■ Ahealthy mouth is important in maintaining quality of life for patients with disabilities.
■ The evidence is that there is significant unmet need in many people with disabilities and that the care offered does not always match that for other people.
■ Most oral disease is caused by:
● frequent dietary consumption of refined carbohydrates, causing dental caries
● infrequent or inadequate removal of dental bacterial plaque, causing gingivitis, periodontitis and halitosis.
■ Apreventive approach is essential.
■ Key workers assigned to a patient should be aware of the importance of preventive dental advice as part of the overall care plan.
■ Regular oral examination by a dental professional is important.
■ The frequency of these examinations must be individually assessed.
■ Early intervention can minimise future oral disease, pain, and the need for operative intervention and the associated use of anaesthesia and other drugs.
■ The key points for an oral health plan for patients with disabilities are:
● early assessment of oral health
● individual care plans drawn up following liaison with family and other health care providers for each case
● establish a good diet in liaison with a dietician – minimise refined carbohydrates, confectionery and between-meal snacking
● establish realistic methods of oral hygiene: – teeth should be cleaned at least twice daily, using a fluoridated toothpaste and a small-headed toothbrush – if the patient is unable to rinse and spit, chlorhexidine gel (gluconate) may be used in place of toothpaste – there are various aids available to help patients or their carers maintain a clean, comfortable oral environment; a dental hygienist can be particularly helpful in delivering advice and support – dentures should be assessed for fit and comfort as ill-fitting dentures can rub and cause discomfort and ulceration. Dentures (complete and partial) should be removed after every meal, rinsed in cold running water to remove food debris and checked for sharp edges and cracks. They should be replaced in the mouth after the mouth has been checked for food debris and wiped or rinsed clean. At night, dentures should be cleaned with a toothbrush and left to soak in fresh tap water overnight.