Dental and mouth care

Oral health and dementia

As a person's dementia progresses, they can get more confused and struggle with daily tasks. This is because they may see things differently and have problems understanding what’s in front of them.

When it comes to oral health, a person with dementia can:

• forget their usual mouth care routine
• struggle to do practical tasks in the right order
• have difficulty holding a toothbrush
• misjudge distances, such as applying toothpaste onto a brush
• show no interest in mouth care, due to low mood, tiredness or apathy
• forget about dental appointments
• have trouble accepting dental treatment
• have difficulty communicating pain, discomfort, or distress.

These challenges will vary from person to person, and at different stages of their condition.

In general, as a person’s dementia symptoms get worse over time, they will need more support with their mouth care.

Common mouth care problems

Many people with dementia develop problems with their teeth and gums.

These need to be looked after properly to prevent them getting worse. If not, they can often lead to difficulties with chewing and swallowing. They can also be very painful.

Tooth decay

This is a common reason for losing teeth. The best way to prevent it is regular brushing with fluoride toothpaste and limiting sugary foods.

Tooth wear and damage

This can lead to the tooth becoming sensitive, causing pain when eating very hot, cold, sweet or sour foods.

Gum disease

This can cause the gum to become inflamed, making it red and sore. There are two main stages of gum disease – gingivitis and periodontitis.

Dry mouth

This can be uncomfortable and make it harder to speak, chew or swallow. When it’s severe, the surface of the tongue can be sore and cracked. It can also lead to fungal infections.

How to tell if a person with dementia has mouth care problems

Eating less

Problems with teeth or other parts of the mouth can make it difficult to eat properly. Over time, a person eating less than they need to loses weight and becomes malnourished.

If you are concerned, ask the person if they have any mouth pain or trouble swallowing. If they can’t understand your question, you can:

• use non-verbal gestures, such as pointing to your teeth
• observe them for signs of dental distress, such as wincing when brushing
• offer them softer, blended food to check their general appetite
• check their mouth for any unusual signs, such as swellings or bleeding.

If you have concerns, speak to a dentist.

A person who wears dentures can also have difficulty eating if their dentures aren’t fitted properly, or they are the wrong size for their mouth.

Identifying toothache and other mouth pain

In the later stage of dementia a person may have difficulty understanding their pain or asking for help.

This means they may not be able to tell when they have a toothache, or take steps to resolve it, such as taking painkillers or seeing a dentist.

It’s important to be on the lookout for signs of pain and distress, such as:

• struggling to eat food or refusing it (particularly hard foods or very hot or cold foods)
• frequently touching their face or mouth
• a swollen face
• leaving their dentures out
• becoming increasingly restless, moaning or shouting
• having disturbed sleep
• struggling to take part in daily activities
• refusing attempts to help them with their mouth care
• behaving aggressively (particularly towards you or someone else caring for them).

These changes in behaviour can be distressing. However, it’s important not to dismiss them as part of the person’s dementia.

It could be a sign that they are in pain and need help. If the person you are caring for is having any of these problems, check their mouth for signs of pain and arrange a visit to the dentist if necessary.

It can be useful to keep a note of when these signs first started, how long they’ve lasted for, and if painkillers have helped. This can help the dentist to identify the problem.

Mouth infections

Germs can get easily into the mouth. Most are harmless so long as the mouth is cleaned and rinsed regularly. However, when they get into a cavity or sore gums, they can cause a tooth infection.

A dental abscess is a pocket of bacteria and pus that forms inside the gums and can be very painful if it isn’t treated with antibiotics. A person with dementia may feel this pain and become very distressed yet struggle to tell others what the problem is.

If you are caring for a person who needs assistance with mouth care, it is important to check for any signs of infection.

You can check that the tongue, cheeks, gums and the roof of the mouth all look a normal, healthy colour.

Seek help from a dentist or a health professional if you see any of these signs:

• red, swollen or bleeding gums that last for more than a few days
• cracked, red, sore or crusty corners of the mouth
• swelling around the mouth
• red or creamy white patches anywhere in the mouth, particularly on the tongue. 

If the person wears dentures, check the area where they would normally fit.

Dry mouth

It can sometimes be difficult to know if a person with dementia has a dry mouth, especially if they have communication difficulties.

However, you may be able to see some of the signs during everyday mouth care, such as:

• dry and cracked lips
• a stickiness on the cheeks or tongue
• food debris in the mouth
• dried saliva on the tongue or palette
• red, sore or swollen gums around a denture, which can cause it to become loose.

A dry mouth can happen for a number of reasons:

• dehydration
• thrush in the mouth (a fungal infection)
• side effects of many medicines
• anxiety
• cancer therapies, such as radiotherapy or chemotherapy
• breathing more through the mouth than the nose, such as when congested or using oxygen therapy.

If a person has a dry mouth, first check to see if they are drinking normally and are well-hydrated. It’s common for people with dementia to not drink as much as they need to.

If dry mouth is being caused by a thrush infection, the person will have red and white patches in their mouth. It can cause an unpleasant taste and soreness.

It can normally be treated effectively with medication, which can either be bought from a pharmacist or prescribed by a GP.

If they are taking any medicines, check the leaflets that come with them to see if they can cause dry mouth as a side effect.

Certain medicines used to treat high blood pressure, overactive bladder, stomach problems, pain, allergies, or mental health problems can cause dry mouth – particularly when someone is taking more than one of them.

A GP or pharmacist may recommend switching to an alternative medicine if one is available.

Relieving a dry mouth

There are several ways that a person with dementia can reduce discomfort caused by dry mouth, including:

• sipping water frequently throughout the day to keep their mouth moist
• chewing sugar-free sweets or gum, if this is safe and comfortable
• using dry mouth products (a gel, liquid spray or lozenges) to help lubricate their mouth. These products can either be prescribed by a dentist or purchased from a high street pharmacy
• lip balm can make dry lips more comfortable.

Brushing teeth regularly helps to prevent the tooth decay that can speed up when there is much less saliva in the mouth.

If the person has memory problems, they may need to be reminded to do these things throughout the day.