DISCLOSURE: Noelle Copeland RDH is an Oral Care Specialist and Dental Consultant who provides content for Brilliant Oral Care and Baby Buddy.
Dental care for people with disabilities is not all that different than dental care for those without. Everyone needs to have their teeth brushed at least twice a day and flossed at least once a day. They also need to see a dental professional regularly for care and maintenance. Therefore, a wheelchair itself may not be a hindrance to oral care. However, the reason behind the need for a wheelchair could be. For instance, someone with cerebral palsy may not have the ability to grasp or hold a toothbrush, making oral care a provider-assisted activity. They may also not have the mobility to hold their head still and upright, making oral care a challenge.
Some of the tips I’ve learned over the years that have helped me professionally and personally while assisting someone in a wheelchair are the following:
- NO matter what, always make sure the brakes of the wheelchair are locked before ever attempting to move a person or perform activities for them like oral care.
Use a wheelchair transfer board as an assistant = This is a board that can assist in moving someone from a wheelchair to another seat or chair. It usually requires 2 people to manage, especially if the person has little or no strength in their arms and upper body. The person should wear a gait belt while being transferred. This helps the assister grasp and slide the patient. Transfer boards are beneficial to move someone to a bed, car, toilet, dental chair, or other chair or seat. Additionally, the board can be used to stabilize the head if needed.
I once had a patient with cerebral palsy, and most of the time, she was up for moving into the dental chair for her cleanings. Sometimes though, she was not. She did have a wheelchair that would recline back some, so we would use her transfer board and slide it behind her back. This allowed her to lean back while having her teeth cleaned and rest her head and neck against the board. This was also how they brushed her teeth at home.
Use your body for stabilization and balance= If you don’t have access to a transfer board, you can also use your body to help balance someone. For example, stand behind the wheelchair and use your arm to gently stabilize the head against the wheelchair or your body. Some people also have head straps they use that help in these circumstances, eliminating the need to use your arm. If needed, use a regular pillow for added support or a small neck pillow (the kind people take on airplanes) to help tilt the head back. You can also follow these steps while you are sitting down in a chair behind the wheelchair.
Move them to another location = Sometimes, it’s easier to do oral care in a completely different setting. The sofa, the bed, on the floor, in a pool, wherever is best for them. You don’t need to be in a bathroom or near it, for that matter. If they can spit and you can use toothpaste, then keep a cup for them to spit in close by. Another handy hack is to use a spray bottle of water to rinse their mouth out while brushing their teeth. In a dental office, we have air/water syringes that do this for us, but at home, you can recreate this using a small, clean spray bottle that’s filled with bottled water.
*Don’t leave the water in the spray bottle*.
Empty it, let it air dry, and refill it with fresh, clean water every time it’s used. You can also use this trick for anyone with a dry mouth to help keep the tissues moist.
Flossing and not flossing = If I’m honest, I have never had great success regularly and effectively flossing the teeth of someone who was in a wheelchair and who also had mobility or muscle challenges. Most of the time, their caretakers also expressed this same frustration. However, I have been able to implement very successful alternatives. If you can floss the front teeth, or at least some of them, then do that in addition to some other suggestions I will make.
The challenge seems to be getting further back in the mouth, around the molars. Flossing the molars and premolars can cause gagging, which induces them to bite down, making it very difficult to floss their teeth for them.
The next best thing to using string floss is to use a proxy brush or a gum soft pic.
| PROXY BRUSHES
These are my FAVORITE dental tools outside of a toothbrush and floss. The end of the tool is used between the teeth at the gum line, kind of like a toothpick. You insert the cleaner tip in between two teeth and gently scrub back and forth to remove plaque, bacteria, and food from underneath the gums and between the teeth.
The great thing about using interdental tools is that you can use them from the ‘front-side’
of the teeth. You don’t need to try and get your fingers into the mouth, near the tongue. There are even units of proxy brushes with a long handle, the length of a toothbrush if you really struggle with compliance.
Most of my success in oral care for someone in a wheelchair has been in utilizing the options above, in addition to what I typically recommend for dental hygiene, which I will highlight below.
How to Brush someone else’s teeth.
For starters, you need to commit to brushing, in any fashion, twice a day, every day, in the morning, and at night before bedtime. This is literally half the battle right there. If you have adopted the habit of twice a day brushing, you can always work on technique and style later. First, however, the foundation has to be there to build anything of substantial value.
Next, choose the optimal brush type for your specific needs. Most people age 1yrs + will be using a bristle-type toothbrush, and this is the best choice. It’s important to rinse the brush with warm/hot water as a prep rinse before using. This rinses away any dried debris and softens the bristles.
Not everyone can tolerate a bristle toothbrush, so other options may need to be explored, like a silicone-based toothbrush, for instance.
- If you haven't already done so, wash your hands with hot soapy water.
- Apply a small amount of gel or paste to the bristles if tolerated.
- Hold the brush and place it in the mouth, preferably starting in the back of the mouth, top or bottom; it doesn't matter. However, it may be easier to start gently on the front teeth and work your back, depending on any sensory issue.
- Angle the bristles to 45 degrees by tilting the brush slightly up toward the gum line, and this applies to all standard flat, one-sided toothbrushes but not Brilliant® toothbrushes.
- Brush every tooth with small back and forth strokes if using a manual toothbrush. If you have a sonic or electric toothbrush, please follow the directions for brush strokes that came with your brush.
- Reach each tooth individually and one at a time. Do not use long sweeping motions but rather short brushing strokes, focusing on one tooth at a time.
- Brush every surface of every tooth, including the top chewing surfaces, and don't forget to brush the tongue. If you cannot brush the tongue, try using a mouth wipe enhanced with xylitol to clean the tongue.
- You should replace a toothbrush every 3-4 months and sooner if the brush displays visuals signs of wear or bent bristles.
If you were looking for effective and healthy ways to establish oral care routines with your family, you found the right place. https://www.brilliantoralcare.com/collections/sonic-toothbrushes
Be sure to check out our selection of specialty toothbrushes for individuals with special needs. This includes our silicone toothbrushes that make oral care easy to start. In addition, our sonic toothbrush for kids makes oral care fun, while our sonic travel toothbrush makes oral care a breeze when on the go.
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