In many people, advanced age may mean advanced disabilities. This may be due to an acute process such as a stroke or a slow process as with arthritis, multiple sclerosis, or Parkinson’s disease. After a stroke, the individual may lose the ability to communicate, swallow, and/or perform activities of daily living including bathing, dressing, eating, and brushing his/her teeth. As a speech pathologist, Mary has worked extensively with disabled people, specializing in swallowing disorders. Often recommending frequent, effective oral care to reduce the risk of aspiration pneumonia, Mary recognized that this can be very difficult, if not impossible, for disabled patients to execute due to limited mobility.

As a practicing oral and maxillofacial surgeon, Dr. Dugan saw a troubling trend among some of his patients. In particular, the elderly patients required proportionately more tooth extractions than his other patients. Often these teeth had hundreds, even thousands of dollars worth of dentistry performed over the years, indicating that at one time, these patients dedicated time, effort, and significant money toward preserving their teeth. In addition to their poor oral health, these individuals had many other severe health issues. Tooth extractions in these patients can be very risky, if not life-threatening. This also places a tremendous financial burden on the patients, their families, and our health care system.

Why were these teeth now decayed beyond the point of repair? Current technology on today’s dental products market offers many toothbrushes that are all only as good as its user. When an individual is disabled or reliant upon a caregiver for oral care, he/she is at further risk for dental decay. Out of mutual concern for their patients and disabled family members, Dr. Dugan and Mary sought to treat and prevent oral health problems. With their combined knowledge of oral anatomy and disabled people, Dr. Dugan and Mary decided to put pencil to paper and designed the "ideal" toothbrush. Three focus groups were assembled with the help of the Western New York Center for Independent Living. These groups consisted of disabled people, caregivers, and nursing home administrators. After extensive questions, all three groups independently designed a toothbrush nearly identical to the Dugan’s concept. This overwhelming affirmation encouraged the Dugans to pursue the development of this practical, revolutionary technology.