The Dental Booklet

The Dental Booklet
Introduction
As parents and carers of children with autism are aware, maintaining
oral hygiene and dental health can be challenging.
Every individual with autism varies in terms of their sensory issues,
abilities and needs.
Literature suggests that many children with autism may be more at
risk of suffering from certain dental conditions as a result of such
characteristics.
These may include tooth decay, gum disease, oral trauma,
tooth wear, acid erosion and dry mouth conditions.
Prevention of these dental conditions is better than cure and may
prevent unnecessary pain and anxiety in the future.
This booklet contains information and tips on how to maintain oral
health to help reduce the risk of dental disease in the future.
Visiting the dentist can also be a very stressful, traumatic experience
due to the unfamiliar sounds, smells, tastes and appearance.
This booklet contains tips and suggestions that may help to prepare
for a visit.
Technique & Tips
It is important to brush our teeth every day to:
Brushing should start as soon as the first baby tooth erupts.
Remove plaque, bacteria and food debris
Keep teeth and gums healthy
Protect against bleeding gums, gum disease and tooth decay
Teeth should be brushed twice daily.
Types
Manual Toothbrushes:
Use a small headed manual tooth brush with soft bristles to minimise
irritation.
Modifications can be made to the toothbrush
handle to improve comfort/handling.
For example, tennis balls, bicycle handles,
velcro hand straps, pencil grips.
Modified toothbrushes with double heads can also be
bought at specialised Shops/websites. These can make
brushing easier as they brush 2 surfaces at once.
Electric oscillating tooth brushes:
These remove more plaque than a manual toothbrush.
They have a chunky handle for comfort and many
have timers.
They are easy to use and do all the work for you.
If you are brushing your child’s teeth: Stand behind your child
or sit them on your knee in front of the mirror.
Head support against a chair/headrest may help reduce resistance.
Use small circular strokes to brush all the teeth and
gumline ensuring that all surfaces are brushed (the
outside, inside and biting surface).
Outside Surface
Ideally, brushing the whole mouth should take 2 minutes.
The use of an egg timer may help your child gauge how
long the ‘activity’ takes.
After brushing, allow your child to spit out the
excess toothpaste.
DO NOT RINSE OUT after brushing as this
washes away the protective fluoride paste.
Inside Surface
If a mouthwash is being used, ensure it is used
Biting Surface
at a different time to brushing for maximum effect.
If your child is unable to ‘rinse’, use a cloth around
your finger to wipe the mouthwash onto the teeth and gums.
Children should be supervised and should never be allowed
to eat toothpaste.
Toothpastes
Toothpaste containing 1350-1500ppm(parts per million) fluoride
should be used to help protect against tooth decay.
For children under 3 years: a smear (a thin film covering less than
¾ of the brush) of paste should be used.
For children aged 3-6 years: a small pea-sized
amount of paste should be used.
Toothpastes are available in a range of flavours, so take the time to
experiment with various brands until a tolerable flavour is accepted.
 Continuous praise and encouragement throughout. Try to avoid
showing your frustration as this may increase anxiety. Try to create a fun
atmosphere instead.
Inroduce a reward system/chart. For example, a tick/colouring the chart after
each brushing session and a reward may be given for a week of successful
brushing.
To minimise anxiety, introduce the toothbrush gradually:
 Introduce the toothbrush over a period of time, allow them to touch it
and play with it until they are comfortable.
 Allow them to lick it and encourage them to put it in their mouth.
Introducing tooth brushing into the routine…..
 Carry out tooth brushing at the same time each day using the
same technique so that it becomes part of the routine
 If this is not successful, try to familiarise them with the sensation by
massaging their gums with your finger and allow them to do the same.
Then perhaps use a flannel or sponge over your finger to introduce different
textures and sensations.
 Carry out tooth brushing in the most comfortable/familiar room to
minimise anxiety.
 Once familiar with the brush, place in the mouth with little
or no brushing at first to reduce anxiety.
 Make it a fun activity, play some favourite music or sing a song
and get the family involved.
Firstly, carry out very slow, gentle movements a little at a time.
Perhaps start by brushing only a few teeth at first to desensitize them
to the feeling.
Gradually increase the brushing over time until it is possible to brush
the whole mouth.
 If you are encouraging your child to brush their own teeth, brush yours
at the same time and go through each brushing stage together. Encourage
them to copy you.
 ‘Tell-Show-Do’ approach: tell them what you are going to do, show
them how to do it and then brush the teeth. It may help to demonstrate and
brush ‘teddy’s teeth’ first.
 Mount a tooth brushing picture chart on a wall where brushing takes
place and follow each stage to aid brushing. Research shows that
picture /visual aids help to improve oral hygiene in autistic children.
If your child clamps down on the brush, use it as a prop and
use a second brush to clean the teeth.
Whilst some may not tolerate the use of an electric
toothbrush due to the sound and vibrations, other
may enjoy the sensation, allowing successful brushing.
 Do not add sugar to weaning foods.
When we consume foods and drinks that contain
sugar, the bacteria in our plaque turn the sugar
into acids.
If sugar is consumed too frequently, these acids can damage
our teeth and cause decay.
 Avoid thickening agents that contain maltodextrin as this contains
sugar. Your GP/dietician can recommend a sugar free alternative.
 Read the food/drink labels as many contain ‘hidden sugars’.
For example: sucrose, glucose, maltose, dextrose, syrup,
honey, treacle, invert sugar, dextrin, maltodextrin.
 Juices that say ‘no added sugar’ still
contain natural sugars that can help to
cause decay. Substitute these drinks with water or cows
milk as milk and water are ‘safe’ drinks.
TIPS TO HELP REDUCE THE RISK OF TOOTH DECAY…..
 Reduce the amount and frequency of food/drinks that
contain sugar.
 Restrict sugar containing food/drink to meal times to allow
adequate time in between meals for the damage caused to
be repaired by minerals contained in saliva.
 Restrict sugar consumption to a maximum of 4 times a day.
 Avoid sugars before bed as the reduced saliva flow during
sleep cannot help repair the damage caused by the acids.
 Brushing 2xdaily with 1350-1500ppm toothpaste. High fluoride
pastes and mouthwashes may be prescribed by your dentist.
 Give dietary supplements containing sugar/glucose at
meal times and not last thing at night.
 The majority of medications contain sugar,
especially in oral suspension form.
If a sugar-free version is not available from your doctor,
try to take these medications at meal times and avoid
taking before bed.
Foods & Drinks containing
sugar:
Chocolate & sweets
Cakes & biscuits
Pastries, fruit pies, puddings
Table sugar
Sugared breakfast cereals
Jams & honey
Ice cream
Fruit in syrup & dried fruits
Fresh fruit juices
Sugared soft/fizzy drinks
Sugared milk based drinks
Syrups and sweet sauces
‘Safe’ healthy Snacks:
Milk & Water
Pitta bread & bread sticks
Wholemeal toast
Cheese & cheese spread
Chesse on toast
Rice cakes
Bagels & crumpets
Unsalted nuts
Lean meats, tuna, egg
Plain yoghurt & chopped fruit
Carrot, celery, cucumber sticks
Apples, grapes, bananas
-The use of fluoride mouthwash can help strengthen enamel
and reduce sensitivity.
Acid erosion is the loss of tooth surface, caused by the
dissolving action of acids over time.
This results in the gradual thinning and loss of enamel and can
progress to the underlying dentine layer causing sensitivity,
increasing the risk of tooth decay and
possibly death of the tooth nerve.
-Visit the dentist, as they can provide topical fluoride
treatments/high fluoride toothpaste to help reduce the
sensitivity and strengthen enamel.
-Consult your GP if your child is suffering from gastric
reflux or if medications are causing vomiting.
Common causes of erosion:
1) Diet: Acids such as phosphoric, citric, malic and ascorbic
found in fruit, fruit juices, sweets, fizzy drinks
sports drinks, aspirin and fruit teas.
2) Stomach acid: Hydrochloric acid from the stomach during
gastric reflux, vomiting, regurgitation.
Ways to reduce acid erosion:
-Limit the frequency of acidic drinks/foods and consume them at
meal times. Drink milk and water as a substitute.
-Use a straw when drinking the acidic drinks and discourage swishing
round the mouth before swallowing
Oral trauma caused by self injurous behaviour and accidents
can be common.
Be vigilant when carrying out oral hygiene and inspect the teeth,
gums, lips, tongue, palate as well as the face for signs of
trauma such as:
Ulcers
Damaged/torn gums
Damaged/missing teeth
Trauma to lips
Visit the doctor/dentist if you notice any unusual
trauma as it may require urgent attention.
-Milk and cheese can help neutralise the acid
-Avoid brushing the teeth for at least an hour after
consuming any acidic drinks/food or vomiting.
Antibacterial/antiseptic mouthwashes containing 0.2%
chlorhexidine provide 12 hour antibacterial action
so are beneficial for acute gum problems,
such as ulcers/sores.
It should be used at a different time to brushing
to maximise its effect.
Excessive grinding and clenching of the teeth during the
day and night can cause gradual wear of tooth surface,
pain, tooth loss and jaw problems.
Dry mouth (xerostomia) due to a reduction in saliva flow
can often be a side effect of certain
antidepressant, antipsychotic and
anticonvulsant medication.
Grinding/wear can be caused by stress, irregular biting position,
medication side effects, epilepsy, seizures, developmental tooth
defects and missing teeth.
Dry mouth can result in discomfort, reduced taste,
increased risk of tooth decay, gum disease and oral infections.
It can effect speech, chewing and swallowing.
Consult the dentist…..
Consult the doctor and if there is no alternative medication,
there are tips to help reduce the effects of dry mouth…..
- The dentist may produce a custom made
mouth guard to help reduce wear.
-The dentist may also be able modify the
way in which the teeth bite together if appropriate.
 Saliva substitutes:
Sprays, gels, pastilles, tablets and mouthwashes,
such as Luborant, Salivix, SST, Biotene etc.
Many are available in chemists or consult your doctor advice.
-The dentist may repair the teeth to reduce pain and restore function.
 Frequent sipping of plain water (avoid drinks containing sugar)
-The dentist may provide topical fluoride treatments/high fluoride
toothpaste to help reduce the sensitivity
 Rinsing mouth with plain water after meals to help cleansing
and removal of food debris
Relaxation/stretching techniques may help…..
The dentist/doctor may be able to recommend some techniques,
such as:
-Stretching and massaging the jaw muscles may help relax them.
With a slightly open mouth, place your knuckles under the
cheek bones and slowly drag them down the face towards the
bottom of your jaw. This can be repeated numerous times
throughout the day if required.
 Bathing the mouth with moist gauze
 Lubricate dry lips with petroleum jelly
 Avoid spicy foods as these dehydrate tissues
 Prescription fluoride toothpastes, mouthwashes and fluoride
treatments from dentist to help fight tooth decay
Here are some tips to help prepare for a visit to the dentist:
Arrange a trial visit to meet the staff & become familiar with the
environment, smells, noises & equipment.
Purchase a disposable mouth mirror from a pharmacy
to practice before the visit.
Take a favourite toy/blanket along for comfort & to help occupy.
Request the first appointment to avoid waiting and a busy waiting room.
Hold hands throughout the appointment to provide support
& to avoid flapping/rocking during treatment.
Keep appointments short.
Spread the treatment out across multiple short appointments to avoid
prolonged stress/discomfort & to develop familiarity & trust
with the dental environment and staff.
Take a personal stereo along to the appointment for your child to
listen to during treatment to reduce the noise of the
equipment.
Inform your child of the appointment in advance to avoid a last minute
struggle. It may seem easier to leave it til the last minute or take your
child to the dentist unaware, but in the long run it may cause increased
anxiety & resistance/refusal.
The use of picture story books eg, ‘My First Trip To The
Dentist’ and ‘autism social stories’ can help explain what
will happen, what to expect and why we need to go to the dentist.
Provide plenty of praise & encouragement during and after the
appointment.
Provide a reward after the appointment for positive reinforcement.
Provide the dentist with as much information as possible about your
child’s medical history, needs, behaviour and sensitivities so they are
fully aware and prepared.
21/09/2010. Copies available from www.autismgm.org.uk
National Autistic Society, Anglo House, Chapel Road,
Northenden, Manchester, M22 4JN, 0161 9984667
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