Polio Place

A guide for people with polio or Post Polio Syndrome (PPS)

Introduction
“Oh, I wish I’d looked after me teeth”, wrote Pam Ayres in her famous poem. Good oral health and hygiene are not just about being able to smile with confidence and eat well – they are important for your general health and well being, becoming even more so as you get older.

This factsheet provides some basic information for people with polio/Post Polio Syndrome (PPS). While having polio and PPS do not directly affect the teeth and gums, \ they may influence your ability to eat, the type of medication you use and how you respond to dental anaesthesia and treatment - all of which can affect your oral health.

The information in this factsheet is for general guidance only. All people with polio seeking dental treatment should be assessed and managed according to their individual needs.

Polio and Post Polio Syndrome
People who had polio years ago and made a good recovery may now be experiencing new symptoms. These can include new or increased muscle weakness and fatigue with or without other symptoms like muscle and joint pain, muscle atrophy or wasting, breathing or swallowing difficulties or cold intolerance.

It is because of the breathing and swallowing difficulties that people living with polio and PPS may develop that we have written this dental factsheet.

A healthy mouth - a healthy body
The health of the teeth and gums is now known to affect the health of the whole body. A good oral hygiene routine throughout your life is the best way to keep your teeth and gums healthy and to prevent tooth decay and gum disease - but it’s never too late to start.

Healthy eating
A healthy, balanced diet, rich in vitamins, minerals and fresh produce is also important in maintaining healthy teeth and gums.

Food and drink containing sugar can cause tooth decay, so it is a very good idea to cut down on these. Acidic foods and drinks such as citrus fruits, fruit juices, red wine and fizzy drinks (even sugar-free ones) can wear away tooth enamel (known as dental erosion) if taken often in large amounts, so try to limit these to mealtimes.

It is also recommended that you not brush your teeth for at least one hour after eating or drinking anything acidic, so that they can build up their mineral content again.

For further information about healthy eating, see our factsheet, Healthy eating - a guide for people with polio/Post Polio Syndrome.

Smoking
Smoking can lead to staining, gum disease, tooth loss and in more severe cases, mouth cancer.

Smokers are more likely to produce plaque, which leads to gum disease. Gums are affected because smoking causes a lack of oxygen in the bloodstream, so the infected gums fail to heal. Gum disease can therefore progress more rapidly than in nonsmokers. Gum disease still remains the most common cause of tooth loss in adults.

Don’t pretend that problems will go away!
Few people enjoy going to the dentist, but it is important to have regular check-ups and to get treatment before any problems arise or become worse.

You should usually visit a dentist for a check-up every six months, but your dentist may recommend shorter or longer intervals, depending on your oral health and risk of future dental disease.

As well as assessing the health of your teeth and gums, your dentist can also spot signs of diseases such as mouth cancer. Dentists can also deal with malocclusion (problems with how the teeth bite together), which can cause headaches as well as other dental problems. 

Things to consider for people with polio
If you have polio, you may have certain health issues that your dentist will need to be aware of, in order to give you the best possible treatment and care.

When you first visit a dentist, you will need to complete a form that asks you lots of questions about your dental and general health, including any health conditions you have and any medication you take. In addition to completing this form, you may wish to give your dentist our Hospital Pack. This includes a What you need to know about my condition form, where you can fill in information about topics such as breathing and swallowing problems, medication and mobility. The pack also includes information about anaesthesia and how people with polio may respond to it and a copy of our leaflet, Post-Polio Syndrome – an introduction.

Your dentist does need to be aware of potential risks, so that s/he can adapt your treatment.

Swallowing problems
If you have swallowing problems and eating a healthy, balanced diet is difficult for you, it is important that you seek help from a speech therapist and/or a dietitian, to ensure that you do not become malnourished. Poor diets can affect the health of your teeth and gums. Ask your GP to refer you for specialist help and advice.

If you have swallowing difficulties it is important that your dentist is made aware of this issue as well. You can ask your dentist or doctor about referral to a speech and language therapist if swallowing is a problem.

Reclining in the dentist’s chair may make clearing saliva during treatment even more of a problem.

Your dentist should also be aware that when using anaesthesia to numb areas in the back of the mouth, swallowing may become more difficult and the risk of choking or aspiration (inhaling fluids) may be higher.

Breathing difficulties
If you have breathing problems, particularly if you use breathing support such as a ventilator, you should discuss this thoroughly with your dentist.

Reclining in the dentist’s chair may make breathing more difficult, so it is important that the dentist finds a position that is comfortable for you.

Hand and arm problems
Normal tooth cleaning may become more difficult if you have problems with your arms, wrists or hands. If you find it hard to grip a toothbrush handle, you may wish to try equipment such as handle adapters. Electric toothbrushes are also ideal for people with limited movement. The handles are thicker and easier to hold and the oscillating head does most of the work. There are many products available, and your dentist or hygienist can help you decide which are best for you.

You may find using a wall-mounted toothpaste dispenser helpful.

If you find cleaning your teeth tiring, you could consider cleaning one part of your mouth in the morning and another part in the afternoon. If your carer assists in cleaning your teeth, they might find it easier to stand behind you when brushing your teeth.

Dentists will always clean your teeth from behind. It is important to brush your teeth before you go to bed. This is because the flow of saliva slows down during the night and this leaves the teeth more at risk from decay.

Psychological issues
Some people with polio have had traumatic experiences of medical procedures, which may make them afraid of going through any more. They may be reluctant to be completely at the mercy of medical professionals.

If it is at all possible for you, you may find it helpful to talk to your dentist about what you have been through and how it has made you feel. If you feel that you cannot do this, give them some general literature to read, such as a copy of this factsheet.

The more you are able to communicate with your dentist, the better s/he will be equipped to understand you and to help you feel safer and more comfortable.

Dentures
If you wear dentures, you still need to take good care of your mouth. Every morning and evening, brush your gums, tongue and the roof of your mouth with a soft-bristled brush, to remove plaque and help the circulation in your mouth. If you wear partial dentures, it is even more important that you brush your teeth thoroughly every day. This will help stop tooth decay and gum disease that can lead to you losing more of your teeth. Your dentist may refer you to the hygienist to have your remaining natural teeth cleaned regularly.

Dentures should be removed before you go to bed. This allows your gums to rest and helps keep your mouth healthy.

Your dentures may need to be relined or re-made at some point due to normal wear or a change in the shape of your mouth. Loose or badly fitting dentures can cause discomfort, as well as sores and infections. They can also make chewing, swallowing and talking more difficult. It is important to replace worn or poorly fitting dentures before they cause problems. Dentures are likely to need replacing after 5 years.

Dental anaesthesia
While people with polio can be more sensitive to general anaesthesia, they also seem to require more local anaesthetic than other people in order to numb pain when having dental treatment.

People with polio may be sensitive to anything that further impairs motor neurons that have already been damaged by the poliovirus. A local anaesthetic may cause facial, tongue and throat muscles to become paralysed for a number of hours, affecting swallowing and breathing. You may also find that the numbing effect of a local anaesthetic takes longer than normal to wear off.

Make sure that you have enough time to rest and recover after you have had any dental work. Consider asking a family member or friend to accompany you home and make sure that you do not drive yourself.

This does not mean that if you have polio you cannot have dental anaesthesia.

Relaxation and sedation
Some members of the general population are so terrified of dental treatment that they need to be completely sedated during procedures. This, of course, may not be a suitable option if you have had polio.

Another sedation method is “relative analgesia”, sometimes known as inhalation sedation. This means breathing in a mixture of nitrous oxide and oxygen (‘laughing gas’) through a nosepiece, which quickly leads to a pleasant, relaxed feeling. You remain conscious all the time, although you may be a little drowsy, and any treatment given should not cause discomfort. Many dentists use this safe and effective technique, which has no after effects.

Other techniques to help you cope include hypnosis and relaxation exercises. While inhalation sedation may not be suitable for everyone, relaxation techniques can benefit all of us.

Do remember
No one knows your body better than you do. You are the best judge of how it responds.  Remember that prevention is better than cure. Get into the habit of looking after your teeth and gums and you will reap long-term benefits.

Checklist for visiting the dentist
• If you have not done so already, tell your dentist that you have polio. Explain how the polio affects you, including any breathing or swallowing difficulties you may have, or any mobility issues. Give them copies of The Fellowship’s publications, as mentioned previously.

• Talk to your dentist about any other health conditions you have and how they affect you.

• Tell your dentist about any medication you take and have taken recently, including over-the-counter medicines.

• Do discuss any treatments thoroughly with your dentist. This would include your options if there were more than one way to manage the problem, the costs involved and how many visits will be necessary to complete the treatment. Make sure you fully understand the procedure(s) and are comfortable. Do ask for further explanations if there is anything you do not understand. 

• If you are afraid of having dental treatment, say so. Lots of people are afraid; it is nothing to be ashamed of.  

• Talk to your dentist about any sign you can make during treatment if you feel any discomfort or pain.

• If it makes you feel more comfortable, ask your dentist to tell you what s/he is doing, step-by-step- and why. Some people find this more reassuring. 

Medical Disclaimer
The information given in this factsheet is not medical advice and by providing it The British Polio Fellowship and our medical advisors do not undertake any responsibility for your medical care. Before acting on any of the information contained in this factsheet, you should discuss the matter with your dentist or any other medical professional who is treating you.

Our thanks go to Mrs. Sandra Knowles, Dental Practitioner, BDS Lond, LDSRCS Eng, for reviewing this factsheet for us.

© 2010 The British Polio Fellowship
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