Keeping It Clean: Toothbrushing Tips

by Miriam Davidson on Sat, 2011-01-01 14:04

With a few simple modifications, a daily routine of brushing and flossing will keep breath kissably fresh

For health and hygiene at all stages of ALS — not to mention the comfort of having fresh breath — it’s important to keep the mouth clean.

A daily routine of brushing for at least two minutes, morning and night, and flossing before bedtime should be maintained, especially when eating a soft diet — and even when the mouth is no longer used to take in food. Mouth care is especially important for those using breathing equipment, as bacteria from the teeth can be drawn into the lungs and cause pneumonia.

But as ALS progresses, oral hygiene can become a challenge for both the person with ALS and his or her caregiver. Here are some suggestions for making it easier.

Plak-Vac/Res-Q-Vac Combination

Floss pick

Tongue scraper

Mouth guard

Brushing: People with ALS may find it hard to hold a toothbrush up to their mouths or to move their hands back and forth. A variety of aids exist to remedy these problems, including reach extenders, wrist cuffs (some with self-rotating brushes attached), children’s toothbrushes, lightweight electric toothbrushes and “water flossers” such as the Waterpik.

It also may be hard to grip the toothbrush. Foam tubing and pipe insulation (available at hardware stores), rubber bands or tape can build up the handle and make the toothbrush easier to manipulate.

Toothpastes made for people with dry mouths, such as Biotene or Tom’s of Maine, don’t foam as much and are easier to swallow or spit out than regular toothpastes.

Toothpaste dispensers, which use a large handle to pump toothpaste on to the brush, are helpful for those who lack hand strength to squeeze the tube.

As ALS symptoms progress, some lose the ability to hold their mouths open or swallow effectively. It may be easier for them and their caregivers to switch to disposable, mini travel toothbrushes or foam-tipped swabs. Products such as Toothette Plus Oral Swabs with Mouth Refresh Solution don’t need water and may be easier to get into a “tight” mouth. They are available at pharmacies and medical supply stores.

For those on a vent, toothbrush attachments are available for suction machines. One, the Plak-Vac suction toothbrush, $7.50 from Trademark Medical supply, cleans the teeth and suctions the mouth at the same time. It attaches to a standard wall or portable suction machine, or, for $110, comes with its own, hand-powered portable suction unit, the Res-Q-Vac. Disposable Toothette swabs that attach to a suction machine also are available.

Flossing: Flossing can be as important, or even more important, to oral hygiene as brushing, yet it is often neglected because it’s so awkward and hard to do. Floss holders can help. A variety of these inexpensive plastic devices, which hold a piece of floss tightly and are ideal for reaching between back teeth, are available at drugstores or on drugstore websites. Even with a floss holder, caregiver assistance is usually required to do an adequate job.

Rinsing: In the early stages of ALS, mouth rinses are helpful in killing bacteria and healing sores, which sometimes occur when people bite their lips, cheeks or tongues.

Strong rinses, such as those containing alcohol or Clorhexadine (requires a prescription), are especially effective at preventing gum disease and healing sores, but should be used with caution as they tend to produce saliva and have been associated with adverse reactions in some people. OxyFresh mouthwash and other oral care products are recommended by some ALS nurses.

But after a person finds swallowing difficult or impossible, mouth rinses should be avoided due to the risk of choking.

Tongue scrapers: When cleaning the tongue with a toothbrush becomes too difficult, these are handy devices. A variety of inexpensive models are available in drugstores or on drugstore websites.

Mouth guards: Mouth guards are designed to hold the mouth open for cleaning, or to prevent people from biting the insides of their mouths or from grinding their teeth at night. They can be custom made by a dentist or, less expensively, purchased at drugstores or sporting goods stores.

Plak-Vac suction toothbrush and Res-Q-Vac portable suction unit: www.trademarkmedical.com/personal/personal-oral.html

Toothette plus suction swab: www.specialtymedicalsupply.com/toothette-plus-suction-swab-single-use-system.html

OxyFresh products: www.oxyfresh.com

ALS Forum chat on toothbrushing and suction machines: www.alsforums.com/forum/tips-tricks-gadgets/9854-suction-device.html

Miriam Davidson
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