Oral Health Care for Individuals with Developmental Disabilities

1. Oral Health Care for Individuals with Developmental Disabilities Tools and Techniques for Providers and Caregivers

2. Modifications may be required due to: • Limited ability to understand • Behaviors that may interfere with treatment • Lack of control over muscle movements and position • Adaptive devices (such as wheelchairs and gastric or breathing tubes) • Multiple medications • Complex medical conditions

3. Importance of Oral Health Care • Key component of general health and well being • Affects behavior and behavioral changes • Also affects: • Appearance • Speech • Comfort • Chewing • Nutrition • Breath

4. Healthy Gums Coral Pink Gums Knife edged papillae Normal pigmentation

5. Unhealthy gums Gingivitis Periodontitis Swollen, shiny, red gums and gum loss Puffy, red gums

6. Unhealthy gums • Bleed easily • Are puffy or swollen • Are very red • May shrink away from the teeth making the teeth appear longer • May be draining pus • Usually appear covered with plaque and food particles

7. What Causes Gum Disease? • Poor oral hygiene and failure to remove bacterial plaque and food debris from teeth and gumlines. • Oral bacteria • Medications that : • Cause dry mouth (lack of saliva) • Cause gum overgrowth • Have high sugar content that promote plaque build up

8. Healthy Teeth

9. Three Steps to a Healthy Mouth 1. Brush every day - twice a day 2. Floss every day – at least once a day if possible. 3. Visit a dentist regularly

10. Providing Oral Hygiene • Make Home Care Routine • Same time • Every day after breakfast and before bedtime • Same place • Bathroom • Kitchen table and chair • Bed (elevate head of bed 30 degrees) • Bean bag chair • Wheelchair

11. Positioning Yourself Tips for homecare: • Stand behind the person. • Additional support may be gained from standing against a wall. • Use one arm to cradle the person’s head against your body. • Use the other arm and hand to brush the person’s teeth.

12. Illustrations

13. Providing Oral Hygiene • Make sure soft bristle tooth brush, tooth paste and floss are easy to reach. • Change toothbrush every three months or more frequently as needed. • Have a cup or basin available for rinsing and spitting if possible. • Have a towel available. • Provide adequate lighting and a mirror.

14. Providing Oral Hygiene • Use “tell, show, do” method: • Tell: person what will happen • Show: what you are going to do. • Do: begin oral hygiene • Be creative: have a favorite toy or music available to comfort person • A person with impaired senses may benefit from smelling, tasting, and touching toothpaste, brush and dental floss. • Acknowledge good behavior with positive feedback • Allow time to adjust to dental care and develop trust when working in and around their mouth.

15. Brushing • Let the person try to brush by themselves first. • Use the hand over patient’s hand technique to guide the toothbrush.

16. If assistance is needed… • Wash hands and/or put on disposable gloves. • Sit or stand where you can see all of the teeth. • Place pea-sized amount of toothpaste on brush if tolerated by person. If not use water or nothing at all. • Brush front, back, top, and gumline of each tooth in short back and forth strokes. • Gently brush the tongue • Rinse with plain water or wipe with gauze sponge. • Be an active observer and check for unusual changes.

17. Adapting toothbrushes • Make the handle easier to hold with Velcro, a tennis ball, bicycle grip, tape etc. Toothbrush handle enhanced with tennis ball Plak-vac toothbrush for swallowing difficulties Collis Curve 3 brushing surfaces

18. Adapting toothbrushes • Power toothbrushes may make cleaning easier. • Take time to help the person get used to using the power brush. • If person is sensitive to toothpaste try different toothpaste flavors such as bubble gum or grape.

19. Flossing • Cleans between teeth where a toothbrush can’t reach. • Flossing is a tough job that may take a lot of practice. • Many types are available: waxed, unwaxed, flavored, or tape. • If you have trouble try using a floss holder

20. Flossing • Wash hands and/or put on disposable gloves. • Use a string of floss about 18 inches long. • Wrap the floss around the middle finger of each hand. • Grip the floss between the thumb and index finger of each hand and work gently between the teeth until it reaches the gums. • Do this for every tooth one side at a time.

21. Rinsing • The dentist or hygienist may recommend a special rinse. • Fluoride rinses help to prevent cavities. • Antibacterial mouth rinses may help to fight gum disease. • For persons with swallowing problems a cotton swab, damp gauze, or toothbrush may be used.