Dementia and oral health | Lauren Mahakian | Columns

Oral health is important for everyone, but age, diminished abilities to perform self-care and medications are just a few of the causes that increase its challenges.

Lack or difficulty of access to regular dental visits and cleanings, poor health and poor hygiene are additional contributors to poor oral health. Some medications may also reduce the production of saliva, which is essential to a healthy mouth.

The implications can go beyond the mouth: Mouth pains and soreness can decrease appetite, and if infection and disease are present, these can enter the bloodstream, adding to ailments such as heart disease.

For those with Alzheimer’s or dementia, the difficulties are even greater.

As Alzheimer’s progresses, the person with dementia may forget simple tasks such as how to brush their teeth or forget its need. In the middle and late stages of Alzheimer’s, he/she may forget what to do with the paste or how to rinse and may be resistant to assistance from others.

A simple task can become the center of opposition, fear or physical combativeness.

For the caregiver, it is easy to want to give up on oral hygiene altogether. 

This is one of the reasons that people living with dementia have a higher rate of mouth disease. Making matters worse, they may not be able to express that they have a toothache and problems may be misdiagnosed and left untreated.

Tips for helping make teeth brushing easier:

  • Allow plenty of time and find a comfortable position if you must assist with brushing;
  • Give short, clear instructions on every step, such as “hold your toothbrush” or “squeeze the toothpaste”;
  • Put your hand over the person’s hand, to gently guide them;
  • If your loved one seems agitated or uncooperative, postpone brushing until later in the day;
  • Very gently, brush the person’s teeth, gums, tongue and roof of the mouth at least twice a day, using gentle, circular movements and paying extra attention to the area where the tooth meets the gum;
  • Set the task to music with a rhythm that encourages small, timed brushing strokes;
  • Make the last brushing of the day after the evening meal or any nighttime liquid medication;
  • A soft-bristled children’s toothbrush or a long-handled or angled brush may be recommended. Experiment until you find the best choice. Be aware that electric dental appliances may confuse a person with Alzheimer’s;
  • Replace the toothbrush when it begins to show wear, every three months, or after an illness;
  • Most dentists recommend flossing daily. If it is distressing to the person with Alzheimer’s, try using an interdental brush to clean between teeth instead;
  • When a caregiver must do the brushing, it may help to sit on a straight-backed chair with the caregiver standing behind to support the person against their body, cradling their head with one arm;
  • If spitting out the toothpaste after brushing is a problem, consider a solution of half antibacterial mouthwash and water instead of toothpaste;
  • Try an oral sponge soaked with a mouth rinse. Keep their mouth moist, and use ointment to keep their lips and corners of the mouth from chapping/breaking;
  • For those with dry mouth, consider using coating products, such as Biotene;
  • Only a pea-sized amount of toothpaste is necessary, preferably containing no less than 1450 ppm fluoride; and
  • If gums bleed more than a couple of weeks, consult a dentist.

For those with dentures:

  • Monitor the fitting on a regular basis and ensure they are not loose or damaged;
  • They should be cleaned twice daily. Cleaning dentures over a bowl or sink of water may prevent breakage if you drop them. Use a denture brush and paste, or nonperfumed liquid soap and water to remove all food and plaque deposits;
  • Remaining teeth and gums should continue to be brushed;
  • If at a facility, speak with staff to find a place where they can be stored safely. Consider getting a second set of dentures made with the person’s name printed on them.

Additionally, be careful with drinks.

Sugary drinks can add to cavities, and sugar-free may still be damaging to health if they are acidic. Water is the best drink to consume to avoid damaging teeth. Milk and unsweetened tea and coffee are good to have in moderation.

Always look for any sign of mouth discomfort during mealtime. Refusing to eat or strained facial expressions may indicate mouth pain or dentures that don’t fit properly. The person may hold their face or grimace if they have loose teeth, frequent bleeding or sensitivity to hot and cold food and drink. If you notice any of these signs, consult a dentist as soon as possible.

Lauren Mahakian is a Certified Dementia Practitioner. She supports families affected by Alzheimers, dementia, and cognitive disorders through care management services and podcast “Unlocking the Doors of Dementia™ with Lauren,” as well as free support groups, and specialty memory care homes located in Torrance and Solvang. Visit familyconnectmemorycare.com for more information.

 

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