Everyone needs dental care every day.  Brushing and flossing are crucial activities that affect our overall health.  A healthy mouth helps people eat well, avoid pain and tooth loss, and feel good about themselves. 

Although critical, excellent oral home care for someone with a physical, developmental or behavioral disability can often be difficult and time consuming.  It requires a great deal of patience, skill, planning and time on the part of the caregiver.  Today, I would like to share some ideas that may help if you or someone you knows is responsible for helping someone brush and floss.

Getting Started

The bathroom isn’t the only place to brush someone’s teeth.  The kitchen or dining room may prove to be more comfortable.  Instead of standing next to a bathroom sink, allow the person to sit at a table so you will have better access.  Place the toothbrush, toothpaste and floss along with a bowl and a glass of water on the table within easy reach.  Make sure you are in an area with adequate light.  It’s hard to help someone brush if you can’t see inside their mouth!

Preparing and Brushing

If the person you are caring for is unable to brush, here are some suggestions that may help.  First, wash your hands and put on disposable gloves.  Be sure to utilize a brush that has soft bristles.  Use a minimum amount of toothpaste with fluoride (pea size) or none at all.  Toothpaste can bother people who have swallowing concerns.  If this is the case, brush with water instead.  Angle the brush toward the gums and brush the front, back and top of each tooth with short, gentle strokes.  Don’t forget to brush their tongue when you are through with the teeth as it will collect plaque as well.  When finished, help the person rinse with plain water or for those who can’t rinse, consider sweeping the mouth with a finger wrapped in gauze.  For continued health, it is important to replace the toothbrush every three months or after a contagious illness. 

Positioning Yourself for Adequate Access

Prior to brushing, it is important for you to have good access to the person’s mouth.  The will help keep the person safe and make your job a lot easier.  You must sit or stand in a position where you can see all of the surfaces of the teeth.  Below are a few recommended positions that allow the caregiver good access and the ability to support the person’s head you are caring for.  Don’t be alarmed, these positions look like you are putting them in a "headlock”, but all of this is done with extreme gentleness and care.  Even so, I would recommend if you work in a group home or care giving facility, get permission from your supervisor before trying any of these positions.  If the person you are helping is confined to a wheelchair, sit behind it, lock the wheels and tilt the chair into your lap.  Another option is to stand behind the person (you can lean against a wall for additional support) and gently cradle the person’s head against your body with your arm.  Both of these positions offer excellent stability and access.  Next week I will offer some advice to help those patients who can brush by themselves, but have physical limitations that make it difficult.