agents are effective in reducing plaque in the short term, but not enough is known
about the effects of their long-term usage. Many children find the taste of 0.2%
chlorhexidine gluconate, either as a gel or solution, unpalatable and parents or carers
are unhappy about the extrinsic brown staining. Many patients with impairments may
be unable to use a mouthwash correctly and either swallow or spit out anything
distasteful. An alternative technique is to opt for chairside application of
chlorhexidene as a varnish. Originally intended for treating dentine hypersensitivity,
application of the varnish has been shown to reduce the incidence of both gingival
signs and dental caries.
Some schools for children with special educational needs provide toothbrushes for
their pupils during their learning of personal hygiene skills. However, supervising
staff may be unaware of the best method of mouth cleaning, which may be more
dependent on their own perceptions of oral health and the perceived difficulty than
any other factor (1140HFig. 17.12).
Toothbrushing can be taught in the same way as other skills, but it requires time for
the individual as well as commitment on the part of the regular carer to ensure that all
areas of the mouth are being cleaned each time. However, many disabled children are
intolerant not only of toothbrushing but also of toothpaste and they may gag when
toothpaste, which they cannot swallow because of poor reflexes, is introduced into the
mouth. Toothpaste also obscures the view for the carer during toothbrushing and they
cannot always be sure that the tooth surfaces are clean. In these circumstances, where
toothpaste is unacceptable to the child, parents or carers should attempt to clean
around the mouth with a piece of gauze moistened in a 0.2% chlorhexidine gluconate
solution or a toothbrush dipped in fluoride mouthrinse (0.05% sodium fluoride if used
on a daily basis). Alternatively, chlorhexidine in gel form or fluoride toothpaste can
be rubbed as vigorously as possible around the tooth surfaces using a finger. Since
chlorhexidene is inactivated by the traditional foaming agents in toothpastes, the
former should be used at a different time of the day to the latter.
Children who are tube-fed for some or all of their nutrient intake still need oral care.
They will frequently accumulate significant quantities of calculus, which, if detached
might be inhaled. Regular mouth cleaning and the use of a 'tartar control' toothpaste
are necessary (1141HFig. 17.13).
Diet
More severely impaired children may have well-regulated eating times and a reduced
likelihood of snacking. The food consumed may be semi-solid or even liquidized, but
those foods which are easily reduced to this form are often dentally undesirable. In
these circumstances the dentist should offer advice on limiting the number of intakes
of food, provided it conforms to the child's general nutritional and dietary needs.
For some children establishing a normal eating routine while 'growing up' becomes a
battlefield and impaired children are no exception to this. It is often easier for parents
to 'give in' to a child and allow them to eat a limited variety of unsuitable foods
frequently. This will be justified by parents saying they are desperate to get the child
to eat something, and so biscuits, and other snacks high in non-milk extrinsic sugars,
become the norm. This pattern is further endorsed in some children with impairments