Oral Hygiene and Dental Health

Oral hygiene and dental care may be considered as a management strategy in response to concerns regarding feeding safety, adequacy, feeding as a positive experience, development, and efficiency.

KEY MESSAGES
  • Good oral hygiene is integral to good general health status.
  • Children with dysphagia, cognitive impairments, oral sensory processing difficulties, or on enteral feeding are at a greater risk of having poor oral hygiene. Poor oral hygiene can lead to respiratory conditions such as aspiration pneumonia in these populations.
  • All healthcare professionals should take a role in promoting good oral hygiene as well as identifying and managing conditions such as oral candida and sialorrhea.

Prevention of Poor Oral Hygiene and Dental Caries

Parents of infants should begin oral hygiene practices before teeth erupt, by using a soft moist cloth. Parents of infants should clean the teeth as soon as they appear, using a soft moist cloth to clean the gums or a soft baby toothbrush if the baby accepts it.

In children, encourage regular tooth brushing twice a day with fluoride toothpaste.  Children should spit out toothpaste after brushing but not rinse. If children are not able to spit then only use a rice grain-size amount of toothpaste for toddlers and a pea-size for older children. Parents need to help young children brush their teeth under the age of eight years.

Also:

  • advise parents to avoid transfer of oral bacteria (see Table 10) to their child by maintaining good oral health themselves and by not placing food, utensils, pacifiers or nipples into their own mouths and then into their child’s mouth
  • all children should receive their first dental visit within six months after the first teeth appear or by 12 months of age, whichever comes first
  • for children with age-appropriate oral sensorimotor function and developmental skills, discourage prolonged bottle feeding or prop feeding and introduce a cup around six months
  • avoid sugary foods and drinks (including bottle or sippy cup containing juice or carbonated beverages)

Refer to:

 

Table 10: Management Strategies for Poor Oral Health

Issue

Management Strategies

Oral Candida

  • referral to a physician for assessment and pharmacological management
  • brushing teeth with fluoride toothpaste and rinsing with water

Sialorrhea

  • Implement behavioural strategies to encourage regular swallowing and wiping of oral secretions
  • referral to a physician and an otolaryngologist for assessment of airway compromise, pharmacological management, administration of botulinum toxin and surgical management of drooling is recommended

Oral health when oral intake isn’t safe

  • clients who are not safe for oral intake and are enterally fed are at risk of the oral cavity becoming dry and unclean; this increases their risk of infection and disease
  • tooth brushing twice daily with fluoride toothpaste, antiseptic mouthwash and water; lip moisturizer, and saliva substitute or oral lubricants may help keep the oral cavity clean and moist
  • referral to pediatric special needs dentist for regular check-ups or assistance with cleaning; a general dentist or dentist experienced in working with children would also be suitable if there are no special needs dentists available

(NSW Office of Kids and Families, 2016)