Oral Health for pediatric CP patient

[FlufferNutter, ASN, RN]

I work with with an 8 year old child in his home. He has Cerebral Palsy, is non-verbal, and for all intents and purposes, he is non-ambulatory. He has a G-tube and a Nissen Fundoplication, but his oral health is a huge concern for me.

It is near impossible to brush his teeth. And, he can't swallow, so introducing any liquid into his mouth is an aspiration risk. Dad has me brushing his teeth with plain water and a toothbrush....but half the time, my patient clamps down his lips and I can't really get a good scrub in.

His teeth are caked in plaque. I can't even fathom how he is at a dentist appointment.....just getting him in and out of the tub is an Olympic event.

Do any of you have any suggestions? Products/maneuvers that may be useful for this type of patient?

[Crystal-Wings, LVN]

That's a tough one! You really can't do anything except try your best. Just be as gentle as you possibly can. I had a client similar to yours, and her mother expected me to use an electric tooth brush on her which made things even more difficult because the noise and vibration scared her. Is it possible to use a little tiny bit of tooth paste?

[TheLorax]

I take care of an 8yo with CP and I agree it's tough. We use a teensy bit of kids toothpaste with water. His teeth are totally caked in plaque as well and the parents are aware of how difficult brushing his teeth can be. Honestly, I find it easiest lay him across my lap and brush his teeth while he giggles at me. He has a gtube and fundo and I just make sure to hold his head up a little with my arm. He does great clearing any secretions. Sometimes, if it's real tough that day, I'll wait until the end of my shift, which is his bedtime, and he's really sleepy so typically I can sneak the toothbrush in then.

Overall, just try your best and encourage the parents to bring him to regular dentists appointments.

[caliotter3]

I try to distract the child by singing a funny song or making funny noises and getting them to laugh. This leads to being able to get the toothbrush into their mouth without too much trouble. I have to make each pass a quick one though, as long as they will tolerate it. Also try to encourage the family to make frequent (quarterly, instead of twice a year for you and me) appointments for professional teeth cleaning.