Helping others brush their teeth

Maintaining a healthy diet, practicing good oral hygiene, using flouride toothpaste and drinking fluoridated water, and regular dental check-ups are important for everyone when it comes to maintaining good oral health. People living with disability, or with reduced capacity for self-care may require help with their oral health routine. This could involve giving a simple reminder, through to helping with brushing and flossing.

Helping with toothbrushing and flossing

Brushing teeth twice a day and flossing daily are essential steps for good oral hygiene for everyone. As a carer, you may need to assist someone with brushing and flossing their teeth. The main aim is to assist them to remove as much plaque from their teeth as possible.

Toothbrushing

Teeth should be brushed twice a day, in the morning after breakfast and just before bed.

When choosing a toothbrush, use a small, soft-bristled toothbrush as it will help you reach all areas of their mouth. An electric toothbrush may be a better option if you, or the person you’re caring for has trouble handling a smaller toothbrush.

If you're assisting someone with brushing their teeth, you should be able to see inside their mouth and move the toothbrush freely and safely. If they have difficulty keeping their mouth open you could try dental aids, such as bite blocks. Speak to their dental practitioner or an occupational therapist for recommendations.

Brushing their teeth

• Find them a comfortable position, either sitting or standing. Make sure they can relax their mouth and jaw.
  • If the person is in a wheelchair, stand or sit behind the wheelchair and lock the wheels.
  • If the person is sitting on the floor, have them sit facing away from you. Sit on a chair immediately behind them and have them lean their head back against your knees.
  • Sitting on a beanbag might be an option as it lets the person relax without fear of falling. Sit them comfortably in the beanbag and kneel behind them. They can lay their head in your lap, or you can use your free arm to support their head.
• Try to position yourself so they can see you. You could place a mirror in front of you, or you could sit in front of them.
• Use disposable gloves for hygiene. Never put your fingers between a person’s teeth.
• Talk them through what you are doing and show them what tools you are going to use.
• Use a pea-sized amount of toothpaste and place the bristles of the toothbrush along the gum line. Brush all surfaces gently.
• Help them spit out the toothpaste into the basin or a bowl. Rinsing out their mouth isn’t necessary.

Remember to support the person's head and take care they do not choke or gag while their head is tilted. Turning their head slightly to one side and reducing the amount of toothpaste you use should prevent gagging or choking.

Flossing

If you, or the person you’re caring for requires help with flossing, teeth can be flossed in the same position as toothbrushing. Teeth should be flossed once a day using the correct flossing technique:

1. Take about 40cm of floss and wrap the ends around the second finger of each hand, leaving only a small piece between the 2 hands.
2. With 1 finger in the mouth, draw the floss down into the gap between 2 teeth using a gentle sawing action until it slips just slightly under the gum level. Use a wiping action to remove plaque and food debris.
3. Unwind clean sections of the floss as you move from gap to gap between your teeth.
4. Repeat these steps around the mouth until the spaces between all teeth are clean.

If you, or the person you are caring for finds it difficult or uncomfortable using dental floss, you can try an interdental brush or floss picks instead. They achieve the same result and may be easier to hold and use.

Caring for the oral health of a person living with intellectual disability

People with dementia or another intellectual disability may only need limited assistance or a simple reminder about their oral care. Here are some tips for carers of people with behavioural problems that may need care to manage their oral health:

• Be fully prepared. Have toothbrush, paste and floss 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. Avoid giving 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 develop their acceptance of the oral care.

An occupational therapist can help carers develop an achievable oral health care plan for people with a disability.

More information

• Public dental services
• healthdirect’s service finder
• Aids to help toothbrushing
• Your dental health: a guide for people with a disability, their family carers, friends and advocates