Dental Care

Posted by Nurse Linda in Life After Paralysis on April 22, 2019 # Health

Ongoing dental care can be an issue for individuals with spinal cord injury. However, keeping your teeth, gums, and mouth clean is necessary for maintaining your health. Healthy teeth and gums allow you to chew your food well which starts the digestive process. Maintaining good oral hygiene can also prevent complications in your general health and well-being.

Performing daily oral hygiene can be a challenge but must be accomplished at a minimum of two times a day. Four times a day is even better, after each meal and before bed. A soft bristle brush works best to protect your delicate gum tissue from damage. Battery powered brushes can be used especially if fine motor control is an issue; up and down motion for a minimum of two minutes is necessary. Rinse with mouthwash. If you have dry mouth, use alcohol-free mouthwash and you can use one of the rinses, lozenge, or gum products that help keep your mouth moist.

Equipment is available if fine motor control of your hands is a challenge. If you have difficulty controlling your brushing technique, you can put your toothbrush in a universal cuff that fits around your hand to get the teeth brushing motion going. If brushing is a challenge due to swallowing issues or if you need assistance in brushing, you can obtain a toothbrush that attaches to a suctioning machine. As your teeth are brushed, the suction will remove toothpaste foam, food particles, and saliva. This is especially helpful if moving your head is difficult. With the suction attachment, you will not need to spit. Rinsing is also taken care of by the suction

Flossing is a bit more challenging. If you can find someone who will floss your teeth, that is the best technique. Otherwise, flossers can be obtained. Some have a handle like a toothbrush that a flossing clip can be attached. Be sure to use a clean flossing clip each time. Don’t put germs into your gums with a dirty flossing clip. There are also some devices with a little brush on the end that can go in between each tooth. Water picks can also do the trick. Have suction nearby if swallowing is an issue.

Gum health is important. Some people have no problems with their gums while others have more issues. This is true in general for all people. Some medications will affect your gums in particular. There are toothbrush brands that have a little rubberish tip at the opposite end. The purpose of this tip is to massage your gums. You may or may not find it helpful. There are other devices for gum massage that might be recommended specifically for you by your dentist or hygienist.

An issue that some people have is an inability to feel food left in their mouth after eating. This is called pocketing -- when food is caught between your teeth and the inside cheek of your mouth. It can happen at the top set or bottom set of your teeth. The cause is usually from some loss of sensation inside your mouth. Typically, a large amount might be felt but small amounts could be overlooked. Check your mouth with your tongue or finger to see if you have any pocketing. You can also rinse your mouth to remove extra food. This is an excellent reason to perform your mouth health routine.

Oral hygiene is an issue not to be neglected. An ignored tooth or teeth with decay can lead to an abscess. That infection can travel to your brain or develop into sepsis. In either case, death can occur if dental and medical care is not provided. Research indicates that your mouth is the gateway to your body. Eating food that is decaying or contains germs can make you ill with gastrointestinal distress (vomiting and diarrhea). Research clearly indicates that poor oral health leads directly to cardiac issues. If you aspirate (choke) on food that is tainted or has been decaying in your mouth for a while, pneumonia will more quickly form in your lungs.

Some prescribed and over the counter medications can affect your teeth and gums. Blood when you brush or floss is an issue. If you take a blood thinner, aggressive brushing, flossing or gum stimulation can cause bloody gums. Some seizure medication can loosen teeth in their sockets. Antihistamines, anticholinergics, and some antidepressants (any ‘anti’ drug) can lead to dry mouth. Check with your healthcare provider, pharmacist, and drug package insert to see if there are warnings about your oral health.

Antacids that are designed to be chewed and asthma medications will leave a sugary coating on your teeth. Medication taken by mouth that is in liquid form is often mixed with syrup to improve the taste but can leave a sugary deposit coating your teeth which can lead to cavities. If you take these medications, you will want to make a specific plan to brush afterward.

Over-the-counter drugs are particularly difficult for teeth, gums, and mouth. Cocaine, crack cocaine and methamphetamine are particularly well known for affecting the enamel of the teeth leading to decay, gum destruction, and nerve damage. Methamphetamine is so well known for rapid oral decay that the term, ‘meth mouth,’ was coined. Ecstasy leads to grinding teeth and dry mouth. Heroin creates a need for sugar, so excessive sweets are eaten.

Your diet can also affect your teeth. Eating sugary or starchy foods can lead to tooth decay. Drinking sugary drinks will further decay your teeth as the liquid will completely coat your teeth. Just letting the food linger in your mouth or between teeth will lead to decay. Take food recalls seriously as tainted food can make you extremely ill. Tainted food lingering between teeth leads to more complications for your teeth and gums. Follow good food preparation practices with excellent cleanup. Always wash your hands prior to preparing food and after food clean up.

A very important point for maintaining oral health is to use a clean glass for fluid several times a day. Some people keep their water bottle handy, refilling as needed which is perfect for maintaining fluid intake. However, the water bottle or cup should be replaced several times a day and not just refilled. Once your mouth is on the water bottle, cup or straw, it is contaminated with bacteria. One bottle and straw used all day will contain millions of multiplying bacteria. Use a clean water container and straw about every four hours. Most people will choose reusable equipment that can be washed between uses.

Some teeth whitening products might be too strong for your teeth. Talk to your dentist or hygienist to see which product might be right for you. Never sleep with the whitening product on your teeth or with whitening trays in place for longer than recommended by the product as enamel might be damaged.

People often find they would like to straighten their teeth either due to naturally misaligned teeth or teeth placement issues from trauma. You have the option of going to an orthodontist to have appliances applied to your teeth which are adjusted about every other week. If you do not feel that you want the expense or cannot make the frequent trips, you can get straightening trays through online services. You make a mold of your teeth using the company’s product they send you a series of trays that will slowly move your teeth into position. If you are using this product because of trauma, make sure your teeth can tolerate this process with your dentist. You do not want to further injure a lost or fractured tooth.

Finding a dentist that can care for your mouth is imperative. Hopefully, your dentist will continue with you throughout all health and functional issues. For some people, just getting into a dental office might be a challenge. The building might not be truly accessible for entry. Once inside, you might need to transfer to the dental chair for care. The chair will be cushioned but not with pressure dispersing equipment. You will need to put your own cushion on the chair seat AND back. Sometimes, moving the seating equipment can be difficult because you are sitting on it, but you must move it out from under you to be able to sit in the chair. You will also need to do pressure releases during your dental exam.

Find a dental office that is accessible to your needs. Take a practice run to see if you can get in with your chair. One of the biggest challenges is to get your chair in the exam room as they are small. It might be necessary to find a dentist who can accommodate you outside of their chair but in your chair. Remember that you will have to be positioned with your chair back extended almost flat. Dental equipment is not always able to be moved to allow this to happen. Some dentists have handheld equipment that can be used. They might be able to accommodate a more upright position for your swallowing safety. Be sure the suction device is in your mouth when having an examination or work done. If you have swallowing difficulty, you might want to bring your own suction machine as the dental equipment might not be strong enough for your needs.

The peer mentors at the Christopher & Dana Reeve Foundation are very helpful in providing information about dental clinics that are accessible and with professionals that have experience treating individuals with spinal cord injury in your area. A couple of odd places to ask about dental care is at a hospital or long-term care facility. Hospitals often have dentists on staff that see patients at the hospital which might be more convenient and accessible. Long-term care facilities have dentists from the community that has experience in examining and providing treatment to individuals with special needs.

You can call ahead and ask questions of the staff about the accessibility of the office, both outside and inside, and relate any special needs you have before your appointment. They will appreciate the notification, so they can be ready for you.

Pediatric Consideration: Finding a dentist for your child or adolescent can be accomplished using the same techniques as listed above. Some dentists specialize in pediatric dentistry which includes education of care of patients with special needs. They are particularly adept at being sensitive to children’s comfort.

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