By Denise Walstra
Many patients who live in group homes and nursing homes during the pandemic were not receiving proper dental care and treatment either at home or in the office. There seemed to be a great need for more effective ways care for their oral health. Since most dental offices were closed and their patients couldn't receive a professional prophylaxis, we were on the precipice of a dental hygiene problem of epidemic proportions. Many of these patients couldn’t take care of their own teeth and depended on their providers and their dental professionals to keep their teeth and gums healthy. Group home agencies during the pandemic were faced with understaffed houses and were overburdened with caring for the residents. These group homes are still facing staff shortages; oral health care can prove to be a daunting, difficult task for the staff and their residents.
I am writing about this issue because I am a dental hygienist for 34 years in a private practice in Connecticut and I have a 25-year-old daughter who has Angelman syndrome (AS). AS individuals have low muscle tone, ataxia, intellectual disability, and little conversational speech; most exhibit seizures. People with AS are also dealing with sensory issues with tactile defensiveness during certain activities, and toothbrushing is one of them.
My daughter lives in a raised ranch with two roommates about 20 minutes from our home. She came to our house every Wednesday and Sunday and on those outings, we always made sure to floss and brush her teeth to help prevent inflammation and gingivitis of her gum tissue. Many staff who take care of her feel toothbrushing was a more difficult task than most of the other personal care they did with her. At that time, Nicole and her staff were using an electric toothbrush we had purchased for her and with intervention a couple of days a week, it seemed to give some baseline care for her teeth.
The pandemic's effect and the solutions we tried
When the pandemic struck in March of 2020, panic set in with not being able to see her or take care of her teeth (or just plain see her beautiful face).
Five long months dragged on, and it seemed eternal. In that time researching led to my buying a few three-sided toothbrushes, which I felt would have the best outcome of most home-care tools.
When Nicole was finally able to return home in August of 2020, her gums were very inflamed with heavy bleeding and heavy plaque, but it only took me a few days with her new three-sided toothbrush and some hand scaling with my dental instruments to get her gums back to health.
The first toothbrush was an electric triple bristle toothbrush. It’s a three-sided electric toothbrush that seems to be quite effective in removing plaque from the gumline. It has ultrasonics that disturb the plaque biofilm, but it was too much vibration for Nicole to handle so moving on to three-sided manual toothbrushes seemed best. If the patient can tolerate the electric one, that is ideal, but a good manual toothbrush can also educe plaque biofilm.
There is another brush called the Benedent. It folds around the lingual (tongue) side and buccal areas (cheek side) while brushing the occlusal surfaces (biting surfaces) of the teeth (hence three sides). Note: if there is significant recession of the gumline, it may not be as effective because the gumline is deeper and lower and the bristles can only go so far down. When brushing both sides at once, it reduces the brushing time to one minute. It helps to play music while doing this, but because my daughter loves music and moves her head side to side to sway with music it didn’t work for us—but it’s been very effective for others.
First using one on yourself to model it can also work—a see one, do one approach. You can even have your patient demonstrate it on their favorite stuffed animal or doll if they are young at heart.
A significant breakthrough
When Nicole returned to her home after being with me for nearly three weeks, they began using the three-sided manual toothbrush. When she came home again after two more months of not being home, her teeth and gums were much healthier with much less bleeding and lighter plaque. We had made a significant breakthrough with her oral health care by the staff finally, and they felt more confident in their technique with a much easier toothbrush to use.
Introducing this toothbrush to some of the patients in the office who are not intellectually challenged but have difficulty maintaining contact with the gumline throughout their brushing experience also proved successful. When they returned at their recall, their gum tissues were bleeding less, with less inflammation.
I have explained to these patients and to the group home staff that there is a significant oral-systemic link to inflammation and the gumline which directly affects susceptibility to heart disease and stroke. The bacterial pathogens that are under and around the gumline infect the tissues and bone, causing periodontal disease. Inflammatory enzymes called cytokines, along with bacterial pathogens under the gumline, spill over into the bloodstream causing an inflammatory response in the arteries; this in turn causes more plaque in the arterial walls that can harden and create blockages, causing premature stroke or heart disease. These bacterial pathogens are found in the walls of arteries 100% of the time after a heart attack. This is the oral-systemic link. It becomes extremely important to get regular checkups with your dental hygienist and dentist to determine whether you have undiagnosed or untreated gum disease. We now know that being diagnosed with gingivitis is a precursor to periodontal disease with dangerous inflammation and bleeding; even though there is no bone loss with gingivitis, it is the first symptom to acquiring gum disease. Prevention is key and with tools such as a great toothbrush, bleeding can be prevented.
This is my story with my daughter Nicole, and it has had a better outcome than most could predict. The pandemic is hopefully now heading into closure; however, good dental hygiene will always be a staple to good health. There is relief in knowing that good dental brushes and flossers are available for the staff to maintain Nicole’s dental and overall health.
Resources
Denise Walstra and her daughter Nicole demonstrating their toothbrushing technique on YouTube
Mouth Monsters
5 Tips for Helping Children with Special Needs Brush Their Teeth
Reference
1. Van Dyke T, El Kholy K, Ishai A, et al. Inflammation of the periodontium associates with risk of future cardiovascular events. J Periodontology. January 2021. doi.org/10.1002/JPER.19-0441
Denise Walstra, AS, RDH, has 34 years of experience as an RDH in periodontal and general dentistry. Walstra was on the board of directors for TheArcNLC, a nonprofit organization running up to 20 group homes in southeastern Connecticut.
