A manual toothbrush can be difficult for an individual with ALS to use quite early in the course of the disease. The narrow diameter of the brush makes it difficult to grip; the need to hold it carefully and move it back-and-forth is a further liability.
An electric toothbrush is a considerable advantage for an individual with muscle wasting in their hands and arms. As long as it can be brought to the mouth and held up for long enough, the brush itself can do most of the work while it is simply held. Pressing the on/off button may pose a significant challenge, however.
String floss is extraordinarily difficult to use with weak hands.
An assistant helping with flossing should be careful to avoid pressing the patient's lips against their teeth with their fingers, as this could injure the lips or insides of the mouth.
Water flossing using an oral irrigator such as a Waterpik™ is a viable alternative for some patients. Ensure that the waste water has a place to go during use.
Mouthwash should be avoided if there is any difficulty swallowing.
Some dental offices have a treatment room suited to patients in wheelchairs. In some cases, these rooms are not configured for wheelchair use every day of the week.
It is recommended to call ahead and disclose the level of disability so that the dental office can make sure any necessary adaptations are in place.