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 Texas, Houston, TX

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

Albuquerque, 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

dental care every day

A Caregiver’s Guide

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.
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. Show how 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.
4

Step 1. Brush Every Day

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.

Get a new toothbrush with soft bristles every 

3 months, after a contagious illness, or when the 

bristles are worn.

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.

Angle the brush at the 

gumline and brush gently. 
5

Make the toothbrush easier to hold.

The same kind of Velcro® strap used 

to hold food utensils is helpful for 

some people.

Others attach the brush to the hand with 

a wide elastic or rubber band. Make sure 

the band isn’t too tight.

Make the toothbrush handle bigger.

You can also cut a small slit in the side of 

a tennis ball and slide it onto the handle of 

the toothbrush.

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.

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. A power toothbrush might make brushing 

easier. Take the time to help your client 

get used to one.
6

Step 2. Floss every day

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. 

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.

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

so the floss is clean for each one.

Try a floss holder.

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.
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

Step 3. Visit a Dentist Regularly

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 Every Dental Visit: Your Role

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.
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 Intellectual Disability

Wheelchair Transfer: A Health Care Provider’s Guide

National Institute 

of Dental and 

Craniofacial 

Research SAFER • HEALTHIER • PEOPLETM

Centers for Disease 

Control and 

Prevention

Special Care 

Dentistry 

Association

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

1–866–232–4528

www.nidcr.nih.gov

This publication is not copyrighted. 

Make as many photocopies as you need.

NIH Publication No. 09–5191

Reprinted July 2009