Top Tips for Maintaining Oral Care in Alzheimer’s Disease

Maintaining good oral health is essential to everyone’s wellbeing. For a person struggling with Alzheimer’s disease or dementia, daily attention to oral health can prevent problems like painful cavities, infections, digestive problems and eating difficulties. Your loved one may not be able to express the pain of a toothache or gum problems, and without proper attention, this can lead to tooth decay, untreated lesions, possible abscess and serious health complications.

When a person suffers from Alzheimer’s disease or another type of dementia, attention to oral care often gets overlooked. As the disease progresses, those with memory challenges need varying levels of support to keep up with their oral hygiene routine. In the early stages of the disease, your loved one may just need reminders on how to brush and why it is important; however, as the disease progresses, your hands-on attention to this important daily routine is critical in maintaining oral care with Alzheimer’s.

Try these tips to help ensure your loved one with Alzheimer’s disease maintains healthy teeth and gums, courtesy of the professionals providing home care in Glendale, AZ and nearby communities at Nightingale Homecare:

Keep the teeth and mouth clean. Very gently brush the person’s teeth, gums, tongue and roof of the mouth at least twice a day, with the last brushing after the evening meal (see below for instructions).

Try different types of toothbrushes. Experiment until you find the right choice for your loved one. You may find that a children’s toothbrush works best, as the head is smaller and the bristles are softer. You may also want to try a long handled or angled brush, which can be easier to use than a standard toothbrush. Be cautious with using an electric toothbrush on a person with Alzheimer’s disease, as this can create fear and agitation.

Floss regularly. Take the time to floss daily. Flossing can be distressing to a person with Alzheimer’s, so try using a “proxabrush” to clean between teeth. A Waterpic is another option, if the person can tolerate it, which is gentler on the gums and much easier than trying to manipulate string floss. As when using an electric toothbrush, remember to proceed slowly and calmly, letting your loved one know what you are going to do next. Monitor the water temperature, pressure setting and the angle of the nozzle while working. Instead of using only water in the reservoir of the appliance, add a small amount of anti-cavity mouthwash.

Be aware of potential mouth pain. Investigate any signs of mouth discomfort during mealtime. Refusing to eat or strained facial expressions while eating may indicate mouth pain or dentures that don’t fit properly.

Monitor sugar intake. As we know, sugar can cause tooth decay, especially when it’s frequently eaten. If your loved one with dementia is in need of a snack, try to avoid giving too many sugary foods. Tooth-friendly foods and snacks include:

• Vegetables
• Fresh fruit
• Yogurt
• Bread with sugar-free spreads
• Crackers and cheese
• Pita bread with hummus
• Rice cakes

Keep your loved one hydrated. Proper hydration helps keep the mouth moist and inhibits bacterial growth. Saliva is meant to serve this purpose, but may older adults suffer from dry mouth caused by a wide range of medications. There are several over-the-counter mouth rinses specifically for dry mouth that aid in keeping the mouth moist. The last step to any meal should be using water to wash everything away.

Timing foods for oral care. Offering fruit at the end of each meal can go a long way in helping break down the sugar and starch from a meal. Crunchy fruits and veggies help remove plaque from the teeth.

Brushing Your Loved One’s Teeth

Everyone should have their mouth cleaned twice a day, so make sure your loved one continues to keep up this routine, and provide assistance when needed. You may find that some days you can just direct the steps, and other days you may have to actually perform the care. Keep these pointers in mind as you accomplish the task of brushing.

• Provide short, simple and clear instructions, broken into steps, such as, “Hold your toothbrush. Now put toothpaste on the brush.”
• Use a “watch me” technique. Hold a toothbrush and demonstrate to your loved one what to do.
• You may need to guide by putting your hand over the person’s hand, gently guiding the brush.
• If your loved one seems agitated or uncooperative, postpone brushing until later in the day.
• Observe your loved one for signs of discomfort: grimacing, bleeding gums or sensitivity to hot or cold. These are signs your loved one may need to see the dentist.

If you need to brush your loved one’s teeth:

• Support the person’s jaw to keep the teeth together to help clean the outer surfaces of the teeth.
• Encourage the senior to open wide to help you clean the inside and biting surfaces of the teeth.
• Use a pea-sized amount of toothpaste.
• Use gentle, circular movements, paying extra attention to the area where the tooth meets the gum.
• Encourage your loved one to spit out the toothpaste rather than rinse it out. The fluoride in the toothpaste will continue to protect their teeth.
• Clean the teeth from the outer surfaces to the biting surfaces and finally to the inner surfaces.
• Replace the toothbrush when it begins to show wear, or every three months.
• If you notice your loved one’s gums are bleeding, this means there is some residual plaque in the mouth, which is irritating the gums. Continue to brush the person’s teeth, but if the bleeding continues more than a week, make an appointment with a dentist.

Dealing with Dentures

Many people living with Alzheimer’s disease have dentures, and it’s important to ensure they are cleaned daily and replaced when necessary. Follow these tips to ensure your loved one’s dentures are cared for:

• Rinse dentures with plain water after meals and brush them daily to remove food particles.
• Clean dentures with a special denture brush and denture paste or non-perfumed liquid soap and water to remove all food and plaque deposits.
• Each night, remove the dentures and soak in a denture cleanser or mouthwash.
• Ensure your loved one cleans remaining teeth and/or gums before going to bed. Use a soft-bristled brush or moistened gauze if there are no natural teeth.

Dental Appointments

Most dental insurance plans cover a teeth cleaning (prophylaxis) every six months. Since it can be extremely difficult getting a person living with Alzheimer’s disease to comply with brushing and flossing twice a day, you may want to consider increasing dental visits to every three months. This can help combat plaque and tartar buildup on the teeth. Additional cleanings also help to prevent serious gum conditions like gingivitis and periodontitis, which contribute to decay and tooth loss.

As the disease progresses, those with Alzheimer’s/dementia may become increasingly agitated and noncompliant during cleanings. Finding the right dentist with experience working with the elderly and persons with dementia is critical. Difficult dementia behaviors and diminishing capacity will eventually make regular cleanings too traumatic for your loved one. At that point, assisting your loved one with flossing, brushing and rinsing as often as possible is the best way to maintain oral health.

If providing oral care for someone with Alzheimer’s disease (or meeting any other care needs) is overwhelming, please know that you always have a trusted partner in care with Nightingale Homecare. As the top provider of home care in Glendale, AZ and the surrounding areas, we can provide a full range of professional Alzheimer’s care services through our specialized Connections Dementia Care program. Call us at (602) 504-1555 to learn more.