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Dementia: Oral Care

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​Dental Care

Oral health is important for everyone. Even if your loved ones have few teeth remaining, or no natural teeth left, daily oral hygiene is essential.
Older persons may have difficulties maintaining oral health because of:

  • Poor eyesight
  • Conditions affecting hand dexterity e.g. osteoarthritis, Parkinson’s disease
  • Conditions affecting their mood e.g. dementia, depression
  • Conditions affecting their mobility to get to the toilet basin e.g. stroke

Why is Oral Health Important?

Maintaining oral health brings benefits to our quality of life. A healthy mouth will make eating more enjoyable, without the woes of dental pain or infection.
Problems associated with poor oral health include:

  • Negative effects on self-esteem
  • Poor nutritional status
  • Difficulty in improving diabetic control
  • Increased risk of pneumonia (especially in elderly with swallowing problems), leading to increased incidence of hospitalisations and mortality

What are Oral Diseases?

There are two main types of oral disease:

  1. Gum (periodontal) disease
  2. Tooth decay (dental caries)

Both of these may cause discomfort or pain and can lead to infection. Both pain and infection can worsen the confusion associated with dementia.

What are Some Tips on Oral Hygiene?

  1. Brush your teeth twice a day
  2. Denture care:
    • Remove dentures after meals and rinse off food debris.
    • Brush dentures with soft toothbrush and water, and soak in cleanser at night. Avoid brushing with toothpaste.
    • Use a soft toothbrush to clean the gums, tongue and roof of mouth.
    • Do not wear dentures to sleep as it will cause unhealthy bacteria to build up in the mouth
  3. Visit a dentist regularly

For older adults that have difficulty brushing, you may either get them to brush by themselves first and have a caregiver check and brush again later. Alternatively, the caregiver can help to brush their teeth for them. It is important to take their feelings into account and maintain their maintain their ability to perform independent tasks for as long as possible.

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Is Oral Hygiene Necessary for Persons With no Teeth or on Tube Feeding?

Definitely. Studies have shown that even on tube feeding, oral bacteria can still get into the lungs and cause pneumonia. Keeping the mouth clean can help to prevent this.

Why are Persons With Dementia Prone to Dental Problems?

  • Reduced saliva
    Saliva prevents decay by protecting your teeth from acid attacks, while the antibodies in saliva prevents gum infection.
    Most older adults are taking some chronic medications that may reduce the production of saliva by their salivary glands.
    The lack of saliva causes dentures to be loose and rub uncomfortably on the gums.
  • Medications
    Certain medications may cause involuntary repetitive movements of the jaw and tongue, making it difficult to wear their dentures and may also cause the wearing down of their teeth.
  • Reduced oral care
    Physical limitations may affect abilities to maintain their oral health.

What to Look out for?

Some behaviours that may suggest your loved ones are experiencing oral problems include:

  • Refusing to eat
  • Refusing to wear dentures
  • Refusing to brush teeth
  • Holding of face
  • Increased restlessness, agitation, shouting
  • Disturbed sleep

What are Some Tips on Tooth Brushing for Persons with Dementia?

As dementia progresses, the person with dementia may forget how to brush his or her teeth or forget why it is important. As a caregiver, you may have to assist or take a more hands-on approach.
You may like to try some of these methods:

  • Change to an electric toothbrush or a toothbrush with larger handle to improve grip

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  • Give short and simple instructions
  • Use a ”watch me” technique and show your loved ones how to brush their teeth
  • Put your hand over your loved ones’ hand to guide them in brushing

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  • Postpone brushing to a later time if your loved one is not cooperative
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