MND Factsheet 36 Oral Health

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					                                                         MND Factsheet 36
                                                              Oral Health
                                                                              Last Updated 13/11/08

Maintaining Oral Health                              fully aware of these problems. Continue
                                                     with regular dental cleanings for as long
Weakened mouth and throat muscles,                   as possible at your usual dental practice.
weakened hands and arms to brush teeth               Consult your dental hygienist for
and tube feeding are all changes which               preventative home care instructions.
require special consideration of mouth
care. Food can easily collect in pockets             Mouth Freshness
in the mouth as well as between teeth.               An applicator with lemon and water can
Retained food debris, thick mucous and               be used to keep the mouth fresh. You
decreased saliva all contribute to poor              can also try an oral rinse such as Biotene
oral conditions such as too much plaque              or non-alcohol mouthwashes.
and tartar, halitosis (bad breath), gingivitis
and tooth decay. It is important that you            Furry Tongue
take care of your mouth to prevent                   Some people with MND, particularly
harmful bacteria from developing.                    those with bulbar symptoms, can develop
                                                     a furry tongue. Water may be used to
Mouth bacteria not only cause bleeding               clean the tongue with an applicator or
gums, bone loss, mouth and tooth                     washcloth. If the tongue appears white
infections but can travel from an infected           for any length of time, consult your doctor
tooth root into the bloodstream causing              or dentist. Sometimes a condition called
life threatening infections such as                  'thrush' can develop.      It is a fungal
pericarditis,   (inflammation    of    the           infection and is easily treated with
membrane around the heart).                          antifungal preparations. Short-term relief
                                                     from the irritation caused by oral thrush
There are many products available to                 can be achieved by rinsing the mouth
make oral care easier.     Good oral                 several times daily with natural live
hygiene can greatly improve your self                yoghourt or a solution of half a teaspoon
esteem and dignity.                                  of bicarbonate of soda in a cupful of warm
                                                     (not hot) water.
ORAL HEALTH ISSUES
                                                     Saliva Build-Up
Here are some issues that you need to be             Build-up of saliva is a common problem
aware of and tips on promoting good oral             among people with MND who have
health.                                              weakened tongue and throat muscles and
                                                     are not able to automatically swallow the
Going to the Dentist                                 saliva that builds up in the mouth. Very
Not many dentists will know about MND,               thick mucus can also build up in the
its effect on your ability to keep your teeth        mouth, making the problem worse. This
clean, excess saliva or the precautions              build-up of saliva can cause annoyance
they should take because of a patient's              and disrupt sleep.
swallowing problems. Make your dentist

MND Scotland is the working name of the Scottish Motor Neurone Disease Association, the only charity
    funding research and providing care and information for those affected by MND in Scotland.

  Company limited by guarantee. Registered in Scotland; Number SC217735. Charity Number SC002662.
     Registered Office 74/76 Firhill Road Glasgow G20 7BA. Tel: 0141 945 1077 Fax: 0141 945 2578
                E-mail: info@mndscotland.org.uk        Web: www.mndscotland.org.uk
                                   MND Factsheet 36 Oral Health


Relief may come from home remedies,                        points to keep in mind when taking over
over-the-counter         products,       and               the- counter medication:
prescription drugs and, in extreme cases,
even surgical procedures. Advice should                        •   Always first talk to your doctor or
be obtained from your doctor and/or your                           nurse       about       medication
local pharmacist. A side effect of drugs to                        recommendations before use
relieve a build-up of saliva is "dry mouth."                   •   Sleepiness is often the side effect
It's a question of finding the right balance                       of medications
for you.                                                       •   Beware that anything containing
                                                                   alcohol can increase muscle
The following have been helpful for                                weakness, at least temporarily
managing saliva but check with your                            •   Beware of anything that slows
doctor or MND Care Team Specialist first                           breathing
as some interventions can sometimes be                         •   Before putting any medication,
counter-productive in MND:                                         crushed or otherwise in a feeding
                                                                   tube, check with a pharmacist to
    •   Portable suction machine                                   ensure that it won't harden and
    •   Decongestants      and     over-the-                       clog the tube
        counter medications used for colds                     •   Generic products are usually
        and allergies                                              cheaper
    •   Certain prescription only drugs
                                                           Excess saliva has one advantage! If you
Transderm V patches, usually used for                      have excess saliva and are still able to
motion sickness, also tend to dry up                       eat by mouth, mixing more saliva with
saliva                                                     your food makes it both easier to swallow
                                                           and digest.
The following have been shown to be
helpful for treating thick mucus:                          Dry Mouth
                                                           Although management of saliva is
    •   Apple juice, grape juice, or hot tea               common in many people with MND,
        with lemon                                         especially those with difficulty swallowing,
    •   SSK1 (potassium iodide) 10 drops                   some are troubled by excessive mouth
        in a glass of water two to three                   dryness. A dry mouth can cause thick
        times per day. This may take one                   mucus to form, which may in turn cause
        to two weeks to be effective. A                    serious choking problems.
        prescription is required
    •   An expectorant cough syrup • Meat                  Excessive dryness is usually caused by
        tenderiser mixed with a little water               one or more of the following:
        can be used to coat the tongue or
        can be placed under the tongue                         •   Breathing mostly through the
    •   Papaya extract placed on the                               mouth, rather than the nose can
        tongue may prove helpful                                   dry out the lining in your mouth. If
                                                                   you consistently wake up with a
Precautions: Some of the suggestions                               dry mouth, thick mucus and/or a
for saliva management include use of                               sore throat, you may be breathing
medication. Here are some important                                through your mouth while sleeping


The information in this leaflet is believed to be accurate at the time of production. MND Scotland cannot give
      detailed medical advice, this leaflet should be regarded only as general background information.

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                                   MND Factsheet 36 Oral Health


    •   A side effect from some surgical                   bristle brush is always recommended to
        operations                                         minimise gum damage. Newer to the
    •   Stress from chronic anxiety or                     market are both manual and electric
        depression                                         flossing aids such as the Reach Access,
    •   A    side   effect   from    some                  Butler Floss Handle and the Oral B
        medications                                        Humming Bird Flosser. The “healthcare
    •   The natural process of aging                       for all website” www.healthcare4all.co.uk
    •   Smoking                                            has a comprehensive listing of flossers
                                                           brushes irrigators and toothpastes.
The following have proved helpful for a
dry mouth:                                                 Proper Brushing Technique:

    •   Make a conscious effort to breathe                     1. Place the toothbrush at a 45-
        through your nose                                         degree angle to the gum-line.
    •   If you suffer from nasal congestion,                   2. Use a gentle circular motion
        ask your doctor for assistance                            several times in the same spot.
        (nasal congestion leading to a dry                     3. Finish with a sweep of the brush
        mouth can cause thick mucus to                            from the gum-line to the chewing
        form, which in turn may cause                             surface of the tooth.
        choking problems)                                      4. Repeat this method as you brush
    •   Increase your liquid intake (ask                          from the right to the left side of the
        your SLT and dietician which                              mouth.
        consistency is best for you)
    •   Use a vaporiser (clean the                         Also be sure to brush the inner surfaces
        vaporiser once a week with                         of the teeth. If a carer is brushing for you,
        vinegar and water)                                 the handle of a soft grip toothbrush could
    •   Ask your pharmacist about oral                     be used as a mouth prop to assist
        rinses, artificial saliva spray, and               access.
        tablets
                                                           Suction Unit
                                                           Another method for moving food caught
ORAL HEALTH DEVICES                                        in pockets of the mouth is a suction unit,
                                                           which is normally used for removing
Toothbrushes and Flossers                                  excess saliva to reduce drool.
If you have weakened hands and arms,
an electric toothbrush is ideal for brushing               Finally
your teeth. There are a variety of electric                As noted earlier, many dental care
brush shapes and price ranges: Oral B,                     professionals may not be familiar with
Waterpik Sensonic, Philips Sonicare,                       MND and symptoms of the disease that
Colgate and Crest spin brushes vary from                   might affect dental treatment. You are
simple rotary brushes to those employing                   encouraged to take this factsheet with
advanced techniques for tooth cleaning.                    you to your dentist or hygienist.
Others may find that an ordinary                           Educating them will improve their ability
toothbrush is very helpful for removing                    to work with you to promote optimal oral
the build-up, which occurs on the teeth,                   health and treat problems if they occur.
particularly after tube feeding. There are
many brushes widely available and a soft

The information in this leaflet is believed to be accurate at the time of production. MND Scotland cannot give
      detailed medical advice, this leaflet should be regarded only as general background information.

                                                      3
                                   MND Factsheet 36 Oral Health


Further Information

Factsheets

Factsheet 6             Feeding Tubes
Factsheet 30            Communication Strategies
Factsheet 34            Adapting to Swallowing Problems
Factsheet 35            Breathing Matters



Helpful Web Sites:

www.healthcare4all.co.uk                 A commercial retailer of oral health products
www.colgate.co.uk                        Colgate, oral care specialists
www.bsdh.org.uk                          British Society for Disability and Oral Health
www.dentalhealth.org.uk/                 British Dental Health Foundation
www.oralb.com/en-UK                      Oral B, a division of Procter and Gamble
www.jnj.com                              Johnson & Johnson, one of the world’s larges suppliers
                                         of healthcare products.




The information in this leaflet is believed to be accurate at the time of production. MND Scotland cannot give
      detailed medical advice, this leaflet should be regarded only as general background information.

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