Improving skill to improve oral hygiene – Dr Svend Ulrich Jensen – principle dentist in Hundested DenmarkFeatured Products Promotional Features
Posted by: The Probe 6th June 2019
In early 2019, a study evaluated the ‘Clinical relevance of dexterity in oral hygiene.’[i]Using a sample group aged between 18 and 60, the research concluded “dexterity might be a good predictor of improvement in oral hygiene (and) should be assessed in order to provide tailored instructions to each individual”.
Dexterity, or fine motor skill, is the ability to perform small, precise actions. We must consider how dextrous our patients are, and help them to improve their fine motor skills, because good brushing technique is a central principle of preventive dentistry. Quite simply, in order to remove optimal levels of plaque and food debris, the patient must be able to handle a toothbrush (and any adjunctive tools) correctly and comfortably.
Age is a key factor for establishing level of dexterity. As they hit the various developmental milestones, infants and toddlers will start to establish fine motor skills, including the ability to grasp objects and manipulate toys with purpose. Pre-school children are usually able to perform a static tripod grasp, which is using their thumb, index finger and middle finger in combination, to draw vertical lines, for example. As they get older, their motor skills become refined with better hand-eye co-ordination and a greater ability to make precise, clear movements.
In 2017/2018, there were over 12,000 extractions because of tooth decay for 0 to five-year-olds.[ii]For this age group, parents should be performing daily parent led or supervised brushing, because a child of this age does not have the manual dexterity to effectively clean their teeth. Once they reach school age, parents must continue to supervise brushing in order to ensure technique is adequately corrected. Research recommends parental supervision with tooth brushing until age 10, at least.[iii]
For children with decayed teeth, it is not a case of them lacking dexterity, but of parents not knowing what constitutes correct brushing protocol. There is no substitute for a hands-on demonstration and GDPs can support parents by doing a ‘show and tell’ at every appointment. A common misconception is that teeth should be scrubbed clean, whereas the gold standard is gentle, thorough and precise cleaning, which parents should first be shown how to do for themselves. When they can feelthe difference of a really clean mouth they can pass this valuable skill on to their child as they first assist, then guide and finally supervise their daily brushing.
At the other end of the scale are our elderly patients, of whom we will be seeing with increased frequency. According to the most recent available statistics, 18.2 per cent of the UK population was aged 65 years or over and projections expect this figure to grow to 20.7 per cent over the next 10 years.[iv]As we age, our movements naturally become “less nimble and less smooth, less coordinated and less controlled”; the relationship between age and hand dexterity has been widely reported.[v]A study that looked at grip strength, age and dexterity suggested that hand dexterity may be moderated by strength and speculated as to whether exercises to improve it would be beneficial in some cases. Suggesting that it is possible to maintain and improvemanual dexterity, as a person gets older. Exercises to do so include grabbing a squeeze ball, placing your palms on a flat surface and lifting your fingers one-by-one, and regularly ‘stretching out’ your wrists.[vi]Performing these exercises for just a few minutes every day may have a long-term positive impact on a patient’s dexterity.
Injury and illness can impair dexterity; these include congenital conditions and neurological disorders such as epilepsy, Parkinson’s disease, multiplesclerosis and stroke. Alzheimer’s disease and dementia will impact significantly on dexterity – these tend to affect older individuals. Anyone on the autism spectrum (children and adults) will often have difficulty with their motor skills and this may include a weak grip. [vii]
Of course, we must also consider the tools that we recommend to our patients.
The best brushes on the market are ergonomically designed and functional, with a handle that is easy to hold and features a head that can be efficiently manipulated around the mouth, including tricky-to-reach spots. Whereas string flossing can be hard to master, interdental brushing with a user-friendly interdental brush, such as the TANDEX FLEXI™, is easier and will allow a patient to get their teeth thoroughly clean. TANDEX’s toothbrushes, interdental brushes and interspace brushes have all been designed to ensure a good grip for optimum functionality and to perform the preventive job that each of them were developed to do.
Dexterity is important for supporting oral hygiene, but motor skills will vary during a patient’s lifetime and can be affected by a wide range of compromising factors. GDPs can help patients improve their cleaning skills and suggest simple exercises to improve dexterity. They can also recommend ergonomically designed, high-quality tools to use, as part of their tailored prevention/oral hygiene plan.
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[ii]Almost 9 out of 10 child hospital tooth extractions due to decay. Public Health England, 6 March 2019. Link: https://www.gov.uk/government/news/almost-9-out-of-10-child-hospital-tooth-extractions-due-to-decay(accessed April 2019).
[iv]Overview of the UK population: November 2018. Office for National Statistics, 1 November 2018. Link: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/november2018(accessed April 2019).
[vi]USC, University of Southern California. 5 hand exercises to help you maintain your dexterity and flexibility. Link: https://www.keckmedicine.org/5-hand-exercises-to-help-you-maintain-your-dexterity-flexibility/(accessed April 2019).
[vii]Motor problems in autism persist into adulthood. Spectrum, 11 November 2017. Link:https://www.spectrumnews.org/news/motor-problems-autism-persist-adulthood/(accessed April 2019).