For any parent this is a thing. Ensure that your child brushes his or her teeth well, eats not too much candy and goes to the dentist every six months. But what about children with disabilities? How do you cope with oral hygiene if your child has a difficulty swallowing or food residue stays behind in the mouth for hours? How do you brush teeth when your child refuses to cooperate? And, what do you do when the incentive processing is different and the mouth area basically is a ‘no-go area’? I talk to experience expert Sanne ter Heide and with Yvonne Kort from Oergezonde Mond. Yvonne is author of the books,  ‘Eet je mond gezond’’ and ‘Gezond begint in je mond’.

Yvonne: “I think you should adjust your goals and above all, you must take small steps. Ensure the amount of dental plaque that’s created is minimized, that’s achieved by adjusting the diet. But if children are fussy eaters already,, you can’t expect everything to change from the get-go. Then it’s important that you clean the teeth well so the dental plaque gets removed.” Of course, it’ll be different in/for children or (young) adults with disabilities when it comes to dental cleaning. Surely if brushing is challenging for a variety of reasons. Sanne ter Heide knows all about this. She has cerebral palsy and is affected by spasms, especially in her mouth. “If anyone comes close to my mouth, I tend to bite. That reflex reduces if someone takes the time and prepares me well for what’s to come. It’s significantly important that parents not just go to the neighbourhood dentist, but actually do (some) research on where their child can get suitable care before planning an appointment,” says Sanne.

How do you get the ball rolling at home? How do you brush your child’s teeth and molars in an effective manner? Yvonne: “Is the child seated on your lap or do you stand behind your child? It’s useful if you’ve a overview from above like a dentist. Do all steps cautiously, take the time and explain what you’re doing. Choose a toothpaste your child responds well to. I usually recommend a toothpaste with active oxygen. blue®m has a good toothpaste with active oxygen combined with manuka honey. This last ingredient has an antibacterial effect and it promotes tissue repair. It causes less inflammation and should this arise anyway then the toothpaste restores it quicker with this ‘wonderous honey’. The oxygen that remains in the mouth after brushing, keeps doing its ‘job’ for a little while longer. Very handy,” laughs Yvonne. “It may all make sense, but if your child’s mouth is quite sensitive, it’s a good thing to find out which flavor, particularly the sharpness, suits your child best. Maybe one toothpaste works easier than another.”

“They always say that you have to brush two minutes, but I wouldn’t mind the clock. Just keep in mind to brush every tooth and molar. Take the time, take it easy. Prefer to brush  longer in one place and more gentle, because brushing hard can work counter productive for your child.”

Saliva and cleaning your teeth

“Brushing twice a day, with the importance on brushing at night, I always say that during the day you’ve saliva production, and saliva cleans quite well. Of course, the question is, if there’s a normal production of saliva. Watery saliva cleans better than slimy saliva. In children with disabilities the saliva is often firmer and tartar is caused more easily. Perhaps it’s better to brush three times a day when it comes to this specific group, ” says Yvonne. “Children who can’t swallow food well, you’ve to remember that they get dental plaque faster. What’s especially bad, are sugars and starches that stay in the mouth for long periods of time. This allows for caries to occur. It’s a good idea to rinse with water after all eating, if possible. A few sips of water can already help.” Sanne is lucky! Because of her cerebral palsy, she has an above average saliva production. Meaning she’s less prone to have caries. She tells us enthusiastically.

Brushing electric, or not?

Sanne: “Brushing is always a challenge for me! I don’t have the motor skills to move a regular toothbrush in my mouth correctly. That’s why brush electric. ” “An electric toothbrush works wonders, of course,” explains Yvonne. “The brush turns around faster, making plaque removal easier. It also cleans well between your teeth and molars. But note, you should be able to place it in the right manner inside the mouth and hold it. For sensitive children a manual toothbrush might do the trick, the brushing is more pleasant perhaps because you can control the brushing motions. In addition, you’re already reach a wider range and cover a larger surface area if you compare it with such a small brush. Which you really use per tooth. Very useful is the V-shaped toothbrush of Dr. Barmans. If you use this brush, you immediately reach all three surfaces of your teeth. Which makes the task of brushing teeth a lot easier if it’s already difficult. Because you ‘hit’ everything you need in one go. Most people know it this: ‘the more power you use for brushing, the more the child will resist’. So prefer not to open the mouth too much; because the cheeks will be less taut and you’ll get more room to brush.

 

Vitamins and minerals

 It’s important that there are sufficient vitamins and minerals present in our body. You can administer fluoride from the outside in to make your teeth strong, but it’s also very wise to look at how the teeth are supported from within. If children eat one sided, it’s important that you compensate for deficits. Especially calcium and magnesium are important for your teeth. blue®m can support you in this with ‘teeth and bone’-dietary supplements. These are effective in maintaining healthy teeth and strong bones. If there’s difficulty with swallowing, you can open the capsule and process the contents in some food or a drink. Give children up to two capsules per day because of the legally established daily dose vitamin B6. You have to look at it like this, your jaw bone and your teeth actually are a storage place for these substances. At the moment when there are deficits, your body will take them from there. The average Dutchman eats bread twice a day and vegetables once a day. Only with our meals we don’t get the amounts of minerals we all need, because this would require many more vegetables than you eat during dinnertime. Vitamin D3 and K2 are needed for the absorption of minerals and must therefore be also sufficiently present in our diet. If not, you can give this extra to your child. In principle Vitamin K is also produced by your gut bacteria, but you’ll need to have a good compilation naturally.

What’s possible when it comes to supplements?

Flossing is important, but completely impractical for some children. Then it’s important that you ensure that there’s sufficient cleaning between the teeth and the gums are taken into account as well. Active oxygen helps, but you can also check or other tools than dental floss. For example, a good quality toothpick can help sometimes. You can even use a little bit of toothpaste on it. A good quality mouthwash, preferably with active oxygen and without alcohol and chlorhexidine, helps quite well too. But the child should be able to spit out. For those parents who’ve tried almost all and still search for a solution, there’s a special dental chewing gum with manuka honey and xylitol available. Ask the dental hygienist about it. In addition to a sweetener xylitol is also a wetting agent which makes it less likely to be affected by a dry mouth. The latter is common in children with disabilities as a result of drug use. Some medications reduce the functioning of the salivary gland and dehydration of the oral mucosa. If the teeth become poorly as a result of drug use, it’s good to look at solutions. Other medications, another moment of intake or some other form of intake. I once spoke a mother whose child got discoloration on the teeth due to the medication for epilepsy. The mother approached the pharmacy and asked if it was possible to put the active substances in a suppository. Although the pharmacy had to prepare it manually, it appeared to be working!

Extra dental treatments are also important, of course! Dental costs are reimbursed up to eighteen years of age. Yvonne: “I’m a great believer that your child should have frequent dental appointments. Some practices are working with the program, ‘Gewoon Gaaf ‘, which really looks for what’s needed. There are children who visit four times a year, others more often. The teeth are cleaned, there’s instruction given, the dentist checks the mouth and teeth. This way there are so many more moments that the dentist looks in your child’s mouth. On a dental chair with the light above it, we can see everything much better and we can also reach the teeth easier. In addition, your child gets used to visiting the dental practice.  It then becomes more normal and less exciting.”

Swallowing toothpaste and the use of fluoride

There are also children who are unable to spit out the toothpaste they use. Some parents continue therefore, to use baby and toddler toothpaste because it contains small amounts of fluoride and swallowing it, is less severe. Still, it’s not advisable. “I’d recommend to brush without fluoride. These toothpastes are available. It tricky, because fluoride strengthens the teeth and besides that, you don’t want cavities. I’d suggest if you change to fluoride free brushing. you immediately plan more frequent visits to the dentist. So fluoride can be applied locally.

 

Photos private collection – Woman in chair at dentist is Sanne. 
Caption for this photo: Marco Egas dentist at Heeldemond Tandartsen in Zwolle.

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