Supporting a person with dementia to keep a healthy mouth

Helping a person with dementia brush their teeth

Supporting a person with dementia with personal care isn’t always easy. There can often be challenges and changes.

If you are helping someone to brush their teeth, there are things you can do make it easier for both of you. 

Establish a routine

The most important part of mouth care is brushing teeth twice a day, including just before going to sleep.

This healthy routine can help prevent dental problems developing. It is also a good chance to check the rest of the mouth for any concerns.

Encourage the person to do the task themselves

Where possible, try to encourage a person with dementia to brush their teeth themselves. Some people may find this difficult because of their dementia symptoms or other health problems, such as arthritis.

If the person is struggling, assist them, but it’s best not to take over completely. Instead, try gently prompting them or only helping when they get stuck. If you need to brush their teeth for them, see tips below.

Having sugary foods less often

Sugary foods can be enjoyable and don’t generally do much harm, providing they’re only eaten occasionally.

If they are eaten regularly throughout the day, however, it’s important to make sure they don’t cause tooth decay. This risk can be reduced by brushing regularly and keeping the mouth moist.

Tips for helping a person to brush their teeth

• Make sure your hands are clean. Wash your hands thoroughly first and wear disposable gloves to avoid risk of infection.
• Apply a pea-sized amount of fluoride toothpaste to a toothbrush. Press it well into the bristles so it doesn’t fall off – particularly if using an electric toothbrush.
• Stand to the side of the person and help them to move their hand as they hold the toothbrush.
• Using two toothbrushes can sometimes help. Use the handle of the other toothbrush to gently lift the person’s cheeks away from their teeth and gums. This should make it easier for you to see inside the whole of their mouth as you brush.
• If you can, check the person’s teeth and gums for any mouth care problems such as bleeding, ulcers, broken teeth, teeth with holes in or dark staining, or any lumps or swelling.
• Brush the teeth and gums in a circular, ‘round-and-round’ motion not backwards and forwards. 
• Make sure you brush the teeth from these different angles:
  • behind the teeth (the ‘inside’), with the toothbrush facing diagonally towards the gum
  • on the top (biting surface) of the teeth, with the toothbrush facing horizontally up or down
  • in front of the teeth (the ‘outside’), with the toothbrush facing diagonally towards the gum.
• Brush the top set of teeth for one minute (spend 30 seconds on each side of the mouth). Repeat this on the bottom set of teeth.
• Use an interdental brush to clean in between teeth, if you are able to do this. Your dentist should be able to advise you on the best way.
• Encourage the person to spit out the toothpaste after brushing. They should not rinse with water or use mouthwash straightaway. This helps to keep fluoride on the surface of the teeth to protect them from decay.
• Use a toothpaste that doesn’t foam if the person with dementia has difficulty swallowing, or problems with choking. This may be easier and safer. Your dentist should be able to tell you where you can get this.

In some cultures, ‘chewing sticks’ may be used for maintaining a healthy mouth, ideally alongside regular brushing with toothpaste. If the person you are caring for likes to use them, try to support them to keep using them safely.

Dentists may sometimes prescribe a high-strength fluoride toothpaste, or a fluoride mouthwash. This can be helpful if a person has ongoing mouth problems or is struggling to brush their teeth.

The dentist can also apply a high-fluoride polish or varnish every three to four months to protect the teeth from decay, if necessary.

Support in the different stages of dementia

The abilities of a person with dementia will change over time. The speed of this change will vary greatly from person to person but in general it can be divided into early, middle and late stages. 

Early stage of dementia

While most people are still able to manage to brush their teeth themselves during the early stage of dementia, it can still be helpful to:

• Provide gentle reminders for a person who may forget to brush. 
• Stand near them if they need some guidance. Alternatively, if they live alone, set a reminder alarm or a note on a visible whiteboard, to prompt them to brush their teeth at a specific time. 
• Having a fixed routine in the morning and evening can help too.
• Make sure there is enough light and space in the bathroom so they can see what they’re doing.
• Buy a toothbrush that has a small head and is easy to grip, such as an electric toothbrush. The extra weight in these may also help to reduce hand and arm tremors.
• Ensure dental care is part of their care plan. If a home care worker is supporting the person as part of a visit, check that the care plan includes prompting them to brush their teeth at specific times.
• Encourage the person to do their own mouth care as much as possible until you think they might need more assistance.

Middle stage of dementia

Routines may need to change as dementia symptoms become more severe.

A person may become more forgetful, confused or anxious when they come to brush their teeth. This can make it difficult to carry out personal care or provide greater assistance with tasks. At this stage you may want to:

• Guide the person to the bathroom – it’s common for people with more advanced dementia to lose their way or become confused about where they need to go.
• Gently encourage the person to brush their teeth. If they don’t want to brush their teeth, then they are allowed to make that decision – just as anyone can. It may still be worth trying again later when they are more ready.
• Assist with brushing – depending on the person’s ability at this stage, you might only need to hand them the toothbrush and explain what they need to do, or you might need to brush their teeth for them. This can be difficult for both of you, and you may find your own way of doing this. 
• Consider using mouthwash – if the person becomes distressed with brushing their teeth, rinsing with mouthwash can help clear food particles from their mouth. Mouthwash isn’t a replacement for brushing but can be helpful at difficult times.

Later stage of dementia

During the later stage, a person will find it hard to do many things for themselves. This could include difficulty holding objects like a toothbrush, or difficulty moving around easily.

Memory, thinking and communication skills will be very limited and full-time care is usually put in place at this time. 

The condition of a person’s teeth and gums can often get worse during the later stage as it becomes harder to make sure their teeth are brushed regularly.

They may be less willing to do so themselves or become agitated when someone tries to help them. They are also much less likely to be able to tell someone that they are in pain.

Despite these challenges, it’s important to keep supporting the person’s mouth care as much as possible to prevent weight loss, dehydration, pain and infections. 

When a person gets to the end of their life, mouth care should focus on keeping the mouth clean, moist and comfortable. A nurse or professional carer can help with this, as well as helping with brushing.