Prevention
Prevention of oral disease is of paramount importance for individuals with physical and mental disabilities. Prevention programs must be developed early and carried out on a long-term basis. Ideally, oral hygiene procedures should be incorporated into daily rehabilitation, education and occupational therapy programs. Patients’ should be involved in performing their own oral hygiene as much as possible
Recommendations include:
- brushing teeth after each meal and before bedtime
- tooth brushes can be modified to enable people with physical disabilities to brush their own teeth
- automatic toothbrushes may improve patient complianc
- use fluoride toothpaste or fluoride gel
- flossing should be accomplished daily, however, it may be difficult for some people to perform. A second person may be required to perform flossing.
- use of disclosing solution may be beneficial in promoting behavioral changes in cooperative patients
- sealants may be beneficial in adults when oral hygiene is not ideal
- chlorhexidine mouth rinse may be beneficial in managing gingivitis and periodontal disease. This product should be swished and expectorated; patients who might swallow a rinse could benefit from its application with a toothbrush or cotton swab.
- topical fluorides are indicated when caries rates are high or patient experiences xerostomia; use brush-on gels, mouth rinses, as well as professional application during prophylaxis
- xerostomia is a frequent problem for many people with disabilities;artificial saliva, sugarless hard candy, or sugarless gum may help to keep the oral cavity moist and decrease the risk of oral disease
- dietary counseling may need to be considered for long term prevention of dental disease
- dental recall should be planned in accordance with the patient’s needs and abilities. People with severe dental disease may need to be seen every two to three months, or more often if necessary.
Patient and Caregiver Education
The first step in obtaining compliance with oral hygiene recommendations is by promoting patient involvement through education of the patient. This also maximizes the patients independence.
Education of the family members or other caregivers is critical for ensuring appropriate and regular supervision of daily oral hygiene. Caregivers should provide oral care only when the patient is unable to do so.
Caregivers should be educated in proper positioning of the person with a disability for oral hygiene care. Pillows, beans bags, chairs and other devices should be considered. Assistance from additional people may be helpful as well.
In-service education programs are necessary for caregivers in institutions and other residential settings such as group homes. In-service training may be presented twice a year at such facilities and can be reinforced at recall visits.
