3. Daily care of teeth
Early stages of dementia
Someone in the early stages of dementia should carry out their own mouth care for as long as possible. They may need to be reminded to do it, or they may need to be supervised. The carer can give them the brush and toothpaste and show them what to do. The person may find it easier to use an electric toothbrush or a toothbrush with an adapted handle to improve their grip.
The dentist or dental hygienist may be able to advise the person and their carer on the best methods for preventing tooth decay and gum disease in the particular circumstances. It is very important to establish a daily care routine in the early stages of dementia. This may include a high-concentration fluoride toothpaste and regular application of fluoride varnish for people with natural teeth. Fluoride can be applied by the dentist every three to four months.
Later stages of dementia
As dementia progresses, the person may lose the ability to clean their teeth, stop understanding that their teeth need to be kept clean, or lose interest in doing so. Carers may need to take over this task. A dentist or hygienist can provide guidance and support on how to assist in cleaning another person's teeth. The technique will vary depending on the individual concerned. Generally, the easiest way is for the person with dementia to sit on a straight-backed chair with the carer standing behind. The carer supports the person against their body, cradling their head with one arm. They can then brush the person's teeth using a dry toothbrush and a pea-sized amount of toothpaste.
How to tell if someone has dental problems
There may come a time when the person with dementia is unable to say that they are experiencing pain or discomfort in their mouth or teeth. They will need to rely on other people to notice and interpret their behaviour and to arrange a visit to the dentist if necessary. There are several behavioural changes that may indicate that someone with dementia is experiencing dental problems. These may include:
- refusal to eat (particularly hard or cold foods)
- frequent pulling at the face or mouth
- leaving previously worn dentures out of their mouth
- increased restlessness, moaning or shouting
- disturbed sleep
- refusal to take part in daily activities
- aggressive behaviour.
If there is no explanation for the change in behaviour, arrangements should be made to identify the cause. This should include a dental assessment as part of the process.