Most severely disabled individuals need some type of special help to maintain good oral health and receive dental care, and often need someone else to brush and floss their teeth for them. The type and level of care will depend on their specific needs. Your dentist will be able to provide more information as well as a referral to a dentist with the appropriate skills for treating disabled and special needs patients.
Patients with special needs are often provided with sedation dentistry. Sedation dentistry allows the patient to remain calm and helps him or her to avoid excessive movement while receiving dental care. Types of sedation include:
- IV (intravenous) sedation – this type of sedation may be provided in a private office or a hospital. Medication is provided via the bloodstream, and the patient is closely monitored to ensure his or her safety throughout the entire procedure. Many states require a special permit to provide IV sedation. You may need to receive an endorsement from your physician before you can receive an IV sedation treatment in a dentist’s office.
- Nitrous Oxide (laughing gas) – a sedation method that relies on inhaling a special gas. Side effects are minimal, and wear off shortly after the patient stops inhaling the gas. This is an extremely safe sedation option.
- Oral Sedation – if you receive this sedation treatment, the dentist will provide an oral medication, usually a pill, which the patient will need to take prior to coming to the dentist’s office.
- Local Anesthetic – basic pain relief, usually provided via injection at the dentist’s office. Local anesthetic affects only the area where the treatment or procedure is being performed.
If a person with special needs will not let you near his or her mouth due to fear, unfamiliarity with the toothbrush, or is defensive when you get close to the mouth we recommend that you gently desensitize him or her over a period of time. Please be aware that this may take several weeks.
- By wrapping wet gauze or a washcloth around your finger, and move it around the lips in a massaging motion until the child or adult will accept it.
- When the individual is accustomed to this and appears to like (or at the very least, accept) it, start to go inside the mouth. This may take a few sessions. The back teeth are generally less sensitive than the front teeth, so start there. Be very patient while doing this.
- Be sure to use a soft or ultra-soft bristled toothbrush. Warm the bristles with warm water to soften them further so that the child or adult will be more willing to accept the toothbrush.
- If the person for some reason is gagging, stop immediately.
- You may give the person an old brush and let him or her play before or after the tooth brushing session.
- Repeat this systematic desensitization in the same place and at the same time each day, and give the child or adult a reward after the session is over.
- Introduce toothpaste at some point in this process. The toothpaste should taste good to the child or adult, so do not use anything that will turn them off . Please use only a pea-sized drop of toothpaste. If toothpaste is not liked for any reason , use water or a mouth rinse. Do not feel bad if your child or adult never becomes accustomed to toothpaste.
Do not use a mechanical toothbrush until your child or adult has accepted a regular brush first. Parents of children with seizure disorders should consult with their physician before using any electric toothbrush, as it may trigger seizures in some cases.