Guide to cleaning teeth for people with dementia

Sometimes when caring for someone with dementia we find that self-care tasks that we may think of as second-nature, are actually complicated and difficult to perform.

Something as simple as brushing teeth can become challenging but we know how important proper dental care is in maintaining good physical health.

Here are simple tips to help someone with dementia care for their teeth.

Why is dental care important?

Oral care is important to prevent tooth decay and infections.

When a person with dementia has mouth pain, they may not be able to communicate that this is the problem, but instead, will stop eating or become restless and irritated.

Of course, dental work, like any medical procedure can be traumatic for a person with dementia, so it is important to care for the teeth to avoid unnecessary trips to the dentist.

How to tell if someone has dental problems

If the person with dementia is not able to communicate there is a problem, the caregiver must be able to notice changes in behaviour. Some things to look for include:

• Refusal to eat
• Pulling at the face or mouth
• Leaving dentures out
• Increased restlessness, moaning or shouting
• Disturbed sleep
• Refusal to participate in activities
• Increased aggression

If you notice any of these indicators or see a change in behaviour that might be related, it is important to get the person to a professional as soon as possible.

What might help increase and improve dental care?

As the caregiver, you might try some of these suggestions to help the dementia sufferer improve and increase their dental care.

• Prompts – In the early stages of dementia, try gentle reminders like a phone call, a text or a note.
• Supervision – If they cannot remember what to do to brush their teeth, try brushing your teeth together, reminding them of the steps and having them copy what you do.
• Use a smaller or children’s toothbrush – This can help the person reach further the inside of the mouth and avoid scraping or cutting the inside of the mouth.
• Remove dentures for cleaning – Be sure to clean dentures outside the mouth, do not leave them in.
• Brush teeth while bathing – If you or the person with dementia is worried about getting toothpaste on clothes, have them brush at the end of their bath when they are calm and relaxed and will not have this worry.
• Use a good fluoride toothpaste – Fluoride is proven to help prevent cavities, so make sure to use a good toothpaste and encourage the person to spit excess toothpaste out but discourage rinsing after brushing because leaving some paste on the teeth can help coat the teeth with fluoride, providing a protective layer.
• Brush the gums – Be sure to brush down to the gum line even if there is a little bleeding. Gum care is as important as tooth care.
• Try distractions – If someone doesn’t like having their teeth brushed, rather than fight them try distracting them with television or music which to take their mind off the process.

Still not able to brush?

If you are still not able to get the job done, even with the suggestions above, try these steps.

1. Brush at the kitchen sink. Place both your toothbrush and toothpaste and theirs beside the sink as a reminder.
2. Use prompts like ‘Let’s go brush our teeth’ or ‘Why don’t we brush our teeth’, then turn on the water and start brushing, inviting them to join you.
3. Brush your teeth without talking or letting them interrupt.
4.  When finished, put down your brush and say something ‘Oh, that feels so fresh and clean’ or ‘I like the way my mouth feels after I brush’.
5. If they still refuse, try encouraging them again with a smile. If they still refuse, then walk away and tell them it’s their decision. This allows them to still feel they have a choice.
6. Try several times a day as moods change and they may be thinking about what you have shown them and become more receptive to the suggestion at a different time.
7. Do not give up. Stay positive and encouraging. Remember, you and they are doing the best you can.

When you visit the dentist

Regular visits to the dentist is an important piece of overall care, so be sure to continue to schedule regular cleanings and checkups.

These visits can be overwhelming for the person with dementia, however, so here are a few suggestions to make the visit easier.

• Make sure the dentist and their employees know that this person suffers from dementia before you go.
• Schedule for a quiet time of day and at a time of day that is easy for the person with dementia.
• If there is a wait at the office, go outside or somewhere else and have the office call you. Sitting in the waiting room can be stressful and agitating.
• Stay with them to help explain what is happening. Remember, the person you are caring for trusts you and understands that you are giving them the best care. Make sure they are part of the process and part of any decisions.

Dental hygiene is important for people of all ages, young and old. Making sure your loved ones are looking after their teeth with brushing and regular checkups is so important to ensure that something more serious doesn’t develop.

Teepa Snow, a nationally acclaimed Alzheimer’s and dementia care specialist, teaches her students how a person with dementia perceives his/her world and how to properly adapt one’s own behaviour to increase communication and mutual understanding.