Preventing oral and dental disease in people with developmental disability

Oral biofilm diseases, specifically dental caries and periodontal disease (eg gingivitis, periodontitis) are preventable. Cleaning the teeth and supporting gingival tissues are fundamental. Medical practitioners have a role in promoting oral health in people with developmental disability, who may see a dentist infrequently. Encourage people with developmental disability to have regular dental reviews.

Many people with developmental disability need assistance to clean their teeth. Toothbrushing is a complex process that requires fine motor skills, planning, memory and coordination. Some people with disability and swallowing disorders also struggle to manage the fluids and pastes used during toothbrushing, and some have reflexes or oral hypersensitivity which impede oral care.

If a toothbrush is used incorrectly, it can cause trauma to the soft tissues of the mouth. It is natural for a person with developmental disability to resist toothbrushing if it has caused pain or if there is a history of orofacial abuse or trauma. People with developmental disability may have retained reflexes (eg bite reflex), have a sensitive gag reflex, or aversion to tastes or touch that makes regular oral care difficult to perform. Consider referring the person with developmental disability and their carers to a behaviour support practitioner for advice and information about addressing barriers to oral care, see Behaviour support for a person with developmental disability.

The following strategies can assist in ensuring good oral hygiene for people with developmental disability:

• Advise people on multiple medications who have a dry mouth or history of previous or current dental caries to use high-concentration fluoride containing toothpaste (see Recommended concentration of fluoride toothpaste according to age and risk of dental caries).
• Train people with developmental disability (and their support persons) on optimal toothbrushing techniques. Electric or battery-operated toothbrushes, wider handles and modified toothbrush heads (eg 3-sided toothbrushes) can assist.
• Encourage interdental cleaning (using interdental brushes or dental floss) where possible to assist in removal of oral biofilm; water jets may remove food particles, but do not effectively remove plaque.
• Consider low-foaming toothpastes that may be more suitable for people with swallowing disorders who cough or choke on the liquids used in tooth cleaning.
• Promote drinking of water between (and with) meals, in place of sugary or acidic drinks; for people with swallowing difficulties, consider using thickened fluid.
• Provide saliva substitutes for people with dry mouth to replace missing enzymes (eg lactoperoxidase, lactoferrin and lysozyme).
• Recommend healthy savoury snacks that are in the correct food texture for the person to eat safely.
• Recommend sugar substitutes (eg xylitol) in sweet foods (although intake should be moderate to avoid osmotic diarrhoea).
• Discourage consumption of high-carbohydrate snacks and sugary drinks as a reward.

For general advice on oral hygiene, see the Oral and dental guidelines. Considerations that apply to older people, including denture hygiene, are discussed here.