In the last article, oral manifestations and common medications taken by patients with specialized health care needs (SHCNs) were discussed, as this is critical to be aware of when providing a comprehensive level of care to this patient population. Depending on the specific need, various oral manifestations may present, which will ultimately tailor practice delivery and treatment recommendations. In this article, oral hygiene aids to help mitigate these oral manifestations, will be covered for both the patient and caregiver. As dental professionals, it is important to recognize the barriers faced by caregivers to prioritize daily oral hygiene for patients with SHCNs. Caregivers have identified challenges, such as patients wanting autonomy but still needing assistance, trying to inform and guide the patient with their oral hygiene routine, lack of skill and instruction by the caregiver on how to perform oral hygiene tasks, and physical restraints sometimes exhibited by the patient.1 The following will serve as a guide based on the patient’s SHCN to provide caregivers techniques when providing oral hygiene care, as well as products that may be beneficial and are specific for the patient. This is not a complete list, but briefly identifies patients that may present with specific needs in your office. Empowering both the caregiver and patient with these necessary resources will help alleviate challenges and promote an optimal oral hygiene routine that is supportive of the patient’s needs.
I. Behavioral
A behavioral SHCN would involve any persistent and repetitive pattern of behavior that violates societal norms or rules, seriously impairs a person’s functioning, or creates distress in others.2 This term covers a wide range of disorders, such as Attention Deficit Hyperactivity Disorder (ASD) and Autism Spectrum Disorder (ASD).3-5 Due to risk factors like xerostomia, sensitivity to sodium lauryl sulfate (SLS), and possible limited ability to brush on their own, the following products could be beneficial for this patient population. Elevate Fluorimax 5000 toothpaste, Spry gum or mints to incorporate xylitol into the patient’s daily routine, the Curaprox Samba brush if dexterity or brushing capabilities are a concern, and Curaprox Be You Toothpaste free of SLS.
II. Congenital
SHCNs that are congenital are patients with structural or functional anomalies that occurred during intrauterine life, also known as birth defects.6 This would include patients that present with Down Syndrome or a Congenital Cardiac Disorder.3-5,7,8 In addition to the aforementioned products, antimicrobial and pH elevating sprays such as CariFree CTx2 spray would be an oral hygiene medicament that would be easy to use for both patient and caregiver, and would support a healthy oral microbial environment. Providing nutritional counseling for caregivers of this patient population will also be critical in caries management and disease prevention. This could be something as simple as encouraging more frequent water consumption and recommending anticariogenic snacks that would suit the patient’s lifestyle. These recommendations that are commonplace for the dental professional, speak volumes for a caregiver that is unsure of how to handle their patient’s oral hygiene from a preventative, rather than a reactive standpoint.
III. Developmental
Developmental needs are a group of conditions where the patient has an impairment in either physical, learning, language, or behavior areas that began during the developmental period.9 These patients, such as those with Cerebral Palsy, face various challenges performing daily oral hygiene care.3 The Curaprox Samba brush would be ideal for these patients and their caregivers if there are dexterity concerns, or if the caregiver is unable to comfortably use a brush with the patient. Utilizing prescription strength fluoride products like Elevate FluoriMax 5000, xylitol products like Spry gums or mints, and brushing with an antimicrobial rinse like TheraBreath Deep Clean Antiseptic, instead of rinsing, would all be beneficial in creating an individualized preventative oral hygiene routine for this patient population. Other considerations for caregivers would be having the patient in a semi-reclined position when brushing and to be mindful of sugar content in liquid medications if the patient is consuming any.10
IV. Cognitive
Patients with a cognitive SHCN are those with any medical condition that influences how the brain processes and stores information. This in turn, has a negative effect on a patient’s memory, attention, perception, and thinking abilities.11 Patients with an intellectual disability (ID) would present with a cognitive SHCN and often have a hard time communicating their wants and needs.12,13 With this in mind, establishing an oral hygiene routine that is understood by the caregiver and that the patient is comfortable with, will be critical to ensure that preventative oral hygiene measures are taken. Similar to the aforementioned products, the Curaprox Samba brush could be useful to provide autonomy for the patient and to ensure that adequate plaque removal is being performed. Utilizing pH elevating sprays like CariFree CTx2 and brushing with an antimicrobial rinse like TheraBreath Deep Clean Antiseptic, are both products to assist with caries prevention and reducing gingival inflammation. Floss holders like the Clix Flosser or a Floss Reach could support autonomy while also helping to alleviate any dexterity concerns around flossing. Another important aspect to discuss with the patient’s caregiver would be reducing the cariogenicity of the patient’s diet. Each of these components are critical to support both the patient and caregiver in achieving the goal of caries management and disease prevention.
Oral hygiene aids and routines should be tailored to patient preferences and specific needs. A product that works seamlessly for one patient, may not apply to another. It is the sole responsibility of the providing dental professional to instruct and inform both patient and caregiver on the specific products being recommended. What products to use and how to use them can be a source of stress, and eliminating this will help create a team that is comfortable with oral hygiene prevention practices, rather than simply avoiding them. Choosing the right product and creating a routine that is understood by all team members will be critical for the oral health maintenance of all patients with SHCNs.
References
1. 1. Leme PAT, Nishiyama RR, Santos CL, et al. Coping strategies of caregivers in performing oral hygiene care in adults with special needs: a qualitative study. Spec Care Dentist. 2022; 42:616-622.
2. APA Dictionary of Psychology [Internet]. American Psychological Association; 2024 [cited 11 March 2024]. Available from https://dictionary.apa.org/behavior-disorder
3. Patients with special needs [Internet]. University of Washington School of Dentistry; 2011 [cited 2023 Feb 11]. Available from: https://dental.washington.edu/dept-oral-med/special-needs/patients-with-special-needs/
4. Attention-Deficit/Hyperactivity Disorder [Internet]. National Institute of Mental Health; 2022 Sept [cited 2023 Feb 11]. Available from: https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd
5. What is Autism? [Internet]. Autism Research Institute; 2021 [cited 2023 Feb 11]. Available from: https://www.autism.org/what-is-autism/
6. Congenital Disorders [Internet]. World Health Organization; 2024 [cited 11 March 2024]. Available from https://www.who.int/health-topics/congenital-anomalies#tab=tab_1
7. Facts about Down Syndrome [Internet]. Centers for Disease Control and Prevention; 2022 Nov 18 [cited 2023 Feb 11]. Available from: https://www.cdc.gov/ncbddd/birthdefects/downsyndrome.html
8. Congenital heart defects (CHDs) [Internet]. Centers for Disease Control and Prevention; 2023 Feb 2 [cited 2023 Feb 11]. Available from: https://www.cdc.gov/ncbddd/heartdefects/index.html
9. Facts About Developmental Disabilities [Internet]. Centers for Disease Control and Prevention; 2022 [cited 11 March 2024]. Available from https://www.cdc.gov/ncbddd/developmentaldisabilities/facts.html#:~:text=Developmental%20disabilities%20are%20a%20group,last%20throughout%20a%20person's%20lifetime
10. What is Cerebral Palsy? [Internet]. Centers for Disease Control and Prevention; 2022 May 2 [cited 2023 Feb 11]. Available from: https://www.cdc.gov/ncbddd/cp/facts.html
11. Bakkour N, Samp J, Akhras K, et al. Systematic review of appropriate cognitive assessment instruments uses in clinical trials of schizophrenia, major depressive disorder, and bipolar disorder. Psychiatry Res. 2014; 216:291-302
12. Miller SR. A curriculum focused on informed empathy improves attitudes toward persons with disabilities. Perspect Med Educ. 2013; 2(3):114-125.
13. Facts about intellectual disability [Internet]. Centers for Disease Control and Prevention; 2022 May 10 [cited 2023 Feb 11]. Available from: https://www.cdc.gov/ncbddd/developmentaldisabilities/facts-about-intellectual-disability.html
