Corrections_Today_July_August_2019_Vol.84_No.4

nEWS & vIEWS

appointments, dental treatment can be administered appropriately during a subsequent appointment. As we increased our engagement with the dental care of the residents, we found that residents were having problems with personal oral hygiene with the toothbrushes that had been provided. A small two-inch tooth- brush with no floss had been the status quo of oral hygiene packets given to the residents. The residents complained about not being able to reach their back molars with such a small toothbrush, therefore they could not brush properly. The residents also wanted to have access to personal floss that had been prohibited in the past because of security concerns. Security concerns can often be attributed to a class of objects, in this case dental floss and toothbrushes, when in fact the concern is not the object itself but an attribute of that object. With dental floss the attributes that concerns most security profes- sionals is the tensile strength and hardness of most dental floss. Offend- ers can braid dental floss into strong rope or use it to saw through other materials if they are persistent enough. Security professionals sometimes, though less often, worry about the rigidity of toothbrushes. While not the most intimidating or effective weapon base, the potential is enough to cause concern in some correctional settings. Rather than a head-to-head battle over the risk/benefit of having the better oral hygiene equipment vs. safety and security, we instead chose to address the attributes of concern and identify a solution that was mutually acceptable. In this case we found rubbery, reus- able dental “floss” with finger loops that enabled the user to hold them

without adding to the length for finger wrapping. We also found semi-flexi- ble, full-length toothbrushes.

each recall visit. There was also a sig- nificant decrease in calculus buildup on teeth that can be attributed to the daily use of floss. The incidence of periodontitis (gum disease) and gingi- vitis has decreased, and residents rarely complain of bleeding gums. Residents’ dental IQ levels have also increased due to the interest in their dental health and keeping dental appointments. Residents are eager to learn about preventive dentistry regimes and imple- menting brushing techniques at least twice a day or after every meal. Work- ing in close proximity with the nursing staff at the facility allowed a true part- nership between the medical and dental departments to formulate shared goals of achieving optimal dental care for the residents housed here. The implemen- tation of this oral hygiene program with its many facets of continuity of care has contributed greatly to the goal of eradicating dental disease in this closed monitored environment. Footnotes 1 . W.E. Mouradin, E.Wehr and J.J. Crall, “Disparities in Children’s Oral Health and Access to Dental Care,” Journal of the American Medical Association . 284, no.20 (2000): 2626 2 . B. Anderson and J.A. Farrow, “Incarcerated Adolescents in Washington State.” Adolescent Health 22 (1998): 363-7

The prevalence of new caries/lesions has significantly decreased during each recall visit. Oral hygiene packets were effec- tively changed to a 4.25-inch Loops Flexbrush Toothbrush and Loops Safety Floss with an emphasis on oral hygiene instructions. These products were ADA accepted, and designed for prison safety. The Flexbrush handle is flexible and bends easily with a non- shank design. The Loops Safety Floss are latex-free loops that are breakable when stretched and cannot be used to make rope or string that could be a safety concern. One issue encountered with the start of the issuing of safety floss was that the residents wanted to use the floss as bracelets on their wrist or hair ornaments in their hair. Reedu- cation of the actual usage of the floss was incorporated into their next den- tal appointment. In this case, we also added a risk/benefit discussion. In the end we could agree that uniform com- pliance could be addressed directly by staff easily and that there was no need to eliminate the safety floss. Conclusion The prevalence of new caries/le- sions has significantly decreased during

Lori S. Wilson, DDS, MPH, FACD, is the chief dentist at Bon Air Juvenile Justice Correction Center

Mark H. Murphy, MS, LPC, CCE-Juv, is the Health Services director for the Virginia Department of Juvenile Justice

14 — July/August 2019 Corrections Today