...More About Oral Health
There is so much to attend to when caring for
a person with dementia (PWD) that it’s easy
to understand that what isn’t seen may not be
thought about or noticed. Nonetheless, good oral
health is important and can affect a PWD’s comfort,
appearance, eating, nutrition and general
health.
Planning for the PWD’s oral health needs early
in the course of dementia is the optimal way to
approach this. Begin by making an appointment
with the dentist and alerting the dentist in
advance of the visit to the PWD’s full medical
history, all medications, and any special needs.
During the visit develop a dental care plan with
the PWD and the dentist. Some of the products
that are frequently included in this plan are the
use of a soft toothbrush, fluoride toothpaste and
antimicrobial rinse. Also, some dentists may recommend
the use of an electric toothbrush but be
aware that the PWD may resist its use.
Early in the dementia all that may be required
is a gentle reminder that it’s time to brush teeth.
As the dementia progresses, the caregiver needs to
take into account what the PWD is able to do
and can tolerate. Brushing teeth requires a number
of steps and may be too complicated and
confusing for the PWD to do on his own. To
compensate for this provide short, one step
instructions, e.g.,“hold your toothbrush (or place
the toothbrush in his hand while explaining what
you are doing); put the paste on the brush; brush
your top teeth…” and coach the PWD through
the process. Sometimes all that may be needed is
for the caregiver to model the process by brushing
her own teeth - going through each step in
the procedure while the PWD observes and
copies what the caregiver is doing.
The PWD may not be able to identify or
describe dental pain. The caregiver can be alerted
to potential oral health problems if the PWD
is rubbing or touching his mouth/jaw; flinching
when washing his face or shaving; increased agitation
or restlessness; wincing when eating, especially
with ingestion of hot or cold foods/drinks;
resisting wearing dentures when previously not a
problem. It’s also important to check the mouth
regularly for signs of tooth decay, sores on the
tongue or gums, or any other potentially harmful
changes.
In the later stages of dementia the caregiver will
need to brush the PWD’s teeth. As with every
interaction involving a PWD, a relaxed, unhurried
approach to the task produces the best
results. If the PWD is unable to cooperate with
the process, back off and try again later. Brushing
the PWD’s teeth may be easiest if you are standing
behind the PWD or with the PWD’s head in
your lap. While brushing the PWD’s teeth place
the PWD’s dominant hand on your arm. The
PWD will feel the movement of your arm and
this may help connect him to the task. The PWD
may swallow the toothpaste, no longer able to
follow directions to spit it out. Consequently, it
may be advisable to brush his teeth with a dry
brush and to discontinue the use of toothpaste
and the antimicrobial rinses — both of which can
be irritating to the stomach. This is something to
discuss with the dentist. Also, toothettes (sponge
like swabs) can be used to clean the PWD’s
mouth. If the PWD is on a soft diet extra care
needs to be taken to remove residual food from
the mouth. In this advanced stage of dementia it
will take more than regular reminders for the
person to keep his mouth open so you can avoid
getting bitten. Using a second toothbrush in the
mouth to prevent the person from closing their
mouth on your fingers can accomplish this. If the
PWD wears dentures be sure to remove and
clean them daily and brush the PWD’s gums and
the roof of the mouth. If the PWD is taking
medications that cause dry mouth, be sure to ask
the dentist or the physician for products that treat
this symptom. They are readily available and easy
to use.
If making a visit to the dentist is too difficult,
especially as the disease advances,we may be able
to assist you. There are dentists who make home
visits. If you wish more information, please call
our Helpline at 1-800-272-3900.
— Della Frazier-Rios, RN, MS
Senior Vice President
Director of Education & Outreach
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