Transcript for: 4 steps for healthy teeth and a deadly smile
Voiceover: Everyone loves a deadly smile.
Having healthy teeth is good for your overall health and boosts your confidence too.
There are four simple steps you can take to keep your mob's teeth strong and healthy.Number one, make sure all the family are brushing their teeth, gums and tongue with toothpaste every morning and every night.
Whenever you brush your teeth, use gentle circles around the inside and outside of your teeth and gums.
It's easy to miss a spot, so make sure you clean every part of each tooth, and reach the back teeth too.
Don't forget to give your tongue a gentle brush as well.
As soon as your bub gets their first tooth, start brushing gently using a child-size soft toothbrush and water.
When your bub is 18 months old, start using a small pea-sized amount of low fluoride child's toothpaste.
Make sure to teach your jar jums the proper way to brush their teeth, and assist with their brushing until they get the hang of it.Number two, eat healthy! The things we eat affect the health of our teeth.
For strong healthy teeth, eat more fruit and veggies, and less packaged foods.Number three, look after your teeth by drinking water and avoiding drinks that are high in sugar.
The next time you are thirsty, choose water rather than juice, soft drinks, or flavoured milk.Number four, get all your mob's teeth checked at the dentist once every year, and have a yarn with them about any concerns.
That's it, the four easy steps for healthy teeth and a deadly smile!
For more information or to find a dental clinic near you, visit health.nsw.gov.au/oralhealth
Transcript for: Keep our smiles strong and deadly with a dental check up
Looking after your mob's oral health is really important.
Having healthy teeth doesn't only give you a deadly smile, it helps us stay strong and to feel good about ourselves.
One of the most important things you can do for your mob's oral health is getting regular dental check-ups.
Check ups at public dental clinics are free for all kids under 18 with a Medicare card and adults with a health care, concession or pension card.
Some Aboriginal Community Controlled Health Organisations also provide dental services.
Your jar jums will feel more comfortable and relaxed about getting a check up if you start taking them from a young age.
Health workers and dental practitioners can give tips on the best ways you can look after your teeth and also how to teach your little one's about good oral health from an early age,
So, when it comes to all the things you do to look after yourself and your mob, don't forget about oral health.
Remember to book a dental check up once every year to keep your teeth deadly and strong, and to stop little problems becoming bigger problems later.
Call your local Aboriginal health service or visit
health.nsw.gov.au/oralhealth to find a dental clinic near you.
Transcript for: Explaining tooth decay
Explaining tooth decay with the Australian Dental Association.
Millions of bacteria live inside the human mouth. Sugar from the foods and drinks we consume feeds some of these bacteria, giving them energy to produce acid. This acid attacks the surface of the teeth causing enamel minerals to dissolve. This is called de- mineralisation.
Together, saliva and fluoride toothpaste protect the teeth by neutralizing the acids and replacing the enamel minerals This is call re-mineralisation By regularly consuming sugary food and drinks, the saliva and fluoride toothpaste may not be able to keep up in replacing the loss tooth minerals
When tooth mineral loss outweighs mineral replacement, this can result in tooth decay. If tooth decay is only in the enamel layer, it can still be stopped. Once it travels to the inner dentine layer, the tooth may require a filling.
Remember to look out for foods with hidden sugars. Eat a diet low in sugar. And brush twice daily using fluoride toothpaste to decrease your risk of developing tooth decay. And visit your dentist regularly to prevent problems and keep on smiling.
Transcript for: Explaining gum disease
Voiceover: Explaining gum disease with the Australian Dental Association
Healthy gums should appear pink and firm. They should not bleed during cleaning. If bacteria are not cleared away from the teeth regularly, the surrounding gums can become inflamed. This is called gingivitis.
Inflamed gums can appear enlarged, red in colour, and may bleed more easily than healthy gums. Thorough tooth brushing and cleaning between the teeth will help gums with gingivitis return to normal.
Cigarette smokers and people with poorly controlled diabetes have greater risk of developing severe gum disease called periodontitis. Periodontitis causes bone around affected teeth to recede. The gums may recede as well. If the gum don't recede, a space forms called a periodontal pocket. Periodontitis can cause the teeth to move, allowing gaps to form.
Treatment from a dentist or periodontal specialist is required. Without treatment, affected teeth may become painful, loose, or even fall out. Cleaning between your teeth is important in preventing and treating gum disease.
Your toothbrush cannot reach these areas. And visit your dentist regularly to prevent problems and keep on smiling.
Transcript for: Pro tips for a healthy mouth
Protect your teeth with these pro tips for a healthy mouth from the Australian Dental Association.
Transcript for: How to keep your mouth, teeth and gums healthy during pregnancy
Dentist: During pregnancy your body is undergoing many changes which can affect your oral health.
Pregnancy hormones can make your gums bleed more easily, morning sickness can increase the acid levels in your mouth causing acid wear, and sugar cravings mean your teeth are more at risk of tooth decay.
Some women also experience sensitive teeth causing discomfort while eating, drinking and brushing their teeth. So, it's really important that you keep your teeth and gums healthy during pregnancy by keeping up your daily brushing and flossing routines, following a healthy diet and visiting your dental practitioner early for a checkup.
Taking care of your own oral health, while pregnant also gives your child the best chance of having healthy teeth and gums as well. When you brush your teeth, use a toothbrush preferably with a small head and a pea sized amount of fluoride toothpaste. Gently brush both your teeth and gums using small circles. Brush all surfaces of your teeth, inside and out and don't forget your tongue, it needs a good brush too. And there is no need to rinse after brushing as the fluoride in the toothpaste keeps strengthening your teeth. Remember to take it slow when brushing, especially if you are feeling unwell.
Sensitive teeth and gums still need to be gently brushed so use a very soft brush and consider trying a sensitive toothpaste with fluoride. If you use a battery driven or electric toothbrush make sure the bristles of the toothbrush are placed along the gumline and on the teeth as well. Try to brush your teeth twice a day and floss daily even if your gums bleed.
If you experience morning sickness, it's important to protect your teeth from acid wear. If you vomit, rinse your mouth with water and wash away the acids. It's a good idea to wait at least an hour before you brush. Instead, you can use your finger to smear some toothpaste onto your teeth. The toothpaste will help protect and strengthen your teeth.
The risk of gingivitis or bleeding gums can increase due to pregnancy, and if left untreated, can lead to gum disease. This can cause lasting problems such as shrinking gums, bone loss, loose teeth and even tooth loss. Some pregnant women experience lumps on their gums. These can form at any time during your pregnancy and can bleed easily, but don't worry because they are not serious and usually disappear on their own after the birth.
To avoid any dental changes becoming serious, maintain good oral health including regular dental checkups. If you crave sugary foods and drinks your teeth will need extra protection. Try to limit the number of sugary snacks each day. Drink plenty of tap water throughout the day especially after snacking to wash away the sugars.
It's safe to have dental care at any time during your pregnancy. Dental emergencies, such as pain or infection should be checked out by a dental practitioner straight away. Be sure to tell your dentist, oral health therapist or dental hygienist that you are pregnant because most non-urgent treatment is best after the first trimester when most of your baby's development is complete.
To give you and your baby the best chance of keeping a healthy smile, remember these key messages: Brush your teeth and gums twice a day, eat healthy snacks, drink plenty of water and visit a dental practitioner early during pregnancy.
Transcript for: Explaining denture care
Intro slide: Explaining Denture Care with the Australian Dental Association. Proudly supported by the NSW Government in association with NSW Health
Voiceover: Protect your dentures with these pro tips from the Australian Dental Association.
Dentures can replace one or more missing teeth inside the mouth. Whether you wear a partial denture or a full denture that replaces all your teeth in the one jaw, the following recommendations apply:
Just like natural teeth your dentures should be brushed, morning and night. Brush your denture with a soft bristle brush and a non-abrasive cleaner, such as soft hand soap.
Do not use toothpaste to brush the surfaces of your denture.
At night, after cleaning your denture, store it in a safe dry location or in a container with water while you sleep. Removing your denture at night, helps to prevent fungal infections affecting the gums and soft tissues on which the denture sits.
If hard tartar, also known as calculus, builds up on your denture, occasionally soak your denture overnight in a solution of one-part white vinegar and four parts water, then clean it in the morning as usual.
If the tartar remains, have your denture cleaned by a dental professional. See your dentist regularly, so they can check the fit of your denture and ensure the gums and any supporting teeth are healthy.
Final slide: For more information on NSW public dental services visit health.nsw.gov.au/oralhealth
Proudly supported by the NSW Government in association with NSW Health.
Transcript for: Pro tips for better flossing
Intro slide: Protect your teeth with these Pro Tips for better Flossing. Developed by the Australian Dental Association. Proudly supported by the NSW Government in association with NSW Health
Voiceover: Protect your teeth with these Pro Tips for flossing from the Australian Dental Association.
There are all kinds of flossing tools available. Try them out to see which works for you. Floss before you brush so your toothpaste can better reach those gaps and corners. For regular floss, wrap 30-40 centimetres around your fingers. Leaving your index fingers free, to help. Wrap more around one side so you can keep revealing new, clean tape as you go.
Slowly saw the tape towards the gums. Don't hit the gums suddenly. Where your gums look like triangles, floss down both sides of the triangle. Don't worry if your gums bleed a little. This will stop in 1-2 weeks if you keep flossing regularly. Kids need to floss too and they'll need your help. This is a good way to do it.
Brushing only reaches about 60% of tooth surfaces. Flossing equals 40%. So, remember, brush twice each day and floss at least once, every single day. And, visit your dentist regularly to prevent problems and keep on smiling.
Transcript for: Pro tips for better brushing
Voiceover: Protect your teeth with these Pro Tips for Better Brushing from the Australian Dental Association.
Use a small soft brush. Harder ones can damage your teeth and gums.
Use just one pea sized blob of fluoridated toothpaste.
For timing, and for fun, listen to music and brush for the duration of a short song you like.
Tilt your brush at a forty-five-degree angle so the bristles are cleaning your gums too.
Brush gently in circles or if you have an electric toothbrush, just hold still at each tooth for three seconds.
Count all six segments as you go. Inside, outside and chewing surfaces. Upper and lower.
Don't miss your inside front teeth. Brush up and down to reach these properly.
Finish by brushing your tongue, to remove bacteria from your mouth.
And avoid rinsing, so your toothpaste can keep working for longer.
Now do it all again! Brush twice each day and floss at least once. Every single day! And visit your dentist regularly to prevent problems and keep on smiling.
Oral health for adults with disability: A guide for carers (part 1)
Presenter: Oral health for adults with disability. A Guide for Carers. In this video, we cover the following topics: Routine, Brushing, Cleaning between the teeth and Sugar reduction.
Topic one: Routine
Angela: So if I had to give advice to anyone who had a child with special needs about cleaning their teeth, I would try and start a routine, breakfast, dinner. We eat and then we go into the bathroom and we clean our teeth.
Avanti: The mouth is an important but sometimes forgotten part of the body, and good, healthy teeth and mouth are incredibly important for communication, for speech, for swallow and for nutrition. Good oral health is really important for good overall health.
Lucy: Getting a routine with it is really important. Like, if I was to brush her teeth straight in the morning, I probably wouldn't get a good response because that's not what is normal for her.
Antonia: Toothbrushing routine at night is always last thing before going to bed. I always give her her tablets and clean her teeth. That's our routine. Last thing at night. Now the trouble is where it is, it's often sitting here on the mat because she'll be watching TV.
Avanti: Whichever location oral care is being performed in, whether that be in the bathroom or outside on the lounge while watching television, it's very important to have good lighting, adequate space. You may need to prepare for the brushing activity and have gloves, your toothbrush and mouth prop if it's required, and the person with special needs or additional needs may require a mirror for visual feedback to see what's going on.
Lucy: So I will explain what I'm doing as I'm going and I'll ask, you know, can I please do this? Can I do that? Obviously with Victoria, she doesn't tell me no or yes, but she will pull away or she will make a face or anything like that. And obviously that's a sign to stop.
Avanti: So sometimes when everything is getting too hard and there's hospital visits, multiple things going on, behavioural challenges, then self-care falls by the wayside and particularly oral health and oral care gets neglected. In a group home setting, restrictive practice might mean that a person is seen to be refusing oral care and so it is no longer attempted. It's very important that oral care is attempted daily, just the same as all other forms of self-care.
Antonia: If you know for people that are busy and going to work, if you might miss in the morning, that's not such a big deal provided you clean last thing at night. I think that's the most important thing.
Avanti: If a person is only going to be able to brush once a day, then at night time just before bed is the best time to brush.
Topic two: Brushing
Angela: We now brush after every time he eats, just with water, we'll rinse his mouth out, use the mouthwash once a day. I get Ben to brush his teeth before we brush his teeth. We're trying to get him to take over every step, but we've also got to make sure that we do it properly. But we never used to brush first and get the food off. We used to just go straight to the toothpaste. Ben always brush first and then we brush second.
Avanti: Some strategies that can be used for assistance with brushing might be introducing a toothbrush or having the person brush their own teeth first and then a carer goes in to assist or a hand over hand technique to help with independent brushing or playing linking where the toothbrush is being held while someone else is brushing your teeth or rescue where one carer is introducing the activity, but then a second carer can then step in to provide the care.
Antonia: A small amount of fluoride toothpaste because if they can't rinse out, if they use a small amount, it does the double job of cleaning as well as leaving fluoride there.
Lucy: So normally the amount of toothpaste I put on is about a pea size.
Avanti: Essentially what we want, is to make sure that we have the patient seated with good light and not going to be holding on to the patient's neck or the chin in terms of holding or cupping them.
Avanti: What we want is a gentle pullback on the lip, averting the lip so that you can get to the centre of where the tooth meets the gum.
Avanti: Very important that we actually pull the lip back, the top lip and open a little bit wider for me. That's the way, and you're getting all the way to the gum line, that's where most of the plaque tends to be.
Lucy: She has a bit of difficulty doing her top teeth. She's excellent at doing her bottom teeth, so I will normally go in and do the bottom teeth and then slowly turn it around and do the top teeth. She's understanding that it's in her mouth and it's around that area. So it's not like, you know, I'm just jamming in and then I do her top teeth as well. Although she is very good at following directions if I do tell her, but obviously not for too long. So I'll go in and, you know, clean up the job afterwards.
Avanti: If someone else is brushing your teeth, it can be actually incredibly painful because you might not be able to tell them if they're brushing too hard or if they're going too far back. So for someone who's had someone else brush their teeth or multiple people brush their teeth, they might find that that's not something that they enjoy and they refuse. When you're brushing for someone else, you don't always know how hard you're pressing on the toothbrush because you don't have the feedback. So it might be a good idea for the person to be able to tell you if that's working for them or if you can practice on another carer or a family member so that they're able to tell you how well the toothbrushing is working in terms of pressure.
Angela: So when I brush Ben's teeth, he's quite tall, but it's really not an issue. I just sometimes he puts his head up and I can't see and I've just got to tell him, can he put his head down so Mum can see. How I taught him to spit is basically I did it myself and he just had to, to copy me. I put a little bit in my mouth and I'd spit it out. He'd put some in his in his mouth and he's swallow it and I'd go, No, Ben, come on, let's make a mess. Let's make a mess. Come on, spit it, spit it, spit it out. Show me. Make a mess. He spit it here. He spit it there.
Angela: And I got it. Made a bit of a fun of it and got him laughing. And then he was spitting it everywhere. So now when he spits it out or whooshes the water around and quite often I say to him, Ben, go close, so that at least it goes in the basin because, you know, six foot five, six foot six, he just does that and it goes down, just goes everywhere. Oh, yeah. Oh, okay. That was good. That was good. So I'm just sort of now bringing it back down, saying, you know, lean over, spit in the basin.
Avanti: If you are only going to be able to have oral access for a short amount of time. Sometimes we recommend that you start in a new position every time so that a different part of the mouth is being brushed. The most important thing is having a standard strength, or if the dentist has recommended a high strength fluoride toothpaste or fluoride containing toothpaste. You may also use additional chemical products such as Mouthwashes that can be brushed on the teeth or tooth mousse plus to allow for remineralisation of the dental surfaces.
Avanti: It might be about adjusting the posture so that someone is comfortable in their own wheelchair or on a couch. Or it might be about making sure that their head is upright.
Angela: He himself wasn't cleaning in his mouth properly, even though we were brushing his teeth morning and night, like, we weren't consciously aware that he was just leaving food on his teeth for the best part of the day.
Avanti: So you know you're doing a good job with the toothbrushing. You won't be able to see any plaque and staining and food debris on the teeth. The gums will also not be red, raw and inflamed. Ideally, we want someone to brush their teeth twice a day. So we want to be able to shift that plaque every 12 hours. So after a meal time works best because you want to be able to remove food debris and remove sugars as much as possible. If you are brushing after breakfast and after dinner and always the last thing before bed is crucial so that you're not having more food after you're brushing.
Antonia: And I find the electric toothbrush has been the best. It's a good grip. So it's big enough for her to hold and it's easy for me to use and for carers to use.
Avanti: Very important to use a small toothbrush with soft bristles. If the person can tolerate an electric toothbrush that might make the job easier or using a three sided toothbrush or a modified grip handle, it might be something as simple as using a mouth prop to hold the person open and not have a bite reflex onto the toothbrush.
Avanti: For me, that's the way. And we can use the mouth prop to hold the mouth open. You can bite together on that.
Topic three: Cleaning between the teeth
Angela: When the dentist said to floss Ben's teeth after morning and night using long string of dental floss. It's just like, it's hard enough to do it on yourself. It is very hard to get it in his mouth.
Antonia: I can't do it with normal floss. I just find I can't get my hand into her mouth.
Angela: And consequently we weren't doing it because it was just too hard.
Antonia: Flossing is really difficult. Most times she won't let me. Of course, today she did.
Angela: But I came across these dental sticks, floss, floss, sticks and they're absolutely fantastic. So they're very, very easy to do in, out, in and out.
Antonia: I find the little floss picks quite good.
Avanti: If brushing is working really well, you can also look to introduce interdental cleaning, which is so important, whether that's with floss, floss sticks or brushing aids such as interdental brushes or picks brushes. You should never use a toothpick or a pin though, because that can be very harmful.
Angela: And I really, really wished that I knew about those floss sticks many, many years ago because all Ben's issues are between his teeth. The bits that you can see, I can see them, but I didn't know what was going on between the teeth. The floss sticks were like a lifesaver to us. I find flossing is possibly easier when he's lying in bed, so in the morning I'll floss in the bathroom after he's eaten. But at night I will clean his teeth in the bathroom. But then I'll floss when he's lying in bed.
Angela: I have tried to get him to floss. He's not interested, but I really, ultimately, we need him to become independent with it. So these things take time. We've got plenty of time.
Presenter: Topic 4: Sugar reduction
Antonia: To make sure she doesn't get decay. We keep the diet very low sugar. She eats a lot of fruit and vegetables, which is really good, but everyone needs a treat. And so like when you pick her up in the afternoon, we go for coffee. Never has sugar in coffee. We'll buy one gluten free cake and divide it into three.
Angela: We've cut back, pretty much taken sugar out of his diet. We used to let him have soft drink. I used to let him eat biscuits, cakes, you know, bad, bad, bad. I didn't realise the damage we were doing. As bad as it was, we removed all that. He absolutely loved it all. We removed it. He never once asked for it. We just explained to him he couldn't have sugar. It's bad for his teeth, Doctor Avanti said, and he just did it. So now he does have baking and he does have chocolates and stuff.
Angela: But it's like on a rare occasion, it's a treat, which it should have always been.
Antonia: So, you know, decay is a really huge problem for people with disabilities. So it's so much easier to be strict with diet and keep the sugars down, keep the treats to a minimum, have them at mealtime and most importantly, clean the teeth before going to bed.
Avanti: Sometimes food and treats can be used for behaviour management as a reward or more importantly, for delivering important medication. Whilst it's important that we are able to continue this, if you can switch out soft drinks, sugar filled fruit juices, switch over to a sugar free cordial or water is best. A good strategy for minimising the harmful effects of sugar might be to stick to meal times for your sugar filled snacks or even natural fruit, and continue with savoury snacks or no snacks between meal times.
Avanti: Try and establish some regular oral care routine and continue daily attempts at the same. Try and minimise dietary sugars, Look out for signs of pain, swelling or infection, ensure there is regular access to professional dental check-ups.
Angela: There's a lot of things. It's all overwhelming. You do the best you can, you stuff up, you try and make it better.
Presenter: New South Wales Health would like to thank Ben, Angela, Victoria, Antonia and Lucy for their kind participation in this video. Special thanks to Doctor Avanti Karve, Special Needs Dentist. Developed in partnership with the Australian Dental Association, New South Wales.
Oral health for adults with disability: A guide for carers (part 2)
Presenter: Oral health for adults with disability. A Guide for Carers. In this video, we cover the following topics: The dental visit, Storyboarding, Preparing for a general anaesthetic, People who are non-verbal and Unique concerns for people with disability.
Topic five: The dental visit
Avanti: For a person with special health care needs or disabilities, because of the higher risk of dental disease, regular dental check-ups with a professional practitioner are especially important, whether that be with your local general dentist or with a dental specialist like a paediatric dentist or a special needs dentist. There are allied health practitioners such as oral health therapists, who might also be involved, particularly in preventive care planning. So, some persons with disability might find it incredibly challenging to come into the dental setting to have invasive care under local anaesthesia, under sedation or under general anaesthesia.
Avanti: And that's why daily oral care at home is so important, to try and avoid future need for invasive care. You must remember to take along a current list of medications, an updated medical summary, guardianship details or a speech pathology assessment if that's been recently undertaken. Taking along the person's toothbrush and toothpaste. A regular carer who's able to demonstrate how brushing is currently being done will also help the practitioner. At the dental visit, your dental practitioner will be able to formulate an oral care plan which outlines the right products to be used for you and the best way that you may be able to access these.
Antonia: We have to prepare well. She has to know exactly what's going to happen. So for the orthodontic treatment, I prepared her for having the impression taken and the mirror and the light and everything. But I forgot about suction. And when the suction went in, she freaked. She needed this filling, and I thought we'd almost got her up to the stage with special care dentist. But when it came to any drill, she wouldn't let it. So it had to be a general.
Topic six: Storyboarding
Antonia: For general anaesthetic, well, first of all, we see the doctor or whoever. I ask, can I have photos of them? I ask, can we go and have like a preliminary visit with the hospital or the day surgery centre that we can go in and meet the staff, show her where it is. I take photos, I make a PowerPoint with pictures of where we're going, who's going to do it, what's going to happen. Now, as long as everything goes according to plan, she cooperates beautifully.
Antonia: Last time when she needed a colonoscopy last year, I had a photo of her with the drip in the hand from an emergency year before. And so I had that the anaesthetists will put a little drip in her hand. When it came to the procedure, the anaesthetist wanted to use the arm and she wouldn't. I said "I've prepared her for the hand" and she said, OK we can do that. So she then puts her hand out. So it has to be really well prepared.
Antonia: And I've just made my own simple PowerPoints. Preparation is the absolute answer. I find with Victoria and with a lot of other people with Down syndrome. If they're very unsure about things, they'll just refuse to move. It's sort of like, the safest place is don't do anything. And so she's got to be prepared. She's got to know where we're going, who's going to be there, what's going to happen.
Avanti: When planning for your dental appointment, it's always good to be able to storyboard the appointment, know where you're going, especially if you've been there before and introduce that nice and early.
Seven: Preparing for a general anaesthetic
Angela: One particular time, we went to the hospital. He did not want the mask on his face at all and they gave me the mask when he was still in the bed before we go into pre-op and they gave me the mask and said, I'm going to need about 40 minutes or something. So basically I had it, got him to hold it, put it on my face. He wouldn't put it on his. Eventually, you know, I worked it up and I said, Just Ben, just put it there. For what? Like, you know, two seconds, one second, you know, and then eventually I got him to be comfortable.
Angela: And then I'd say, okay, now leave it on for ten seconds. So it took about 40 minutes and I've got him comfortable to do that. Then we went into the theatre and the problem was I just had it and there's no air or anything going through. So when we get in the theatre and the air bits going through yeah, no way. He wasn't going to put it on his mouth. Anyway, so it just took a little bit of convincing and we got there. So after that experience, the next time he had to have a general, I briefed the anaesthetist and he basically he gave him more, whatever the drugs are, to calm him and however many he gave him, Ben was sound asleep before we even got into the theatre.
Topic Eight: People who are nonverbal
Antonia: A really important thing to remember is a lot of people with Down syndrome are non-verbal or selectively mute. She's also got a processing delay. So when you ask her something, it might take 30 seconds for the response. Everyone assumed because she wasn't speaking that she wasn't understanding, and she understands. And I often say to carers to try to get them to realise that she's understanding and listening, I say "just crack a slightly dirty joke" and watch her.
Antonia: And with me, whatever I do, she'll do the best eye roll or she'll giggle. And they will cooperate if you speak to them. I find if a dentist or a doctor speaks to me and not Victoria, she won't cooperate at all. If they speak to her and just speak properly, but keep it sort of slow, not too fast and questions to give her. I often give her a choice.
Antonia: What would you like to wear today, Victoria? Do you want the black pants or the blue pants? And sure, if she doesn't want to speak, she'll tap which ones. And this is really important to remember. These people, they're not children. They're adults. They want to be treated like adults. They have adult feelings.
Lucy: If Victoria is in pain, she will pull away. She might, you know, touch her face. She'll make her upset expression. And those are all the signs. She won't tell me. But sometimes if she is in pain, she won't show those signs. You know, it's a bit of a guessing game sometimes. And if you guess it wrong, that's okay. If you guess it right. Amazing. Her little expressions can sometimes be very fleeting. And if you don't catch them as she's doing them, she might not do them again.
Angela: A bit of his tooth broke and I, I contacted Dr. Avanti and she said, Is it worrying him? I said, No, it's not. So we made an appointment and then maybe it was a week or two weeks. I'm not quite sure. I can't really remember. He started to be putting his finger in his mouth, like playing with it a lot. And then when I'd brush, he'd, you know, respond like, you know, a reaction sort of thing. So I rang Dr. Avanti and said, Yeah, it's affecting him now.
Angela: He'd stopped swallowing like we used to tell him to swallow and he just leave the saliva in his mouth. And so much so that like, if he tipped his head down, it would just spill out. So he was sort of walking around with his mouth open, so he himself wasn't cleaning in his mouth properly. Also, he had stopped talking as much, so he wasn't using his mouth as much.
Avanti: Providing regular oral care also gives the carer a great opportunity to look for any signs of oral pain or underlying oral disease, whether that be ulcers in the mouth or broken or cavitated teeth. You may also need to be looking out for signs of oral pain, particularly if a person with special needs is not able to communicate these verbally. There may be changes in diet, behaviour or sleep patterns. There may be new mouthing behaviours or you may be looking for signs of infection such as redness, swelling or fever.
Topic Nine: Unique Concerns for People with disability
Avanti: Persons with disability can be more at risk of dental disease because of malocclusion, weakened teeth or missing number of teeth or smaller teeth. They can have swallow difficulty, aspiration risk, drooling, but also dryness in the mouth caused by multiple medications can also put someone at very high risk of dental disease. Some persons with disability may have a compromised swallow or dysphagia, and so contents from the mouth, including oral care products or indeed contents from the stomach, can go into the airways and be aspirated.
Avanti: As such, they might be at risk of aspiration risk. For those people, it's important that you're using a low foaming toothpaste or very specific products recommended by your dental practitioner to be able to provide safe care. Or, it might be about making sure that their head is upright and they're not at risk of aspiration. So oral care, if you think about it, it's such a complex task because it requires fine motor skills, it requires manual dexterity. You need to have muscle memory and good muscular adaptation to be able to have the toothbrush in the mouth. For someone with special needs or additional needs, that might be quite difficult because you've got someone who might have altered vision. You might have someone with a strong gag reflex or taste aversion, someone with postural difficulties who's kind of facing forward with kyphosis or someone who can't extend their neck might find that incredibly difficult.
Avanti: Try and minimise dietary sugars to try and establish some regular oral care routine and continue daily attempts at the same. When planning for your dental appointment, it's always good to be able to storyboard the appointment, know where you're going, especially if you've been there before and introduce that nice and early.
Avanti: You must remember to take along a current list of medications and updated medical summary, guardianship details or a speech pathology assessment if that's been recently undertaken. Taking along the person's toothbrush and toothpaste, a regular carer who's able to demonstrate how brushing is currently being done will also help the practitioner. At the dental visit, your dental practitioner will be able to formulate an oral care plan which outlines the right products to be used for you and the best way that you may be able to access these.
Angela: There's a lot of things. It's all overwhelming. You do the best you can your stuff up. You try and make it better.
Presenter: New South Wales Health would like to thank Ben, Angela, Victoria, Antonia and Lucy for their kind participation in this video. Special thanks to Doctor Avanti Karve, Special Needs Dentist. Developed in partnership with the Australian Dental Association, New South Wales.