Mouth care for people with dementia

Maintaining good oral health is essential to your overall well-being. Daily care can help stop problems like painful cavities and infections before they arise, and helps avoid pain when eating, drinking and communicating.

People living with dementia have a high rate of tooth decay and gum disease. This may be because they find it difficult to perform their normal daily activities, and require some support to keep up with their oral hygiene routine. Others may not be able to express that they have a toothache and leave problems untreated. It’s important that people living with dementia receive the help they need to keep their teeth and gums clean and free of debris so that they can maintain their self-esteem and avoid pain and infections.

Sugar and oral health

Sugar can cause tooth decay, especially when it’s frequently eaten. If you are caring for someone with dementia, try to avoid giving them too many sugary foods, both between meals and at mealtimes. Tooth friendly foods and snacks include:

  • vegetables
  • bread with sugar-free spreads
  • savoury crackers and cheese
  • pitta bread with hummus or guacamole
  • rice cakes
  • fresh fruit
  • oatcakes
  • plain yoghurt

Drinks that are labelled sugar-free may still be damaging to health if they are acidic. Water is the best drink to consume to avoid damaging teeth. Milk and unsweetened tea and coffee are good to have in moderation.

Caring for teeth and gums

Everyone should have their mouth cleaned twice a day, so make sure that the person living with dementia continues to do this and help them if they
are unable or reluctant to do it themselves. You may want to make brushing your teeth an activity you do together so that you can prompt, observe, and help them if needed.

If you need to brush the person’s teeth for them, you could try:

  • supporting their jaw to keep their teeth together to help clean the front
    of the teeth
  • encouraging the person to open wide to help you clean the inside and
    chewing surfaces of the teeth
  • using a toothbrush with a small head and medium bristles; a child’s
    toothbrush may be easier to use
  • using a pea-sized amount of toothpaste containing no less than
    1450ppm fluoride (look on the tube or box to find out how much fluoride
    is in your toothpaste)
  • using gentle, circular movements, paying extra attention to the area
    where the tooth meets the gum
  • encouraging the person you’re helping to spit out the toothpaste rather
    than rinse it out. The fluoride in the toothpaste will continue to protect
    their teeth
  • replacing the toothbrush when it begins to show wear or every three
    months.

When you are helping your family member or close friend who has dementia to brush their teeth you may find that their gums bleed. This means that they have some plaque in their mouth, which is irritating their gums.

You should continue to brush their teeth. If the bleeding doesn’t stop after two weeks, make an appointment with a dentist, who may decide to treat the gums.

It’s also important to keep up with routine check-ups at the dentist, remembering that the person with dementia may need support in arranging and sticking to appointments.

Wearing dentures

Many people living with dementia will have dentures. It’s crucial that the dentures are kept clean and are replaced if they become loose. If someone has recently received dentures to replace lost teeth, they may need support in forming new cleaning habits. You might like to try the following with the person living with dementia:

  • encouraging them to clean their dentures twice daily or do it for them if
    they are unable
  • use a soft-bristled brush if there are no natural teeth for a gentler clean
  • encouraging them to clean their remaining teeth or gums before they
    go to bed
  • speaking to a dentist about getting a second set of dentures made. Your
    dentist can advise on having the person’s name printed on the dentures
  • making sure you speak with staff at any new care setting to let them
    know the person has dentures and ask where they can store them safely
  • making sure the dentures are cleaned over a bowl or sink of water so
    that they won’t break if you drop them
  • cleaning dentures with a special denture brush and denture paste or
    non-perfumed liquid soap and water to remove all food and plaque
    deposits. Don’t rely on overnight tablet cleaners in water as these are
    not as effective
  • making sure they take their dentures out overnight.

Encouraging oral care if someone is reluctant

A change in a care routine or the prospect of treatment may make some
people feel confused or uncomfortable. Try to help this by:

  • giving the person short, clear instructions
  • demonstrating what to do, and gently guiding the person to take care of their mouth and teeth in stages
  • clearly and simply explaining what you are about to do, gesturing with a toothbrush and toothpaste if you are brushing the person’s teeth
  • observing the person for signs of discomfort. The person may hold their face, grimace, struggle with ill-fitting dentures, have loose teeth, frequent bleeding or sensitivity to hot and cold food and drink. If you notice any of these signs, consult a dentist as soon as possible.

Need help or advice to find a dentist?

www.nhs.uk

Call NHS Customer Services on 0300 311 2233 if you require further assistance with finding a dentist.

If you need any advice and support in your caring role, contact the Admiral Nurse Dementia Helpline on 0800 888 6678, or email helpline@dementiauk.org