Dental Care (for dementia)

• Dental hygiene is important for overall health. Poor dental hygiene may lead to heart disease, gingivitis, stroke, osteoporosis, and respiratory disease. In addition to causing bad breath, inadequate dental hygiene can also affect one’s ability to eat, chew, and talk. Certain medications can cause “dry mouth.” Dry mouth makes it more difficult to eat and swallow, produce saliva, and causes tongue irritation.
   
• Brushing teeth is a complicated process with many steps. Although most of us do it automatically, if someone is having memory problems, some of the steps might be forgotten. Supervision or assistance is often necessary.
   
• Talking someone through the steps or modeling the steps yourself at the same time might help the affected person be more successful. Give the person the toothbrush with toothpaste already on it and put your hand over theirs to start the up-and-down brushing movement to help get started. It may be easier to stand behind the person while doing this.
   
• The bathroom is not the only choice for brushing teeth. A basin on a table or the kitchen sink might work better. It also doesn’t have to be the last thing at night before bed or the first thing in the morning. Find a time when both you and the person for whom you are caring are calm and have time to devote to the task.
   
• A toothbrush with a large handle can be easier to hold onto and maneuver. Put the handle through a tennis ball to give the person something larger to grasp. Another option is an electric toothbrush, which may prove easier to use.
   
• Although fluoride toothpaste is the best, if the person is likely to swallow the fluoride toothpaste, rather than spit it out, try brushing just with water or baking soda toothpaste.
   
• Never force someone to open their mouth, and do not pry their lips apart. Take a break and try later if there is a problem or resistance. If the toothbrush is too invasive or if the bristles are too rough on your loved one’s delicate gums, try using a Q-tip or gauze wrapped around your finger. If dental care at home is proving to be very difficult or extremely unpleasant for you both, make an appointment to see a dentist every two months for regular dental care.
   
• It might be easier, if you are doing the brushing, to sit the person on a chair and to brush their teeth from behind. Flossing is also easier from this position.
   
• Flossing may be more important than brushing. Use a floss holder, Flexi-Picks, or Stim-u-dent, or use a tiny brush that can fit between teeth to clean the gums as well as the teeth.
   
• Anti-plaque mouthwash can be helpful in preventing gum disease—but ONLY if it won’t be swallowed. This can be a substitute for brushing, if necessary. Some mouthwashes can also help with dry mouth, as can artificial saliva products. Talk with your dentist about alternatives if swallowing mouthwash is an issue.
   
• Dentures need to be taken out daily, brushed, and rinsed. While they are out, try to brush the person’s gums and the roof of their mouth with a soft bristled toothbrush. Gum shrinkage can cause dentures to fit improperly, leading to pain, trouble eating, and infection. Have them checked regularly by your dentist.
   
• Possible signs of dental problems include someone rubbing or touching their cheek or jaw, moaning or shouting out, head rolling or nodding, and flinching, especially when washing their face or being shaved. Restlessness, poor sleep, increased irritation or aggression, and refusal or reluctance to put in dentures when previously there was not a problem are other signs of dental issues.
   
• Find a dentist who understands dementia who will work with you and your loved one.
   
• Apples can help clean teeth while being chewed. Avoid hard candy, and be sure to drink plenty of water.
   

This tip sheet was prepared by Family Caregiver Alliance. © 2012 Family Caregiver Alliance. All rights reserved.