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The ALS Oral Care Guide

With all of the recent awareness of ALS, at Shane McDowell, DMD., we want to provide some tips on how patients who suffer with ALS can still maintain their dental hygiene.

What Is ALS?

Amyotrophic lateral sclerosis (ALS), often referred to as “Lou Gerhig’s Disease,” is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. The progressive degeneration of motor neurons means the motor neurons die off, which rids the brain its ability to initiate and control muscle movement. For most people, dental care is generally an easy, non-time consuming ritual. But for a patient struggling with symptoms of ALS, it can be a challenge.

Here is our quick guide to dental hygiene with ALS:


Brushing your teeth is a basic way to take care of dental hygiene, but it could sometimes be neglected, due to a patient feeling tired or having difficulty moving. After meals and before bedtime are the recommended times to brush teeth, for at least 2 minutes per session. This will help remove food particles and bacterial plaque that can cause gum disease. Focus should be placed on the gum line while brushing, because this is where bacteria lives and will behind eroding teeth if not properly cleaned away.

If a patient struggling with ALS can no longer brush their teeth, it may be up to a caregiver to help. This could be a challenge for both the patient and caregiver, but it’s still very important. If a patient is in a wheelchair, it is easiest to stand directly in front or to the side of the chair, facing the patient. If there is no headrest, make sure the patients head is supported for this process. Use one hand to stabilize the chin, and move the brush around the teeth with your other hand.

Which toothbrush is best?

Some toothbrushes in the store may not be best suited for patients with ALS. Most of these toothbrushes have small, skinny handles that are difficult to grip in which the patient will have difficulty keeping a grip on the brush. If the handle is too short, patients may have difficulty lifting their arms to reach the mouth. Here are the types of toothbrushes and equipment that are designed specifically for this type of patient:

  • Electric toothbrush: this type of toothbrush is great because it eliminates the need for extensive arm action, which will help the patient keep from getting too tired when brushing their teeth. Many of these models are designed with a thicker handle to help make gripping the toothbrush easier. A disadvantage may be that the toothbrush is too heavy to lift.

  • Handle build-ups: these are a very inexpensive solution that helps the patient keep hold of the toothbrush. For a quick-fix, try making a cut into a tennis ball, and inserting the end of the toothbrush into the tennis ball. Make sure it is securely fastened into the tennis ball before use.

  • Toothpaste dispenser: a toothpaste dispenser can help eliminate the need to squeeze toothpaste from a tube. This may seem like a rather ordinary task for most people, but for patients struggling with ALS, it may be a daunting task. Try this relatively inexpensive “As Seen on TV” option.

What is the best way to floss?

For a caregiver to help a patient with ALS floss may be a larger challenge than just brushing alone. However, the attempt is definitely worthwhile. If you are using manual floss, stand along the side and slightly to the rear of the wheel chair or any chair the patient is sitting in. Wrap your arms around the patients head, lean in a bit, and open the mouth and start flossing. It’s best to try to be as gentle as possible.

If flossing with the hands become too difficult, using a floss holder can help make flossing easier. For an even more convenient option, try Floss Picks, made by almost every major toothpaste brand.

Be cautious of mouth rinses

While mouth rinses are a great way to achieve a healthy mouth and gums, and help prevent gum disease, it can become impossible because of swallowing difficulties. If this is not a problem, still beware of rinses with high levels of alcohol. It’s usually best to go with an alcohol free rinse.

Other Important FAQ’s:

  • The progression of ALS can affect respiratory muscles to the point where patients may need a ventilator. Ventilators often have mouthpieces that cup around the mouth. It’s important to maintain dental health, because studies have shown that the presence of periodontal disease, plaque, or bacteria that can infect the lungs through the ventilator, and could potential cause pneumonia.

  • Some patients with ALS may experience an increase or decrease in saliva. This can be caused my certain medications or the need to breathe through the mouth. A decrease in saliva can be a problem, as saliva helps keep the teeth clean.

To help raise awareness and funds for ALS research, our entire team at Dr. Shane McDowell has participated in the ALS Ice Bucket Challenge! See the video here:

At Shane McDowell, DMD., we love helping our patients live a happy and healthy lifestyle. We hope this ALS Dental Care guide is helpful to all of our patients and caregivers. For more tips on living with ALS, and to donate to research, visit the ALS Association Website or the Lee Memorial ALS Clinic Website.

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