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Putting teeth into oral health care: good care of oral hygiene begins at home.

Ever been unable to find a dentist who can care for a person with special needs? Has your child ever been upset or frustrated by mouth pain?

Does oral hygiene get put at the bottom of you or your family's list of pressing medical and health needs?

Barriers to good oral health for people with special needs exist for all sorts of reasons. Medical, nutritional and emotional needs can often seem to outweigh the need for daily oral hygiene and regular visits to the dental. And with the few number of dentist who are experienced and ready to care for a child with special needs, it is easy to become overwhelmed trying to keep oral health a priority.

It is crucial for parents of children with disabilities to understand the strong link between oral health and overall health. By paying attention to good oral hygiene, avoidable illness and the undue expense of treating it can be avoided. Pain in the mouth can cause discomfort and limit a child's ability to properly chew and swallow. Without this competency, digesting food and getting the right nutrients can easily become difficult and cause sickness.

Certain medicines and genetic disorders can cause an unfortunate side effect or symptom, "dry mouth,' which reduces the flow of saliva, thus reducing the natural cleansing of the mouth. Dry mouth can affect nutritional and psychological well-being and can also lead to tooth decay, gum disease and other mouth infections.

Self-esteem is another major issue for growing children, especially those with disabilities. A child who has bad breath because his or her teeth are not brushed and flossed regularly can suffer from embarrassment and receive poor treatment from others.

Teeth and gums that are healthy and clean help children and young adults feel good about the way they look and make it easier for them to get along well and feel accepted in social situations, whether at school, work or in family settings or other gatherings of friends.

Oral health begins at home

The first step towards good oral health is to develop an oral hygiene program in the home. There are three important daily routines -- and techniques -- that are a part of such a program: brushing, rinsing and flossing. These tasks can be difficult, but there are several ways to adapt a toothbrush and floss for a child at almost any level of disability.

Arranging an appointment with a dentist or hygienist to discuss personal oral hygiene is typically the best way to get started with a daily-care program. Before you visit your dental professional, take some time to understand your child's level of dental hygiene skill. Is the child able to clean his or her own teeth with a toothbrush? Can he or she hold and manipulate dental floss? What is his or her current brushing method?

Brushing up

Daily brushing is essential for removing buildup and bacteria that normally comes from eating and drinking. Not brushing one's teeth will eventually lead to gum disease and tooth loss -- both painful to experience and expensive to treat.

If a child cannot clean his or her own teeth -- or just needs a little bit of guidance -- you can place your hand over the child's and guide him or her through each movement.

Try to brush the teeth with the toothbrush at a 45-degree angle to the gums. Press gently and use short strokes back and forth or use a light scrubbing motion. Start with the upper teeth, brushing the outside, inside and chewing surfaces. Do the same for the lower teeth. Be sure to brush each tooth.

For children with limited motor skills, try the "circular method." With teeth closed, place the brush so its back presses next to the inside of the cheek with the bristle tips lightly touching the teeth. Use a fast, wide, circular motion, applying very little pressure.

If your child cannot hold a toothbrush you can adapt it by:

* attaching a brush to the person's hand with a wide elastic band;

* using an electric tooth-brush (for children who hold, but cannot manipulate, a toothbrush);

* lengthening the brush's handle with a ruler, tongue depressor, or wooden spoon (for children who cannot raise his or her hand or arm).

For children who simply cannot brush their own teeth, no matter what the adaptation, there are several methods you can use to clean someone's mouth. Remember to support the child's head and position yourself so do it is easy to see properly inside his or her mouth.

If your child is in a wheelchair, you can either sit or stand behind the wheelchair, depending on their size and weight. If you stand, use your arm to brace the child's head against the chair or your body. If you sit, tilt the chair back into your lap, always remembering to first lock the chair wheels.

You can also lay the child down on a bed or sofa with his or her head in your lap. A big beanbag cushion or pillow also works well for someone who has difficulty sitting up straight. Use the same positions as for the bed and sofa.


Flossing, a difficult task for patients with limited dexterity, is one of the most effective practices for maintaining good oral health.

For flossing, it's best to take a piece of floss -- around 20 inches long -- and wrap it around the middle finger of each hand. Grip the floss fully between the thumb and index finger of each hand to maintain a degree of tension and work it gently between the teeth until it reaches the gum.

Curve the floss into a C-shape around the tooth. Slide it up and down the side of the tooth. Remove it carefully and repeat for each tooth. Be sure not to injure the gums.


For rinsing, take a recommended dose of fluoride rinse (usually a capful) and swish it around the mouth for 60 seconds. Take care not to swallow it. For full fluoride protection, do not eat or drink for thirty minutes after rinsing.

If unable to rinse without swallowing, use a cotton swab or toothbrush to place a little fluoride rinse on teeth or try pouring a little rinse into a cup, dipping the toothbrush and brushing the rinse on.

If a chlorhexidine gluconate product, such as Colgate Periogard[R] is prescribed, use a sponge applicator (available in many medical supply stores) rather than a cotton swab, dip into the chlorhexidine, and rub on the teeth and gums.

Make it routine

Once techniques are developed and skills honed, daily oral hygiene should be emphasized. It may take patience and diligence to make it happen, but the payoff is worth it.

Regular dental check-ups should also become part of the family routine. If you would like more information or assistance finding a dentist who is experienced in caring for children with disabilities near your home, contact the Academy of Dentisty for Persons with Disabilities, 211 East Chicago Ave., Chicago, EL 60611. (312) 440-2660.

Steven P. Perlman, D.D.S., M.Sc.D., specializes in dental care for people with disabilities. In addition to his private practice, he teaches pediatric dentistry at the Boston University Goldman School of Dental Medicine. He is the former president of the Academy of Dentistry for Persons with Disabilities and a board member of the Federation of Special Care Organizations in Dentistry. Dr. Perlman also devotes much energy and time to the Special Olympics as clinical director of Special Smiles, a nationwide effort to screen Special Olympics athletes for oral problems. Dr. Perlman lives in Swampscott, Massachusetts.
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Author:Perlman, Steven P.
Publication:The Exceptional Parent
Date:Aug 1, 1997
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