Oral Health Care for Elderly Dementia and Alzheimer's Patients

October 3, 2024 - Reading time: 8 minutes

Oral health is essential for everyone, especially elderly dementia patients who face greater challenges. Cognitive decline can hinder daily tasks like tooth brushing and recognizing dental discomfort in Alzheimer's patients. Providing suitable dental care for seniors with dementia prevents severe health issues, improves life quality, and reduces pain. This blog explores common behaviours linked to oral problems in elderly dementia patients, explains underlying causes, and provides practical advice for caregivers.

Common Oral Health Behaviors in Dementia and Alzheimer's Patients

As dementia progresses, individuals may exhibit several behaviours related to oral health care:

• Forgetting to Brush Teeth
• Resistance to Mouth Care
• Difficulty Holding a Toothbrush
• Lip-Closing or Teeth-Clenching
• Refusing to Open Their Mouth
• Eating Less or Avoiding Certain Foods
• Increased Restlessness or Aggression
  
  

What Causes These Oral Health Challenges?

Behavioural changes related to oral care in dementia patients stem from physical and cognitive impairments. Key causes include:

• Memory Loss: Dementia patients may forget to brush their teeth or lose understanding of oral hygiene's importance.
  
  
• Coordination Issues: Dementia affects motor skills, complicating tasks like holding a toothbrush or applying toothpaste.
  
  
• Pain and Discomfort: Gum disease, tooth decay, or ill-fitting dentures cause discomfort, leading to resistance during care.
  
  
• Fear and Anxiety: Loss of independence and unfamiliar oral care sensations trigger fear, causing teeth-clenching or aggressive behaviour.

Solutions for Managing Oral Health in Dementia Patients

Addressing oral health challenges in people with dementia requires patience, time, creativity, and adaptability. Here are some practical solutions for common behaviours:

1. Encouraging Independence in Oral Care

   • What’s the issue?: Patients may lose interest in brushing or struggle with the toothbrush.
     
     
   • Solution: Encourage dementia patients to maintain independence by offering clear instructions, showing easy brushing techniques, and using hand-over-hand guidance. You can also mirror your actions (called "bridging") to help them follow along.

2. Managing Resistance to Oral Care

   • What’s the issue?: Lip-closing, teeth-clenching, and head-moving can make it difficult to clean the dementia patient's mouth.
     
     
   • Solution: Create a calm, well-lit environment and approach the task gently. Use distraction techniques like familiar music or objects, and choose a time of day when the patient is more relaxed. For biting or clenching, try rubbing their cheek to relax the muscles, or use a second toothbrush such as a kid's toothbrush to complete the task.

3. Handling Aggression During Mouth Care

   • What’s the issue?: Resistance/refusal or aggression may occur due to frustration, fear, or pain.
     
     
   • Solution: Stay calm and take a break if the patient becomes aggressive. Always check for signs of discomfort, such as face-holding or swollen gums, and address any pain or infection with professional help. When needed, include someone who knows the patient well to assist in calming the dementia patient down.

4. Assisting with Denture Care

   • What’s the issue?: Dementia patients may forget to remove or clean their dentures, leading to infections or discomfort.
     
     
   • Solution: Assist them in cleaning their dentures twice a day with a soft brush with the recommended paste. Ensure they remove the dentures at night to give their gums a chance to rest. If the patient is reluctant to accept help, offer gentle encouragement and assist as necessary.

5. Reducing Sugar Intake

   • What’s the issue?: Sugary foods increase the risk of tooth decay, especially when oral hygiene is not maintained regularly.
     
     
   • Solution: Offer healthier options such as fresh fruits, vegetables, and water. Minimise sugary snacks and sweets to help protect their teeth from decay.

Spotting Dental Problems in Dementia and Alzheimer's Patients

Caregivers must be vigilant in recognising the signs of dental problems in patients with dementia, as they may not effectively communicate pain. Common indications include:

• Eating less or avoiding hard foods
• Swollen, bleeding gums
• Changes in behaviour, such as restlessness or aggression
• Red patches or sores in the mouth
• Foul breath or visible decay

Conclusion: The Importance of Consistent Oral Care with Dementia Patients

Oral health plays a significant role in the overall well-being of people with dementia. By maintaining a regular oral care routine, managing behaviours associated with dental discomfort, and spotting early signs of dental problems, caregivers can help ensure that their loved ones remain comfortable and healthy.

Proper oral care can prevent infections, reduce the risk of tooth decay and gum disease, and help maintain quality of life as dementia progresses. With patience, a gentle approach, and appropriate techniques, caregivers can overcome many of the challenges associated with dementia and oral health.

Key Takeaways for Caregivers:

• Use gentle prompts and demonstrations to encourage independence in brushing.
• Recognize non-verbal signs of discomfort like restlessness, aggression, or eating less.
• Reduce sugar intake and offer healthier food options.
• Seek dental help when signs of decay, gum disease, or infection appear.

By incorporating these practical tips into daily routines, caregivers can make a significant difference in the lives of dementia patients, ensuring their comfort and well-being through better oral care.

Electric vs. Manual Toothbrush for Dementia Patients: Which is Best for Oral Health Care?

When choosing between an electric or ordinary toothbrush for dementia patients, both options have benefits and drawbacks. An electric toothbrush is often highly recommended because it requires less manual dexterity, making it easier for dementia patients with coordination issues to achieve a thorough cleaning. Its rotating bristles can be more effective at removing plaque with minimal effort. However, the noise and vibrations might cause discomfort or fear for some dementia patients, potentially increasing resistance to brushing their teeth.

Conversely, a manual toothbrush is quieter and often more familiar, which can lessen anxiety during brushing. It allows caregivers to easily control the pressure, benefiting patients with sensitive gums. However, it demands greater effort and precision, which may be challenging for individuals with cognitive or motor impairments. The decision should hinge on the person's comfort and capability, emphasizing gentle yet thorough cleaning.

Home: Dementia Care Support Guide