Oral health advice for children and adults with extra needs

Encourage the person you are assisting to do as much toothbrushing as they can themselves. An adapted toothbrush may be needed to help them enable this.

The Collis Curve toothbrush and the Dr Barman’s Superbrush (which can both be ordered off the internet) are good toothbrushes to help aid with toothbrushing. If a person has difficulty gripping a toothbrush handle, wrapping foam tubing around the toothbrush can help.

Ideally, toothbrushing should be twice a day and the order of cleaning to be the same each time to avoid any areas of the mouth being missed. In circumstances where there might be resistance to cleaning, try cleaning a different part of the mouth each day.  To ensure that no teeth are missed, it’s a good idea to keep a toothbrushing chart so carers know which teeth need to be cleaned.

If there are any loose teeth then extra care should be taken to ensure they are cleaned thoroughly.

If swallowing is difficult, tilt the head forwards to help prevent aspiration of water.

Massage around the mouth and cheeks to help improve muscle tone and saliva flow.

Use a low-foaming toothpaste such as OraNurse, Biotene or Sensodyne Pronamel.

It can sometimes take two people to brush the teeth – one to brush while the other encourages or uses distraction techniques.

A small child can be cradled in the arms.

Supporting their head, you can brush the teeth by standing, kneeling or sitting behind them.

Sometimes brushing can cause distress. Try finding a time to do it when they are more relaxed.

Distractions like music or TV can help.

Grinding can sometimes be a problem to stop. Massaging the cheeks and mouth may aid in relaxation.

If gagging is a problem, start by brushing the front teeth and gently move the toothbrush towards the back of the mouth as much as they will allow.

Clamping down on the toothbrush can sometimes happen and if this is the case leave it in as a prop and use another toothbrush to clean the teeth you can reach.

It’s important to keep the mouth as clean as possible. Poor oral hygiene, fungal and bacterial infection can cause a sore mouth which may lead to poor eating and distress.

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Adults and children who are fed via a feeding tube:

Toothbrushing is still just as important if being fed through a feeding tube. A clean mouth is more comfortable.

Plaque bacteria can lead to a chest infection.

Brushing the teeth also helps get into good practice if the feeding tube is temporary.

Certain medications and systemic diseases can cause a dry mouth which can lead to potential tooth decay and gum disease.  Saliva substitutes can help to alleviate a dry mouth but it is important that you don’t stop medications unless advised by the person’s GP.

Changes in behaviour or eating habits can indicate that there is a dental problem, so it is important to consult a dentist and if it is dental-related they can advise the appropriate treatment.

It is important that the carer wears a new pair of clean, disposable single-use gloves each time they assist with oral health care.