toothbrush would not do a good job in cleaning. 6
In general, a fluoride toothpaste is ideal for adults. Children’s toothpaste is specifically formulated for young children who are prone to swallowing toothpaste, brushing haphazardly, or may have a dislike of strong, minty flavors. People with sensitive teeth may need a toothpaste formulated to reduce sensitivity, though one should check with their dentist if the sensitivity is a sign of other problems. Toothpaste containing clay or other “natural” abrasives are not recommended as these are often too abrasive and can strip teeth of enamel (outer layer of tooth). 8
Dentists may recommend different brushing techniques to different people based on their oral condition. 9 Here are some videos that demonstrate the general brushing techniques.
Tips for Caregivers on Assisting and Brushing Care Recipient’s Teeth
When assisting your care recipients in toothbrushing:
- Support the individual’s head
- To avoid choking or gagging, turn the individual’s head slightly to one side and reduce the amount of toothpaste used
- Ensure they can see properly inside the mouth and be able to manipulate a toothbrush freely and safely
If you are assisting an individual on a wheelchair:
- You can stand or sit behind the wheelchair
- Lock the wheels of the wheelchair for safety
- Use one arm to brace the individual’s head against the back or headrest of the wheelchair or against your own body
If toothbrushing is to be done while lying down:
- Have the individual lie on the floor, bed or sofa with their head raised slightly on a pillow.
- Caregivers can kneel behind the individual’s head or lay the individual’s head on the caregiver’s lap.
- Caregivers can use their free arm to support the individual’s head and/or gently hold them still, if necessary.
You can also use a beanbag to help the individual relax without the fear of falling. Sit them comfortably on a beanbag and use the same technique as for someone who is lying down. 7
Interdental cleaning is a step often overlooked by many. However, it is an important step to ensure that there is no food debris stuck between the teeth, to reduce gum disease and dental caries.
It is recommended to use interdental aids (e.g. dental floss, powered air or water flossers, or wooden plaque removers etc) once a day.10
Persons with disabilities and children under the age of 12 may need help in interdental cleaning.11 Interdental cleaning can start at an early age (when children start having two teeth).12 Here is a video to demonstrate the general flossing technique.
Tips for Caregivers on Flossing
Floss holders, interdental brushes and other cleaning tools can be helpful for persons with disabilities. For those who are not able to floss independently, caregivers can help them to floss by positioning them in the same way as the steps used in toothbrushing. 7
Mouth rinses, or mouthwashes, may be a good addition to daily oral hygiene routine, especially for people with limited dexterity. However, it is not a replacement for daily brushing and flossing. 13
Like interdental cleaners, mouth rinses can help to reach areas not easily covered by a toothbrush. Though manufacturers may recommend a specific order of use depending on the ingredients, a mouth rinse can generally be used before or after brushing. 13
Mouth rinse is usually not recommended for children below six years old as their swallowing reflexes may not be well developed. If children swallow large amounts of mouth rinse, it can trigger adverse effects like nausea, vomiting, and intoxication (due to the alcohol content in some rinses). 13
Mouth rinses can be categorised into two groups – cosmetic and therapeutic.
- Cosmetic mouthwash may be temporary fixes to control bad breath and leave behind a pleasant taste.
- Therapeutic mouthwash has active ingredients to help control or reduce conditions like chronic bad breath, gingivitis (gum disease), plaque formation and accumulation and dental caries. They are recommended by a dentist. 13
People with disabilities can consult their dentist on which mouthwash would suit their needs. When using a mouthwash, persons with disabilities can adjust their head position appropriately to aid in gargling and prevent gagging, nausea, and vomiting.
After gargling, it is best to inspect the mouth for any food debris and remove them with a swab or toothbrush. Additionally, visiting the dentist once every six months (or as advised by a dentist) will help in maintaining oral health. 14
With these techniques and strategies, we hope that they are useful in helping persons with disabilities and their caregivers in managing their toothbrushing needs, thus ensuring good oral hygiene.
Stay tuned for more tips to achieving better dental health in our next article.
This article is contributed by Dr Sneha Sundar Rajan. Dr Sneha has a master’s degree in Dental Surgery (MDS) from Manipal University, India. She was a researcher with the National University of Singapore at the Faculty of Dentistry and Centre for Advanced 2D materials before taking a break for motherhood. Besides being a volunteer writer at SPD, Dr Sneha also contributes her time as a befriender, bringing much joy to our clients with disabilities. Keen to volunteer your time and skills to uplift the lives of persons with disabilities? We welcome you to join us in our journey as we advance the disability cause. For more information, please contact email@example.com.
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The Importance of Regular Dental Visits to People with Disabilities
- Clin Microbiol Rev. 2000 Oct;13(4):547-58. doi: 10.1128/CMR.13.4.547