More than Just a Pretty Smile

By Jacqueline Thrash, OTR

When I was young, my father was in the military; so we had good preventive dental care coverage. I learned that if I had my teeth cleaned every six months, then I didn't get cavities. I got my first cavity at 9, and my second one at 29. For a long time, though, I actually thought that the teeth cleaning process was just the polishing part, because I went frequently enough that I didn't get plaque or tartar build up.

My husband has said, "Jackie, you'll go out with you hair looking any kind of way, (I keep it short, and only comb it once a day), but if you lost or broke a tooth, you'd actually call in sick until you could get it fixed!"

Well, I guess I have my grandfather to thank. He scared us by removing his dentures and gumming at us, and told us to take care of our teeth. My obsession has paid off—at 48 I haven't lost any teeth nor had any root canals.

Recently I have been using the services of the Pasadena City College Dental Hygiene students to take care of my teeth and give the students an opportunity to practice. It was fun, actually;

I learned about my teeth (anatomy, function etc); helped a few students learn their craft, got pampered (teeth, not hair), and saved money.

I hadn't been to the dentist since right before my accident over two years ago, so I was behind in my preventive care. While sitting in the dental chair, I was listening to my hygienist, Tanna, call out to her assistant the tooth surfaces and the pocket depth between my gums and teeth. I learned that plaque was a build-up of bacteria, that tartar was hardened plaque, and that both of these irritate the gums and can cause gum disease. I also learned that the actual teeth cleaning involved scraping the tooth's surface with the sharp hygiene instruments, not just the flavored polishing. I even went through a scaling or deep cleaning under the gums' surface. It was time consuming, since it was a student clinic; however, it gave me an opportunity to sit still for 4 hours!

While I was in the dental chair, I had plenty of time to think. I started thinking about how I incorporate oral care with my patients, and how important it is for us to reinforce dental hygiene with them. Many of our clients are weak, and can't sustain the effort to brush their teeth well; they just dab at their teeth with the brush. Many of them don't have the finances available for regular visits to the dental office; and their insurance, if they have any, only covers one cleaning a year. Also, in the facilities in which I work, many of the CNAs don't always have time to brush the residents' teeth twice a day.

A speech therapist, Srinivas Sarikonda, MS, SLP, had told me that oral bacteria increases the risk for aspiration pneumonia in dysphagia patients.

A course called "Adult Dysphagia Management for the OT and Interdisciplinary Team," by Dynamic Learning Online, states that "in a study by Susan Langmore et al, 19 percent of the patients who developed aspiration pneumonia did not have dysphagia, e.g. they did not abnormally aspirate food or liquids when swallowing. Microaspiration (normal inhalation of saliva) of oral secretions that have a high content of bacteria can cause aspiration pneumonia in those who are NPO or do not have dysphagia." This information alone is good enough reason for us to help the client improve their oral hygiene skills.

Infections in the mouth also can cause heart problems or brain damage. I actually know a young man in Berkeley, CA, who at 13 had a tooth infection that went to his brain, and he has irreversible brain damage.

As I mentioned earlier, plaque builds up and becomes tartar, and causes gum disease. This leads to bone and tooth loss. When our clients lose their teeth, they can't chew properly, and have to have their diet textures modified by speech therapy or nursing. Since food texture is part of the eating experience, having a pureed or mechanical soft diet can change the quality-of-life portion of the eating experience which may lead to appetite loss, depression and poor nutrition. Poor nutrition leads to a decline in energy and strength, and this leads to a decline in functional ADL. Also, according to Melissa Cohn, OTR/L, of Dynamic Learning Online, poor intake can lead to dysphagia, which then becomes a vicious circle. So, it's all related.

During my OT evaluation, I notice the condition of my clients' teeth and oral care. If they have a ring of white sediment (plaque and food residue) along the gum line, I initiate tooth brushing as part of my OT treatment. This treatment reinforces what the speech therapist may be working on, oral motor control and strengthening. I have my clients brush their teeth, rinse with mouthwash (swish) and spit, spit, spit. I even encourage them to make the spitting sound (hawk too) when they spit, to get enough force to expel the mouthwash and food matter.

One of the techniques I previously used in a SNF setting was to recommend the facility buy some $10 electric toothbrushes for the clients with decreased strength and endurance, so they could brush their teeth themselves. It did, and we passed them out to clients who could benefit from them.

Also, during self feeding I have the clients use their tongues to find the food in the teeth and buccal (cheek) pockets, which also reinforces the speech therapist's goals of increased oral motor awareness and control.

The result of good oral and dental hygiene can be more than just a pretty smile. So grab a clean brush, some toothpaste, and go for it!

Jacqueline Thrash, OTR, has nearly 20 years of clinical experience in California and Arizona, in acute care and outpatient rehab, SNF, adult day treatment, and home health. Reach her online at www.livingskillstherapy.com or by email at thrash@pinkiemae.com