Introduction: Cavity Prevention for Dexterity Challanged People

About: I like to rock harder than granite! Actually, I just like rocks.

Dental Caries (aka tooth decay or cavity) is the most prevalent disease in the world.  People with dental caries suffer from results including but not limited to pain, tooth loss, decreased chewing function therefore poor diet, and infection. Tooth loss can also have other psycho-social effects causing people to be uncomfortable about their appearance. 

This disease is initiated, most commonly, by bacteria known as Streptococcus mutans.  Bacteria thrives in a sticky matrix called plaque.  The best way to prevent this disease is by manually removing the bacteria and plaque from the tooth surface; thereby preventing the acid challenge from the bacteria that dissolves the tooth structure.  It takes an average of twenty-four hours for a tooth surface to have damage from the bacteria sitting on it.  Plaque removal is recommended in the morning and before bed.

There are populations that are unable to clean their teeth properly due to various disabilities.  This can include loss of function in the hands or loss of dexterity.  This can impair the person's ability to manually remove the bacteria causing tooth decay.  Assisted devices can improve a persons ability to remove the bacteria and plaque matrix therefore preventing dental caries.

Devices that improve oral health should be tailored to the patient needing assistance and the barrier the patient experiences.  Following are examples of ways to improve oral health for people needing assistance.

Step 1: Electric Toothbrush

There are five sides of a tooth that need to be cleaned on a regular basis, the cheek side, tongue side, chewing surface, and the two surfaces that oppose other teeth or spaces. A tooth brush can effectively clean three of the five surfaces if used properly.

The electric tooth brush is a fantastic tool to help remove plaque from the tooth surface.  It is designed to be held in place while the brush head turns thereby removing the sticky plaque from the tooth surface. 

People with dexterity issues can find this useful.  It is recommended to look at different products available.  Things to look at when selecting an electric toothbrush are: weight, ease of depressing the power button, cost, and cost for replacement brush heads.  Always select a brush with a timer to ensure the person is using the brush for a full two minutes in order to allow proper time for plaque removal.  A pressure sensor is also a wonderful feature to consider because excessive force does not help clean teeth and instead can cause problems like receding gum tissue and premature erosion of the tooth surface.

The built in timer available on an electric tooth brush is separated into six units of time.  These sections are to be broken into:
1- Upper right
2- Upper front
3- Upper left
4- Lower left
5- Lower front
6- Lower right

Be sure to put the brush on the cheek side, chewing surface, and tongue side of each sextant.

Step 2: Simple Modifications to Manual Tooth Brushes

A toothbrush can be modified in many different ways for a person with a disability to properly grasp and use.

A toothbrush grip is a common, reusable, and easy way to modify a handle for those with decreased grip strength hold on to a tooth brush.  These can be made at home with various products like sugru or bought ready made from online retailers.  A tennis ball can be added to the end.  A bike handle can work too.  Also a holder can be added made from elastics or velcro.

One recent instructable modifies a spoon that could also do the same with a toothbrush.

Another recent instructable modifies utensils including a toothbrush.

Step 3: Floss Holders

Floss holders are devices that allow people to clean the surfaces of teeth that face other teeth and are next to areas without teeth that are not accessible with a toothbrush.  Because these areas do not build plaque as much as the other three it is recommended to floss at least once a day.

The proper way to allow floss to clean these surfaces and to put it in between the teeth and have it form a C-shape and scrape one tooth, then press it against the opposing tooth and scrape the other tooth.

Things to consider for floss holders are ease of use, cost, and if it is disposable.  Fully disposable floss holder add to the landfill and are more expensive long term but are easier to use. 

Step 4: Two Person Oral Hygiene

Sometimes a person's disability can require another person helps brush their teeth.  For an adult, it is best to start with them in seated position while the person to brush the teeth is standing above the other.  Have the person to get their teeth brush tip their head back so that the mouth is easily visible.  Pull the person's cheeks out in order to have all surfaces easily viewable (ass seen in the photos of dog's teeth).  Brush as in step one breaking two minutes into sextants.

Step 5: Chemotheraputics

If a person is unable to regularly clean their teeth even with modification, there are chemical options to prevent tooth decay.

Fluoride treatments and toothpaste:
Professionally applied fluoride treatments have been proven time and time again to decrease the incidence of caries when completed in a regular interval.  Chemically, the fluoride ion incorporates into the enamel on the tooth surface.  This requires the initial pH of the acid bacteria discharges to be lower and more acidic in order for a cavitation to occur than on enamel that has not had fluoride ions incorporated.  Fluoride is a natural ion found in many water sources.

All anticavity toothpastes available over the counter have fluoride in them.  A prescription toothpaste has one hundred times the concentration of fluoride in it and has been proven to decrease cavities.

Chlorohexidine rinse:
In the US, chlorohexidine is a prescription regulated drug but it is not so in other countries.  This medication is a topical antibacterial that coats teeth and does not allow bacteria to stick to teeth thereby decreasing cavities.  It can cause large deposits of calculus and tarter.  If the person using it does not have regular visits for dental cleanings it is not a recommended product due to the potential for buildup.

Step 6: Visit the Dentist

Nothing can substitute a good relationship with a dental care professional.  They  can treat and monitor disease and also suggest other modifications specific to a patient.  Professional cleaning can remove tarter or calculus that is not possible to remove at home.  Patients with increased disease risk are usually recommended more cleanings in one year to remove plaque that is difficult for a person to clean at home and to monitor changes in cleaning ability.

Humana Health Challenge

Participated in the
Humana Health Challenge