Brushing twice a day is only the starting point for a consistent oral hygiene routine. Toothbrushing alone may only reach 60% of the tooth surface and removes a lowly 42% of the overall dental biofilm.[i] Poor biofilm disruption can lead to dental caries, gingivitis and periodontal disease.
Some individuals may find oral hygiene challenging, particularly those with Developmental Coordination Disorder (DCD), often referred to as dyspraxia. This common disorder affects the motor coordination in children and adults; writing, typing, riding a bike, driving and DIY tasks are some everyday aspects that individuals with DCD may struggle with.[ii] Coordinating movements is a complex process involving many different nerves and parts of the brain, so any problems within this process can inhibit movement and coordination.
According to the Dyspraxia Foundation, DCD affects up to 6% of the UK population.[iii] Those with it can often have attention deficit hyperactivity disorder (ADHD), dyslexia, autism spectrum disorder, depression and anxiety.[iv] Most of these conditions have also been connected to poor oral hygiene.[v]
Brushing up on your oral health
Toothbrushing requires a level of coordination that individuals with DCD may struggle with, especially children. This can lead to non-compliance and the neglect of their oral health – if regular toothbrushing already misses 40% of tooth surfaces, then a poor brushing technique, common among individuals with DCD, will add to the problem. This increases the risk of gingivitis and periodontal diseases.
It is paramount that individuals with DCD protect their teeth. Brushing must be supplemented by interdental cleaning to ensure that the plaque biofilm is sufficiently disrupted.
Interdental cleaning is always recommended by dentists to clean the places that toothbrushes struggle to reach. For individuals with DCD, string flossing has been reported as “near-impossible” – preparing the floss and then manipulating the floss successfully between the teeth requires the precise coordination that individuals with DCD struggle with.[vi] As such, flossing has a low compliance because of its technical difficulty.[vii]
A helping hand
Instead of flossing, interdental brushing should be recommended to individuals with DCD. Interdental brushes are more effective at removing plaque from between the teeth than toothbrushes and are as good, if not superior, to string floss at reducing plaque and the risk of gingivitis.[viii] They are especially good for periodontal patients and are the preferred method for cleaning around implants.[ix]
For individuals with DCD, interdental brushes still demand some coordination. However, only half the hands are needed when compared to string flossing and the movement of an interdental brush is like using a key, with a simple in-and-turn motion.
There is no cure for DCD and its symptoms are largely dependent on the self-management of the individual. However, with patience, encouragement and education, individuals with DCD can improve their ability with certain tasks such as interdental brushing. Not only will this be a huge victory for their oral health, but the successful completion of a coordinated task, no matter how simple or complex, will boost their self-confidence.[x] Moreover, increased patient convenience and acceptability towards something new promotes compliance and comfort with new oral hygiene practices.[xi]
Recommended action
Surprisingly, there is very little research on oral care and DCD.[xii] To help raise awareness of the impacts that DCD can have on oral health, having brochures or posters highlighting some of the problems in your practice can increase the chance of a patient discussing it with you. This can therefore help you to steer DCD patients towards interdental brushes as a method of reducing biofilm that is less technically complicated than flossing.
For an ideal interdental brush, consider FLEXI interdental brushes from TANDEX. With 11 different sizes, the FLEXI reaches all the areas a toothbrush cannot, reducing plaque comfortably. The ergonomic handle is flexible and the brush can be shaped perfectly, making it easier for individuals with DCD to coordinate their brushing and achieve success. FLEXI works brilliantly with PREVENT Gel, from TANDEX, a non-abrasive substance used like toothpaste that strengthens enamel and adds an anti-bacterial effect through the application of fluoride. With the right interdental brush and gel, plaque won’t stand a chance.
The indirect health impacts of DCD make it an important condition to be aware of. By supporting DCD patients by offering manageable solutions, you can ensure that their oral health is sustained by a consistent hygiene routine.
For more information on Tandex’s range of products,
visit https://tandex.dk/
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Author: Jacob Watwood
[i] Ng, E. and Lim, L.P. (2019). An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dentistry Journal, [online] 7(2). doi:https://doi.org/10.3390/dj7020056.
Lee, J.-Y., Kim, S.-J., Lee, H.-J. and Cho, H.-J. (2021). Effect of Triweekly Interdental Brushing on Bleeding Reduction in Adults: A Six-Month Retrospective Study. Healthcare, 9(9), p.1239. doi:https://doi.org/10.3390/healthcare9091239.
[ii] Association, B.D. (n.d.). Dyspraxia (DCD). [online] British Dyslexia Association. Available at: https://www.bdadyslexia.org.uk/dyslexia/neurodiversity-and-co-occurring-differences/dyspraxia.
[iii] Thurston, Mark. (2015). Oral Health for Adults with Dyspraxia v1.01. Available at: https://www.researchgate.net/publication/327449563_Oral_Health_for_Adults_with_Dyspraxia_v101/citation/download
[iv] NHS Choices (2020). Dyspraxia (developmental co-ordination disorder) in adults. [online] NHS. Available at: https://www.nhs.uk/conditions/developmental-coordination-disorder-dyspraxia-in-adults/.
[v] Como, D.H., Stein Duker, L.I., Polido, J.C. and Cermak, S.A. (2020). Oral Health and Autism Spectrum Disorders: A Unique Collaboration between Dentistry and Occupational Therapy. International Journal of Environmental Research and Public Health, 18(1), p.135. doi:https://doi.org/10.3390/ijerph18010135.
Brancher, J.A., Begnini, G.J., Guimarães, A.T., de Araujo, M.R. and Pizzatto, E. (2019). Oral Health of Children and Adolescents with Attention Deficit Hyperactivity Disorder. International Journal of Clinical Pediatric Dentistry, [online] 12(6), pp.543–547. doi:https://doi.org/10.5005/jp-journals-10005-1691.
Mohammadi, T.M., Sabouri, A., Sabouri, S. and Najafipour, H. (2019). Anxiety, depression, and oral health: A population-based study in Southeast of Iran. Dental Research Journal, [online] 16(3), pp.139–144. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474177/.
[vi] Thurston, Mark. (2015). Oral Health for Adults with Dyspraxia v1.01. Available at: https://www.researchgate.net/publication/327449563_Oral_Health_for_Adults_with_Dyspraxia_v101/citation/download
[vii] Ng, E. and Lim, L.P. (2019). An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dentistry Journal, [online] 7(2). doi:https://doi.org/10.3390/dj7020056.
[viii] Ng, E. and Lim, L.P. (2019). An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dentistry Journal, [online] 7(2). doi:https://doi.org/10.3390/dj7020056.
[ix] Ng, E. and Lim, L.P. (2019). An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dentistry Journal, [online] 7(2). doi:https://doi.org/10.3390/dj7020056.
[x] Nash, Julie & Woolley, Stephen. (2021). Managing patients with developmental co‐ordination disorder in dentistry: Developing an online resource for dental professionals by a review of the literature. Special Care in Dentistry. 42. 10.1111/scd.12661.
[xi] Umalkar, Y.N., Jadhav, V.V., Paul, P. and Saoji, K.P. (2023). Comparative Evaluation of Cleaning Efficacy of Interdental Brush and Interdental Floss in Orthodontics Patients From Vidarbha Region: An Interventional Study. Cureus. [online] doi:https://doi.org/10.7759/cureus.46191.
[xii] Nash, Julie & Woolley, Stephen. (2021). Managing patients with developmental co‐ordination disorder in dentistry: Developing an online resource for dental professionals by a review of the literature. Special Care in Dentistry. 42. 10.1111/scd.12661.
