It is not unusual for parents and carers responsible for the day to day care of autistic children and adults to find it difficult to encourage the person with autism to clean their own teeth and mouth. Equally delivering this care can be even more difficult.
It is essential that mouth care is delivered. The obvious reason for this is to maintain good hygiene and quality of life. It is also considered a form of abuse if oral care is neglected and you are the carer (Department of Health ‘No secrets’ publication).
Trust plays a major role in co-operation and compliancy with mouth care. Give plenty of time and room when care is provided. There is no law to say when mouth care should be delivered, so wait until they are ready or in the right mood for the delivery of care – but don’t break a routine if you know it works for them. Use your knowledge of the individual to assess when or where is a good time for them to be relaxed about mouth care.
Every person has their own needs and tastes so it is essential to establish what the best tools are to deliver care. For instance, a child may not like strong flavours i.e. mint and could find it hard to use a standard minty toothpaste.
They may react badly to care being delivered because of a previous bad experience, perhaps they don’t like bright lights or be distracted by a smell in a room or nearby sounds. It could also be that they have been restricted while their teeth have been cleaned to prevent them lashing about – this is not unusual with some parents who feel this is the only way mouth care can be delivered.
They may also be in pain or have an irrational fear of gagging or choking – perhaps even be put off by the colour of the toothbrush.
Always bear in mind that if a person doesn’t need assistance and can clearly manage to clean their teeth reasonably well, then let them manage their own care and keep them as independent as possible.
Good oral care can still be provided if the person is nil by mouth, has excessive drooling, is positioned awkwardly, has swallow problems or even if unconscious.
- Never wet the toothbrush. Apply a pea sized piece or even just a scraping of SLS free (non-foaming) toothpaste onto a dry brush – clean the teeth in the usual way – and just walk away and rinse out the brush.
- This greatly reduces any gagging or choking hazards and reduces cleaning time; fast cleaning doesn’t mean mouth care is ineffective.
- Should there be any kind of mouth infection i.e. ulcers, cold sores or oral thrush – once the infection has cleared throw away the toothbrush – this is commonly how reinfection occurs.
- If they refuse to open their mouth why not smear some toothpaste on their lips – chances are they will lick it off and although not ideal to replace brushing as least toothpaste is getting into the mouth.
- Use a high fluoride (1400-1500ppm) toothpaste.
- Use an unflavoured toothpaste if minty is too strong or fruit flavoured pastes don’t have a high enough fluoride content.
- Use a toothbrush that cleans the whole tooth in one motion i.e. a 3 headed toothbrush.
- Use a mouthrinse with fluoride but no alcohol.
- Prepare for a dental visit by finding a practice that understands how to manage adults and children with difficulties; tell the dentist what problems may be encountered:
- Does not like the dental chair moving
- Does not like the dental chair to be moved right back
- Finds loud noises causes distress
- Cannot always tell where it hurts
- May not respond to pain, or may respond in the usual manner
- Is frightened of strange environments and this may show in unusual or challenging behaviour
- Cannot wait, so may need to be seen promptly
- Does not like to be touched, but may touch others
- Finds smells, textures or taste upsetting
- Finds bright lighting disturbing and this can influence behaviour
Prepare the patient: A slow introduction to the surgery over a period of time will help the patient get used to the unfamiliar surroundings and to gain in confidence.
Prepare and explain what is going to happen and make sure that the patient goes with someone that they know well and who has been part of the preparation.
Practise opening mouth ready for the dentist to look inside. Use dental pictures or photos, books and toys to familiarise the patient before their visit.
Before the first visit, discuss previous experiences of dental appointments with the dental team and let them know of useful tips (see above). Ensure to take details of current medication or their Health Assessment Book, Personal Health Action Plan (or similar).
Ask the dental team if you can visit the surgery before the appointment so you know what to expect. Experiencing the sights sounds and smells of the surgery may help you identify something that will help in preparing the patient for their first visit.