Dental Health in 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.

Persons with dementia are susceptible to dental problems because of:

Reduced saliva  Saliva is essential to maintain a healthy mouth and to prevent the onset of dental decay and other oral lesions. Saliva acts as a lubricant and also cleans the mouth and teeth. Lack of saliva can thus lead to a build-up of plaque and increase the risk of dental decay, gum disease and infection. A dry mouth can also cause dentures to become loose and uncomfortable. A moisturising mouthwash may help with dry mouths as well.

Saliva production decreases as a person ages. In addition, some medications may reduce the production of saliva by salivary glands.

Denture fixatives and artificial saliva (a fluid to lubricate the mouth) can help some people with denture problems.  Frequent sips of water throughout the day, especially at mealtimes, will help.
Medications  Certain medications can cause involuntary repetitive movements of the jaw and tongue, making it difficult to wear dentures and may cause wearing down of teeth. In some cases, these movements will continue after the drug is stopped. A dentist may be able to advise on what can help, and how best to ensure that your loved one is comfortable.
Reduced oral care  Physical limitations may affect abilities to maintain their oral health.
DENTAL HEALTH IN PERSONS WITH DEMENTIA 

What to look out for?

Behaviours that may suggest your loved ones are experiencing dental problems include:

  • food refusal
  • refusing to wear dentures
  • facial expressions such as grimacing
  • increased restlessness, agitation, shouting
  • disturbed sleep
  • aggressive behaviour

Tips on toothbrushing for persons with dementia

Mild dementia stage

Your loved one may find it easier to use an electric toothbrush or a toothbrush with an adapted handle to improve their grip.

Tips on toothbrushing for persons with dementia

Moderate to severe stage

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

  • You can modify the toothbrush handle by putting the handle through a tennis ball. Try different types of toothbrushes until you find the best choice

Give short and simple instructions 

  • Break down instructions step by step. E.g. "Hold your toothbrush." "Put toothpaste on the brush." Then, "Brush your teeth."

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 

  • Give your loved one 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 your loved one while doing this.

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

Anti-plaque mouth wash can be helpful in preventing gum disease—but ONLY if it won't be swallowed. 

My loved one with dementia may swallow toothpaste or mouthwash. What can I do?

Safer options for persons with moderate to severe dementia include:

  1. Fluoride free toothpastes 
  2. Alcohol-free, chlorhexidine gel to clean teeth 
    • Use your fingertip or a very soft toothbrush to apply the gel to the teeth
  3. Any commercial alcohol-free chlorhexidine mouthwash 
    • do not gargle mouthwash
    • instead, dip toothbrush in mouthwash, shake off excess and brush teeth
  4. Sodium bicarbonate solution 
    • mix 1/2 teaspoon of sodium bicarbonate in 200mL of water, dip toothbrush in mixture, shake off excess and brush teeth
  5. Brush teeth with toothbrush and water only 
    • mechanical brushing is more important than the pastes/mouthwash we use

More retail items for dental care in older adults can be purchased at Dental Clinic (Clinic 6B, Level 6, TTSH Medical Centre.