Oral health for people with special needs
This fact sheet is designed to help both carers of people with special needs and individuals with a reduced capacity for self-care to develop and maintain a complete oral health care plan.
The most important components of maintaining good oral health is diet, access to fluoride and daily oral hygiene practices.
Maintaining a healthy diet
To protect oral health, provide a well balanced diet high in fruit and vegetables. Include lots of dairy products as they contain calcium, which is essential for healthy teeth.
Keep sugary snacks to a minimum. Each time food containing sugar or starch is eaten, the bacteria that attack teeth are immediately activated. Limiting the number of snacks reduces the incidence of these attacks. Avoid drinking sugary high acid soft drinks, sports drinks and fruit juices. If you do drink these, follow with a glass of water (preferably fluoridated tap water).
Fluoride strengthens tooth enamel, making your teeth more resistant to decay. Drink fluoridated water whenever available, and use a fluoride toothpaste twice daily. Fluoride tablets or drops should only be used if prescribed by a dental professional. They do not provide the same benefit to teeth as water fluoridation. For people at higher risk of developing tooth decay, seek professional dental advice about other fluoride options such as high dose fluoride toothpastes, gels or rinses.
Maintaining good oral hygiene
The main aim of good oral hygiene is to remove as much plaque from the teeth as possible. This is usually achieved by regular toothbrushing and flossing. However, brushing and flossing can be difficult for persons with special needs. Tips for carers are provided below.
Helping others brush their teeth
If a person is unable to hold or to use a traditional toothbrush, one of these suggestions may help:
- The person may be able to brush their teeth using an electric or battery-operated toothbrush.
- You may be able to attach the toothbrush to the individual’s hand using a wide elastic band (taking care the band is tight enough to secure the brush but loose enough not to limit circulation).
- If you run the handle of the toothbrush under very hot water to soften the plastic, you may be able to gently bend the brush handle to create a better angle.
- If the individual has difficulty grasping the toothbrush, thicken the handle by inserting it into a sponge, rubber ball or bicycle handle grip.
- If the individual has difficulty raising their hand, lengthen the toothbrush handle by attaching an extender such as a ruler, tongue depressor or wooden spoon.
- If the individual has difficulty holding their mouth open, consider using a mouth prop such as a rolled-up moistened washcloth, sterilised rubber doorstop or three or four tongue depressors taped together.
Brushing other people's teeth
There a number of different positions that can make brushing someone else’s teeth easier. The carer should always:
- support the individual's head
- take care that the individual does not choke or gag while their head is tilted (turn the head slightly to one side and reduce the amount of toothpaste used)
- ensure they can see properly inside the mouth and be able to manipulate a toothbrush freely and safely.
If the person is in a wheelchair, stand or sit behind the wheelchair, and lock the wheels of the chair for safety. Use one arm to brace the individual's head against the back or headrest of the wheelchair or against your own body.
To brush teeth sitting on the floor, have the person sit on the floor facing away from you. Sit on a chair immediately behind them and have them lean their head back against your knees. If they are uncooperative, gently place your legs over their arms and shoulders to keep them still.
You can also brush someone's teeth while they are lying down. Have the person lie on the floor, bed or sofa with their head raised slightly on a pillow. Kneel behind their head. They can also lay their head in your lap. Use your free arm to support their head and/or gently hold them still if necessary.
Sitting in a beanbag often lets the person relax without the fear of falling. Sit them comfortably in the beanbag and use the same technique as for someone who is lying down.
Flossing can be difficult. Floss holders, interdental brushes and other cleaning tools are available to help, however many people with special needs will not be able to floss independently. A carer can floss a person's teeth by positioning them in the same way as for toothbrushing. Visit our website for more information on correct flossing techniques.
Caring for the oral health of people with intellectual disabilities
People with dementia or other intellectual disabilities may require no, or only limited assistance, or may simply need reminding about their oral care. However, some will need a great deal of assistance and may have behavioural problems that make providing care difficult. Tips for carers are provided below.
- Be fully prepared. Have toothbrush, floss and paste ready.
- Make good use of verbal and non-verbal communication. Speak clearly and calmly and be reassuring. Explain what you are doing and remain in their sight if possible.
- You may find prompts such as placing a toothbrush in the individual's hand helps them to understand what you are about to do. However, never give a toothbrush to someone who is aggressive or has uncontrolled hand movements.
- Giving the person something familiar such as a favourite toy, pillow or cushion may provide them with a safe and pleasant distraction while you clean their teeth.
- You may find that placing your hand over their hand and brushing together helps with their acceptance of the oral care.
An occupational therapist can help carers develop an achievable oral health care plan for people with special needs.
For more information:
- contact your dental professional
- call 13 HEALTH (13 42 25 84) for confidential health advice 24 hours a day, seven days a week
- Queensland Health oral health website