1137H
Fig. 17.9 Dental treatment under day-stay general anaesthesia for a child with
impairments.
17.2.4 Home care
Oral hygiene
There is little to be gained in embarking on elaborate treatment plans including
advanced restorative work when it will not be maintained by regular oral hygiene
measures at home.
Parents or carers need specific advice and practical help in the best way to care for
their child's mouth. Great reliance is thus placed on the parent or carer who must be
actively involved in oral hygiene instruction and given positive suggestions for
modifications to the standard techniques. Examples include advice on the way to
position a child (a bean bag can be helpful), in order to clean their mouth more
efficiently and less traumatically. Another aid is the use of a prop such as a toothbrush
handle to gain access to tooth surfaces on the other side of the mouth. Modification of
existing, often very narrow-handled toothbrushes or the use of specially modified
brush heads can be helpful (1138HFig. 17.10). Carers may be concerned about being bitten
when they attempt to clean a child's mouth, in situations when toothbrushing is a
battle. In these circumstances, use of an infadent brush (1139HFig. 17.11), with bristles
incorporated onto the end of a plastic-type material that fits over the end of a finger,
similar to a finger-stall, can overcome these problems and ensure adequate tooth
cleaning.
For some children, the mechanical removal of plaque can be more readily
accomplished using a powered toothbrush. Once the child has become accustomed to
the sensation, results can be better than by conventional toothbrushing. Chemical