Brain Injury and Oral Health

Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. TBI can occur as a result of  impact to the head with an object or when an object pierces the skull and enters brain tissue. Brain injury can be mild, moderate, or severe.

A concussion is also classified as a traumatic brain injury that alters the way your brain functions. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination. It can happen to anyone! So protect yourself and take the proper precautions.

Football Player

Concussions are common, particularly if you play a contact sport, such as football or hockey. But every concussion injures your brain to some extent. To heal properly this injury needs time and rest. Most concussive traumatic brain injuries are mild, and people usually recover fully, sometimes people don’t even realize that they had a concussion if loss of consciousness doesn’t occur.

Signs & Symptoms of a Concussion

Signs and symptoms of a concussion may not be immediately apparent and can be delayed for several hours or even days. They can also be very subtle, but may persist for days, weeks or longer!

Most common symptom after a concussion are headaches and possible memory loss or confusion.

Signs and Symptoms may include:

  • Headache
  • Confusion
  • Temporary loss of consciousness
  • Slurred speech
  • Delayed responsiveness
  • Amnesia
  • Dizziness
  • Ringing in the ears
  • Nausea/Vomiting
  • Fatigue

Always see a doctor within 1-2 days after injury. Do not return to any sport or strenuous activity while any of the symptoms persist.

There has always been the debate of whether a mouthguard will help prevent a concussion.


Regulations have changed just this year in hockey, no longer requiring the use of a mouthguard. I personally think that is ridiculous. The more protection one can take against injury, the better. An ounce of prevention is worth a pound of cure! An independent dental hygienist or dentist can make a professional custom fit mouthguard, that offers superior protection. They fit better, it is easier to breath and speak with them in, and players are more compliant to wear them!

Here is a great link to a current article that studied  custom made mouthguards vrs. store bought

The Canadian Dental Hygienists Association has lots of supportive information on the importance of mouthguards. Check out the following link.



Moderate or Severe Brain Injury

Depending on the severity of the brain injury a person with a moderate or severe injury may have difficulty with adhering to their daily home care routine, and special oral hygiene care may be required from a caregiver. These caregivers  ensure their loved ones receive proper oral care  which is important for their comfort, general health and quality of life.

Bacteria from oral infections can enter the blood stream or airways and travel to other parts of the body, increasing the risk for other health problems such as stroke, heart disease, and respiratory disorders such as pneumonia and lung disease. So maintaining good oral health for the patient with a brain injury is important.

The person may be able to brush their teeth on their own and should be encouraged. An electric toothbrush may be easier for the patient or caregiver but can be too stimulating for some individuals and may not be tolerated.


Tips For The Caregiver

Make sure to communicate what you are doing in a gentle tone of voice to reduce any anxiety.  Tell the person what is going to be done and how it will feel and then show them. Routine alleviates stress too, so try and use the same technique at the same time and place.


  • Brush teeth 2x day using a soft bristle toothbrush, an electric toothbrush maybe easier, if tolerated. Make sure to clean at the gum line (base of teeth) a common area where plaque is missed.
  • Use a pea sized amount of fluoridated toothpaste, make sure they don’t swallow it.
  • Clean in between the teeth daily. Flossing may be difficult so try using a proxabrush (small interdental brush), or  floss wand with a longer handle.
  • If experiencing a dry mouth avoid sugar gum or mints, try xylitol mints or gum instead. There is also special products for dry mouth such as mouth wash and toothpaste etc.


Dental visits at an office can also be a challenge.  Arrange for a professional dental hygiene assessment and cleaning from a mobile dental hygienist. This will make it easier for the person with the brain injury since they are in a familiar and comfortable environment.