DENTAL CARE

EVERY DAY

A Caregiver’s Guide

U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES

NATIONAL INSTITUTES

OF HEALTH

National Institute of Dental and

Craniofacial Research
Contents

Getting Started .................................................................................. 2

Three Steps to a Healthy Mouth .......................................... 3

Step 1. Brush Every Day ..................................................... 4

Step 2. Floss Every Day....................................................... 6

Positioning Your Body: Where To Sit or Stand.................... 8

Step 3. Visit a Dentist Regularly.......................................... 9

Prepare for Every Dental Visit: Your Role ........................... 9

ACKNOWLEDGMENTS

The National Institute of Dental and Craniofacial Research thanks

the oral health professionals and caregivers who contributed

their time and expertise to reviewing and pretesting the Practical

Oral Care series.

Expert Review Panel

• Mae Chin, RDH, University of Washington, Seattle, WA

• Sanford J. Fenton, DDS, University of Tennessee, Memphis, TN

• Ray Lyons, DDS, New Mexico Department of Health,

Los Lunas, NM

• Christine Miller, RDH, University of the Pacific,

San Francisco, CA

• Steven P. Perlman, DDS, Special Olympics Special Smiles,

Lynn, MA

• David Tesini, DMD, Natick, MA
1

Taking care of someone with a developmental

disability requires patience and skill. As a

caregiver, you know this as well as anyone does.

You also know how challenging it is to help that

person with dental care. It takes planning, time, and the

ability to manage physical, mental, and behavioral problems.

Dental care isn’t always easy, but you can make it work for

you and the person you help. This booklet will show you

how to help someone brush, floss, and have a healthy mouth.

Everyone needs dental care every day. Brushing and flossing

are crucial activities that affect our health. In fact, dental care

is just as important to your client’s health and daily routine as

taking medications and getting physical exercise. A healthy

mouth helps people eat well, avoid pain and tooth loss, and

feel good about themselves.

DENTAL CARE EVERY DAY

A Caregiver’s Guide
2

Getting Started

Location. The bathroom isn’t the only place to brush

someone’s teeth. For example, the kitchen or dining room

may be more comfortable. Instead of standing next to a

bathroom sink, allow the person to sit at a table. Place the

toothbrush, toothpaste, floss, and a bowl and glass of water

on the table within easy reach.

No matter what location you choose, make sure you have

good light. You can’t help someone brush unless you can see

inside that person’s mouth. Page 8 lists ideas on how to sit or

stand when you help someone brush and floss.

Behavior. Problem behavior can make dental care difficult.

Try these ideas and see what works for you.

At first, dental care can be frightening to some people. Try

the “tell-show-do” approach to deal with this natural reaction.

Tell your client about each step before you do it. For example,

explain how you’ll help him or her brush and what it

feels like. Showhow you’re going to do each step before

you do it. Also, it might help to let your client hold and feel

the toothbrush and floss. Do the steps in the same way that

you’ve explained them.
3

Give your client time to adjust to dental care. Be patient as

that person learns to trust you working in and around his or

her mouth.

Use your voice and body to communicate that you care.

Give positive feedback often to reinforce good behavior.

Have a routine for dental care. Use the same technique

at the same time and place every day. Many people with

developmental disabilities accept dental care when it’s familiar.

A routine might soothe fears or help eliminate problem

behavior.

Be creative. Some caregivers allow their client to hold a

favorite toy or special item for comfort. Others make dental

care a game or play a person’s favorite music. If none of these

ideas helps, ask your client’s dentist or dental hygienist for

advice.

Three Steps to a Healthy Mouth

Like everyone else, people with developmental disabilities can

have a healthy mouth if these three steps are followed:

1. Brush every day.

2. Floss every day.

3. Visit a dentist regularly.
If the person you care for is unable to brush, these

suggestions might be helpful.

First, wash your hands and put on disposable gloves. Sit or

stand where you can see all of the surfaces of the teeth.

Be sure to use a regular or power toothbrush with soft bristles.

Use a pea-size amount of toothpaste with fluoride, or none

at all. Toothpaste bothers people who have swallowing problems. If this is the case for the person you care for, brush with

water instead.

Brush the front, back, and top of

each tooth. Gently brush back and

forth in short strokes.

Gently brush the tongue after you

brush the teeth.

Help the person rinse with plain water.

Give people who can’t rinse a drink of water or consider sweeping the mouth with a finger wrapped in gauze.

If the person you care for can brush but needs some help, the

ideas listed on the next page might work for you. You may

think of other creative ways to solve brushing problems based

on your client’s special needs.

Get a new toothbrush with soft bristles every 3

months, after a contagious illness, or when the bristles

are worn.

Step 1. Brush Every Day

4

Angle the brush at the

gumline and brush gently.
Make the toothbrush easier to hold.

Try other toothbrush options. Guide the toothbrush.

Help brush by placing your

hand very gently over your

client’s hand and guiding the

toothbrush. If that doesn’t

work, you may need to brush

the teeth yourself.

Others attach the brush to the hand with a

wide elastic or rubber band. Make sure

the band isn’t too tight.

The same kind of Velcro® strap used to

hold food utensils is helpful for some

people.

You can also cut a small slit in the side of

a tennis ball and slide it onto the handle of

the toothbrush.

A power toothbrush might make

brushing easier. Take the time to help

your client get used to one.

You can buy a toothbrush with a large

handle, or you can slide a bicycle grip onto

the handle. Attaching foam tubing,

available from home health care catalogs,

is also helpful.

5

Make the toothbrush handle bigger.
6

Flossing cleans between the teeth where a toothbrush can’t

reach. Many people with disabilities need a caregiver to help

them floss. Flossing is a tough job that takes a lot of practice.

Waxed, unwaxed, flavored, or plain floss all do the same thing.

The person you care for might like one more than another, or

a certain type might be easier to use.

Step 2. Floss Every Day

Use a string of floss 18 inches long. Wrap that piece

around the middle finger of each hand.

Grip the floss between the thumb and index finger

of each hand.

Start with the lower front teeth, then floss the upper front

teeth. Next, work your way around to all the other teeth.
7

Work the floss gently between the teeth until it reaches the

gumline. Curve the floss around each tooth and slip it under

the gum. Slide the floss up and down. Do this for both sides

of every tooth, one side at a time.

If you have trouble flossing, try using a floss holder

instead of holding the floss with your fingers.

The dentist may prescribe a special rinse for your client.

Fluoride rinses can help prevent cavities. Chlorhexidine

rinses fight germs that cause gum disease. Follow the

dentist’s instructions and tell your client not to swallow any

of the rinse. Ask the dentist for creative ways to use rinses

for a client with swallowing problems.

Adjust the floss a little as you move from tooth to tooth

so the floss is clean for each one.

Try a floss holder.
8

Positioning Your Body:

Where To Sit or Stand

Keeping people safe when you clean their mouth is important.

Experts in providing dental care for people with developmental

disabilities recommend the following positions for caregivers.

If you work in a group home or related facility, get permission

from your supervisor before trying any of these positions.

If the person you’re helping is in a

wheelchair, sit behind it. Lock the wheels,

then tilt the chair into your lap.

Stand behind the person or lean against a

wall for additional support. Use your arm

to hold the person’s head gently against

your body.
9

Your client should have regular dental appointments.

Professional cleanings are just as important as brushing and

flossing every day. Regular examinations can identify

problems before they cause unnecessary pain.

As is the case with dental care at home, it may take time for

the person you care for to become comfortable at the dental

office. A “get acquainted” visit with no treatment provided

might help: The person can meet the dental team, sit in the

dental chair if he or she wishes, and receive instructions on

how to brush and floss. Such a visit can go a long way

toward making dental appointments easier.

Prepare for EveryDental Visit: YourRole

Be prepared for every appointment. You’re an important

source of information for the dentist. If you have questions

about what the dentist will need to know, call the office

before the appointment.

Know the person’s dental history. Keep a record of what

happens at each visit. Talk to the dentist about what occurred

at the last appointment. Remind the dental team of what

worked and what didn’t.

Bring a complete medical history. The dentist needs each

patient’s medical history before treatment can begin.

Bring a list of all the medications the person you care for is

taking and all known allergies.

Bring all insurance, billing, and legal information. Know

who is responsible for payment. The dentist may

need permission, or legal consent, before treatment can

begin. Know who can legally give consent.

Be on time.

Step 3. Visit a Dentist Regularly
Remember...

Brushing and flossing every day and seeing the dentist

regularly can make a big difference in the quality of life of

the person you care for. If you have questions or need more

information, talk to a dentist.

Other booklets in this series:

Continuing Education: Practical Oral Care for People

With Developmental Disabilities

Practical Oral Care for People With Autism

Practical Oral Care for People With Cerebral Palsy

Practical Oral Care for People With Down Syndrome

Practical Oral Care for People With Mental Retardation

Wheelchair Transfer: A Health Care Provider’s Guide

For additional copies of this booklet, contact

National Institute of Dental and Craniofacial Research

National Oral Health Information Clearinghouse

1 NOHIC Way

Bethesda, MD 20892–3500

(301) 402–7364

www.nidcr.nih.gov

This publication is not copyrighted.

Make as many photocopies as you need.

NIH Publication No. 06–5191

Reprinted December 2005

National Institute

of Dental and

Craniofacial

Research

Centers for Disease

Control and

Prevention

National Institute of

Child Health and

Human Development

Special Care Dentistry