Your step-by-step guide to dental care and dementia

Are you worried the person you’re caring for isn’t brushing their teeth properly? Do they refuse to let you do it for them? Find out how to encourage a loved one with dementia to keep their teeth clean.

Tooth brushing may be second nature to you, but it’s actually quite a complex task which can become increasingly difficult for a person with dementia. Find out how to prevent pain and unnecessary problems.

Why it’s important

- If the mouth isn’t kept clean it could cause painful gum infections and tooth decay.
- Tooth ache can cause people with dementia to go off their food or become restless and easily irritated.
- Dental work, such as fillings and tooth extraction, isn’t pleasant at the best of times, but can be traumatic for someone with dementia – and is best avoided.

What might help?

Prompts
In the early stages of the dementia journey, a quick reminder may be all that’s needed. This could mean a phone call, a text, or a note stuck in a prominent place in the bathroom.

Sensitive supervision
If you suspect a loved one might be struggling to remember what to do with a toothbrush, you could suggest you both brush your teeth at the same time. Watching you, and copying what you do, might be enough.

Use a children's toothbrush
Helps improve access to difficult to reach areas at the back of the mouth because the brush head is smaller.

Remove dentures becore cleaning the teeth
Sounds obvious, but you'd be surprised how many people assume you can keep them in. Removing them makes cleaning them much easier.

Try brushing in the bath
There's less worry about getting toothpaste on clothes - just save it for the end of the bath session just before they get out and when they're at their most relaxed.

Use a fluoride toothpaste
This helps keep enamel strong and encourage spitting but not rinsing of the mouth as that keeps toothpaste on the teeth rather than washing it away where it can't provide a protective layer. Especially important if they suffer from sensitive teeth.

Brush the gums
Don't avoid brushing near the gums, even if they're bleeding. If they are left unclean, this will only worsen gum problems.

Try distraction videos or music
Useful if they don't really enjoy having their teeth brushed but have a favourite TV show or piece of music to keep them happy while it's being done.

Not working?

Don’t worry, you aren’t alone. If the person you’re caring for refuses your help and/or is adamant they’ve already brushed their teeth, it can be extremely difficult to persuade them otherwise.

Here’s a step-by-step guide that’s worth trying

1. Use the kitchen sink, rather than the bathroom. A change of environment could lead to a change in response. Put their toothbrush and toothpaste right next to the sink (beside yours) where they can easily see it.

2. Say something like, ‘we need to brush our teeth’ or ‘why don’t we brush our teeth together?’ Then turn on the water, pick up your brush and get started.

3. Brush your own teeth without talking.

4. When you’re finished, put down your toothbrush and say, ‘oh my mouth feels really fresh and clean now.’ Then pick up their toothbrush, put some toothpaste on it and hand to them smiling but without talking.

5. If they still refuse to take the brush, try offering it again once more, smiling. But if they still won’t budge, smile and say, ‘it’s up to you,’ and walk away.

6. Try this technique several times a day – maybe you might be able to find a time when they’re more responsive to the idea?

7. Don’t give up. Try to stay positive, remember you’re doing the best you can under very difficult circumstances.

Visiting the dentist

Regular dental check-ups and hygienist appointments are important as they provide a good clean when they're not being cleaned well at home. But it can be daunting for a person with dementia. Here’s a few ways to make the experience a little easier.

1. Make sure the dentist is aware of your loved one’s illness beforehand (phone ahead of the appointment if necessary).

2. Try to arrange the appointment for a quiet time of day, avoiding school holidays, and opt for a time when your loved one is usually at their best. For example, early evening might not be a good idea if they experience symptoms of sundowning.

3. If the dentist is running late and the person you care for is growing agitated, consider waiting outside and ask to be called in when your dentist is ready.

4. Stay in the dental surgery with the person you’re caring for. If you sense he doesn’t understand what the dentist is saying, try rephrasing it until he does understand. It’s important he feels respected and that the dental care he receives is person-centred.

Expertly reviewed by Professor Raman Bedi, ex-Chief Dental Officer for England (2002-2005), 06/08/2015.