When taking care of someone who has disabilities, reward systems are often used. As the dentist, we hear a lot of these rewards being offered because we are sometimes the “thing” that has to be done to earn the reward. We want to encourage healthy reward systems and discourage development of unhealthy habits.
Some reward systems we like to hear: “If you cooperate for the dentist then we can go to the carwash” or “If you take this x-ray, then we can go to the dollar store”.
Others we do not like like to hear: “If you cooperate for the dentist, you can have a soda” or “If you take this x-ray we will get you a milkshake”. We like to encourage caregivers from using unhealthy food options as rewards.
Once a system is successful, it can be hard to change. The longer it is in place, the harder it becomes to change. This is why it is so important to think of the health outcomes of reward systems as they are in development. When we repeatedly tie unhealthy rewards to good behaviors, it creates unhealthy habits. We don’t want the expectation to be, “Every time I am good, I will get sugar.” Increased consumption of sugar can increase the risk for health problems (diabetes, periodontal disease, cavities, obesity and many others). As people get older, these risks can have more of an effect on their quality of life.
We can take oral health as an example. Perhaps the patient did not have cavities as a child because the caregiver was able to help them with their oral hygiene as recommended. Now, perhaps, they are grown and their cooperation has decreased. Because they are physically larger, and less cooperative, oral hygiene may become more of a challenge for the caregiver. If this patient’s reward system contributes to oral disease (sugar or carbohydrate rewards) and the patient does not cooperate with oral hygiene, now this patient has two major risk factors for oral disease- frequent consumption of fermentable carbohydrates and inadequate oral hygiene. These patients have higher risk to suffer from dental pain.
If food rewards are the only rewards that seem to work, try to find healthy alternatives. Look for sugar free products sweetened with xylitol or use fruits or vegetables. (Not fruit juice which usually has tons of sugar). We recognize that it may be difficult to change after a system has been established. It is still important to try. It is also important to try to start healthy rewards at a young age.
We wish all caregivers the best of luck in their efforts to help keep their loved ones healthy and safe.
