With the seemingly never ending tasks involved in caring for someone with dementia, oral/dental care is something that could be easily overlooked – or something we feel like we can “skip over.” But dementia does not take away the need for quality oral care or its factor in quality of life.
As dementia progresses, personal grooming tends to decline – this is very common. The person with dementia may forget that they need to brush their teeth, or be able to sequence themselves through the steps needed to brush his or her teeth.
Empower remaining abilities
A cornerstone of good dementia care involves matching the person’s remaining abilities with the task at hand. This applies to dining, dressing, grooming, oral care – and all tasks of daily living. Simply stated, caregivers should empower the person to do as much for themselves as possible, for as long as possible. Abilities will decline as the disease progresses, so it is important to observe and be aware of changes in your loved one, and make changes to their care plan, and communicate any changes to everyone involved in their daily care.
Although every person is unique, when it comes to personal care quite often the amount of assistance needed will progress in the following way:
- Reminders (reminding the individual of the need to do the task)
- Setting out supplies (making supplies visible and accessible to the person)
- Visual cues (demonstrating the task for the person to then mimic or copy)
- Hands on guidance (placing your hand under the hand of the individual and guiding the movements)
- Doing the task for the individual (typically end of life)
Simply stated, caregivers should empower the person to do as much for themselves as possible, for as long as possible.
Oral care throughout the stages
Oral care in early stage
In the early stages of dementia, dental care is focused on maintenance and preventing dental issues in the future.
- Brush teeth twice a day
- Do a daily oral rinse
- Ensure good hydration
- Check the mouth for cavities or sores
- Regular check-ups, cleaning, and flossing teeth
Consult with the dentist in this stage for any potential significant procedures that may need to occur. The individual with dementia will likely be able to tolerate them better in early stage vs later stages.
Oral care in middle and late stage
During the middle and late stages of dementia, daily oral care may become more challenging as the person’s cognitive and physical abilities decline. The person may forget what to do with a toothbrush, or how to rinse their mouth. They may attempt to swallow toothpaste vs spitting it out. Consider the following:
- Demonstrate each step for the individual
- Consider a toothpaste that is not harmful if swallowed
- Be extra vigilant to check for changes in the mouth, as the individual may not be able to communicate pain or distress
- Be aware of any loss of appetite as this may be an indicator that the individual has pain in their mouth due to sores or dentures that do not fit correctly
- If the individual becomes agitated, stop what you are doing and try again later
Oral care in end stage
Still endeavor to keep the individual’s teeth and mouth clean. Use a soft bristle brush and very gently brush the person’s teeth, gums, tongue and mouth at least twice a day, with the last brushing taking place after the evening meal and any liquids that are not water – including liquid medication. Its important to be patient and allow plenty of time.
Dentures
If the person wears dentures, it’s important to rinse them with plain water after meals, brush them daily, and remove each night to then soak in a cleanser or mouthwash. You can then use a soft toothbrush or moistened pad to clean the individual’s gums, tongue and mouth.
Try different types of toothbrushes and flossing options.
Due to the sensitivity many people with dementia experience, a soft bristled toothbrush may likely work better than a hard bristled brush. Try an angled brush or a long handled brush. As the individual progresses in their journey and connects to long term memories more, you may find that an electric toothbrush is confusing to them. Try gently using a proxabrush or similar tool to clean between teeth if flossing is agitating to the person.
Find a dementia aware dentist
Contact your local dental organization to find the names of professionals who specialize in working with individuals with dementia. Be sure to give the dentist a list of any and all medications or supplements your loved one is taking, as well as a list of any health care providers.
