27 Sep 23

People with learning difficulties/special educational needs are often at extra risk of dental problems due to a lack of understanding on their part and poor communication by carers or dental professionals. There’s plenty that can be done, though, to reduce their anxiety in the practice and help them and their carers to maintain good oral hygiene at home. BioMin® F can play an important part in supporting this.

Everyone is entitled to the best chance of a healthy mouth, but for many people with special needs or learning difficulties, this can be hard to achieve. Some might not understand the importance of oral hygiene and are unwilling to cooperate with a daily cleaning routine. Some carers may not have the knowledge or expertise themselves to get the person into a good cleaning habit and, if the person is fearful of going to the dental surgery, they might not be able to access the professional help they need.

It’s quite common for a person with special needs also to have other medical conditions, or to have a limited or unhealthy diet, especially those people struggling on low incomes. Some medicines may cause a dry mouth, while others contain sugars. Poor eating habits also increase the risk of dental decay. All these things, together with the current shortage of NHS dentists, mean that many people with special needs are suffering with dental problems that will affect their general health and wellbeing.

Autism

Dental care for people with autism can be extremely challenging. The National Autistic Society defines autism as ‘a lifelong developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them’. Every autistic person is different in how they react, but anxiety and sensory issues are common problems, and can impinge on all aspects of their lives.

This has a number of implications for the oral health of an autistic person, as sensory issues – including extreme sensitivity to sound, smell, taste and texture - affect how they are able to manage their oral hygiene at home, and their visits to the dental surgery with all its smells, noises and bright lights. Conversely, some people with autism may not be able to recognise pain and discomfort, or are unable to voice these, so problems can go undetected. Additionally, many people with autism have a limited (and often unhealthy) diet, or drink a lot of fizzy/sugary drinks, both of which increase their risk of tooth decay or erosion.

Fear of the dentist and a change of environment for somewhere strange and clinical can be a big worry. Some autistic people will not like having their personal space invaded as a professional looms over them. Anxiety and a lack of understanding of what is going to happen can make appointments extremely stressful – sometimes even impossible. As a result, some people with autism don’t get the dental care they need, and it’s a downward spiral which can lead ultimately to them losing their teeth.

In practice

Generally, people with learning difficulties or other needs have less access to dental care than the general population. With some thought, though, it’s possible to make some simple adaptations in the surgery to make it more accessible for them. While wheelchair access for people with physical disabilities can be installed quite routinely, a bit of imagination is needed for the less visible disabilities, especially autism.

Professionals need to take some time to learn about these conditions, and understand the individual fears and anxieties of a particular patient with special needs. Be flexible about the timing of the appointment and maybe let the anxious patient wait outside in the car till it’s time to go in. Perhaps music can be turned down or off (not everyone finds it soothing!), lights dimmed and a calm atmosphere created as much as possible. Do they have to be tipped right back in the chair? Parents and carers really appreciate it if the practice notes their child’s or client’s preferences so that they can be taken into account on future visits and they don’t have to go through everything each time.

Take time to explain to the person what is about to happen and show them the instruments and materials you are going to use. Be specific and clear. If you can provide simple visual materials with pictures, to help with explanation, that can be really helpful. Demonstrate with models or toys what you are going to do, or use them to show brushing technique.

Organisations such as MencapOral Heath Foundation or the National Autistic Society have guidance on oral health care for people with special needs. Offer easy-read leaflets on healthy eating as well as oral care.

Some patients might be helped by sedation or relative analgesia (RA) but, if the level of anxiety or behavioural issues is very high, the local Community Dental Service should be able to point parents or carers to a special needs dentist. Carers – ask around if other parents/carers can recommend a dentist who is skilled at working with people with special needs.

 

Home care

At home there are a number of practical measures that can help to improve oral care for people with special needs of various types. Again, visual materials, social stories for people with autism, laminated cards and reminders, can all help. Whatever works!

An electric toothbrush can be helpful for those with poor dexterity, enabling them to brush hard to reach areas, though some people with autism might struggle with the noise and the vibrating sensation. It also reduces the risk of brushing too hard. It’s worth trying a few different toothbrushes out to see what works best.

BioMin® F toothpaste can be a great benefit for people with sensory issues. Unlike other toothpastes that have a strong flavour necessary to mask other ingredients, BioMin F has a unique fluoride source and so we use a mild minty flavour. This, combined with its low abrasivity makes it much easier to tolerate for those who dislike strong flavours or rough textures. For those who really dislike mint, BioMin® F for Kids offers the same protection but with a pleasant strawberry flavour.

BioMin F also has the ability to remineralise (strengthen) lost and damaged enamel. Using a toothpaste that provides maximum protection is especially important if the enamel has been worn down through bruxism or if oral hygiene is poor. Its slow release mechanism provides round-the-clock protection, and means that even if the brushing technique is patchy, the teeth have the best possible chance of being strengthened and coated with fluorapatite, the fluoride analogue of natural tooth mineral formed by BioMin F.*

What’s more, if the person has a poor diet or drinks a lot of fizzy drinks throughout the day, BioMin F can help to keep the pH in the mouth steady despite the acidic ups and downs of snacking. This reduces the likelihood of tooth decay. If at all possible, it’s worth investing in a good quality toothpaste like BioMin F to provide that extra layer of protection for those most at risk.


* How BioMin F works

When you brush with BioMin F toothpaste, the active ingredient in the toothpaste sticks to the tooth surface where it gradually dissolves over 12 hours, slowly releasing an optimum balance of calcium, fluoride and phosphate ions.
These work with the saliva to form fluorapatite (FAP) which is deposited on the tooth surface and into the tiny dentinal tubules.
The fluorapatite acts to remineralise lost or damaged tooth enamel preventing decay whilst also plugging the tubules and so preventing the fluid flow that causes sensitivity. Remember: spit, don’t rinse! 

 


Take time

Above all, carers and professionals need to take a bit more time with people with special needs and learning difficulties, and think creatively about how to support them. Their condition and lifestyle may make them particularly at risk of dental decay or erosion, and a lack of understanding - both of their own needs and what is being ‘done to them’ - can make oral care especially hard. Make use of any materials, information and products to help them understand why oral hygiene and attending dental appointments are important, and encourage them, if you can, to take care of their teeth in between dental visits.

 

 


For further information on the science behind BioMin visit our science pages.

To buy BioMin F, BioMin C or BioMin F for Kids go to: Upbeat Care | CTS Dental | Growing Smiles

Calling all dentists! Want samples or a practice visit?
Speak to our UK dealers, Trycare on 01274 88 55 44 or email: dental@trycare.co.uk,
or CTS Dental on 01737 765400 or email: sales@cts-dental.com