Maintaining good oral health is essential to the overall well-being of people living with dementia. 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 as dementia progresses, they may 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 when it’s frequently eaten. If you are caring for someone with dementia, try to avoid giving them too many sugary foods between meals. Tooth friendly foods and snacks include:
bread with sugar-free spreads
savoury crackers and cheese
pitta bread with hummus or guacamole
rice cakes or oatcakes
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 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.
Some 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
If the person with dementia’s dentist can no longer manage their treatment needs, they may be referred by the dentist or another healthcare professional to the local salaried community dental service or local specialist dental service. These are NHS dental services for people with additional needs. For example, a person with dementia might be referred if they have difficulty communicating that they’re in pain, or if they can’t consent to their own care. They might require extra assistance or guidance about carrying out and maintaining oral hygiene, or they might be resistant to dental treatment. The service will be able to attend to these needs with specialist medical equipment and staff who are trained to put people at ease. Treatment and appointments cost the same as standard dental care.
Details of the local community dental service can be obtained from the local primary care organisation (England), the local health board (Wales) or the local trust (Northern Ireland).
If you need any advice and support in your caring role, contact the Admiral Nurse Dementia Helpline on 0800 888 6678, or email: firstname.lastname@example.org