Presentation for Gr8 Support Workers
(Please read below or click and download the PDF here David Mudie Oral Hygiene Sessions)
Oral health is defined by the World Health Organisation as “a state of being free from mouth and facial pain, oral diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking and psychosocial well- being.” In other words, a mouth which is pain-free and works well.
It is well-recognised that people with learning disabilities, when compared with the general population, on average have:
• higher levels of gum disease
• more gum inflammation
• more missing teeth
• more toothlessness (i.e. no natural teeth left)
• more plaque on their teeth
• more untreated disease in their mouths
• poorer access to dental services including preventive care.
To achieve good oral health, we need:
• a good diet (i.e. low in sugar, particularly sugary snacks between meals, and acid, e.g. fizzy drinks, fruit juice)
• good oral hygiene (good brushing technique and the necessary equipment e.g. a toothbrush!)
• access to professional dental care – for prevention advice and treatment, and, when necessary, repair of damage caused by tooth decay, gum disease and trauma.
Expanding on this:
Diet – confine sugar and acid intake to mealtimes, cut out sugary snacks and fizzy drinks between meals.
Oral hygiene – make sure the supported person has a toothbrush, is able to use it well or has hands-on help; electric is better than manual, but manual is fine (some don’t like the sensation of electric); non-foaming, taste-free toothpaste, and water temperature, for people with sensory difficulties; Dr Barman’s Superbrush; brush for 2-3 minutes if possible – maybe play a song of that length on a phone or Bluetooth speaker while brushing; make it fun! High fluoride toothpaste may be appropriate (prescription only). Mouthrinse is an adjunct to oral hygiene but brushing is most important. Finger guard may be useful in gaining access to the mouth.
Access to dental care – there is almost certainly a Community Special Care Dental Service in your area, but it may be a bit difficult to track down. Some high street dentists are happy to see people with learning difficulties, but the Community Service may have more accessible premises and more experience in this area of dentistry. Will almost certainly be able to provide sedation options if appropriate, or referral into GA services if necessary.
Managing fear of the dentist: alert dentist that the person is nervous/anxious. Any specific triggers for the fear e.g. dental instruments, injections, entering the surgery? May be helped by a chat with the dentist in the waiting room, or a visit to the surgery just to look around, or photos of the building, waiting room, surgery, dental staff which can be shown to the person beforehand in the run-up to a dental visit. The dentist may be happy to do a home visit. Acclimatisation can take time and many visits.
Get specific advice from the dentist on oral hygiene targeted for that person. Take toothbrush to the dental appointment.
What if someone refuses to go to the dentist? Dentist may be happy to do a home visit. May be appropriate to prescribe pre-med e.g. Diazepam. Try to engage the dentist in working out a plan. Some may be more willing to go if they have pain – try to maximise the opportunity if this occurs.
How to help someone understand the impact of not keeping their teeth clean: depends on the person’s understanding and insight. Have they, or do they know someone else, who has had dental pain? Do they know anyone with really smelly breath?
Managing sensory issues: oraNurse toothpaste. Can they tolerate manual brushing? Electric brushing? What are the specific sensory issues?
Top tips
1) Brushing teeth – do it in order, e.g. starting on the outside of the lower jaw on one side at the back, then slowly working around all the teeth until the other end of the dental arch is reached. Then swap to the inside and go all the way back round; then the outside surfaces of the upper teeth from one end to the other, then the inside surfaces.
2) Build channels of communication with everyone involved in the care of the person you’re supporting
3) Be guided by the supported person’s dentist
4) Try to make brushing sessions fun in some way
Resources
Feel free to contact me with any questions: david.mudie@nhs.net
easyhealth.org.uk – a website providing health information with easy-to-understand word, pictures and short films, including items about dentistry, and a short film about what to expect when visiting the dentist.
oraNurse toothpaste – un-flavoured, non-foaming toothpaste ideal for people with sensory issues. Use a pea- sized blob of paste on a dry brush.
Information: https://www.dentalhealth.org/dental-care-for- people-with-special-needsdentocare.co.uk – oral hygiene products including Dr Barman’s brushes
