Maintaining good dental hygiene for people with dementia can be difficult, but it’s important to make it a part of your daily care routine. According to the Alzheimer’s Association, prevention will be the goal of dental care in the early stages of dementia because unfortunately, the condition can get worse over time. Poor oral hygiene can negatively affect a person’s behavior, or his or her ability to eat and maintain good nutrition. It can also lead to tooth decay and gum disease. If you are caring for someone with dementia, here are some things to keep in mind.

Are there special dental hygiene issues for people with dementia?

Dental care for dementia patients is especially important because of the unique conditions that typically affect these individuals. For example, people with dementia may take prescription medications, some of which may cause a “dry mouth” side effect, according to the Alzheimer’s Society. Saliva acts as a natural lubricant to help clean the teeth and mouth; when there is not enough saliva, plaque can build, leading to gum disease, infection, and decay.

Add to this a reduced ability to adequately maintain self-care and routine professional dental hygiene appointments, and it’s easy to see how minor dental conditions can turn into major health problems over time. According to the Family Caregiver Alliance, poor dental hygiene has been linked to heart disease, stroke, osteoporosis, and respiratory disease.

Are there tips for dental care for natural teeth?

If your loved one still has natural teeth, your most important dental hygiene task is keeping the teeth clean and free of tartar.

Try these tips from the Family Caregiver Alliance to make it easier:

  • As dementia progresses, the steps for dental care are easily forgotten. Sometimes, modeling the behavior or placing your hand over the patient’s hand and guiding them through the process can help.
  • Don’t be rigid about timing. Even though first thing in the morning and last thing at night is optimal, it’s OK to practice dental care whenever your loved one is calm and cooperative during the day. You can also be flexible about location—sometimes a basin at the kitchen table is the most practical place. Make it easy for your loved one to use a toothbrush. Try a large-handled one, or even stick the handle through a hole in a tennis ball to give him or her something easier to grasp.
  • Use flossing tools such as a floss holder or tiny brush to clean between the teeth as part of your dental care.
  • If your loved one has a tendency to swallow toothpaste or mouthwash, look for types that are safe to swallow, or switch to a homemade paste of baking soda and water. Anti-plaque mouthwashes can be an occasional alternative to tooth-brushing in difficult situations.
  • Never pry your loved one’s mouth open or force an implement into his mouth; take a break and try another time. If the toothbrush irritates his mouth and gums, use cotton swabs or a finger wrapped in gauze to clean the teeth. If home dental hygiene is especially challenging, schedule more frequent visits for professional dental care.
  • If you are having trouble brushing your loved one’s teeth, try standing behind her. This is a more natural position for you and may help you do a more thorough job. This also works for flossing.

What dental care is needed for dentures?

As dementia progresses, it may not be possible for your loved one to tolerate dentures, but they should be worn as long as possible to help maintain self-esteem and dignity, and to encourage clear communication and proper nutrition.

If your loved one wears dentures, remember these tips from Alzheimer’s Australia for dental care:

  • Try to rinse dentures after every meal and scrub them with a denture brush.
  • Dentures should be removed at bedtime and soaked overnight. A denture cleaning tablet or strong physical cleaning is needed at least once a day.
  • You can have dentures cleaned professionally to remove any stains and bacteria.
  • It’s always a good idea to have the dentures of a dementia patient marked for identification, especially if you use respite care. If dentures are lost or misplaced, it can be very difficult to get replacements because the patient may be unable to cooperate with the dentist during the process. If they are gone for any length of time, the patient may forget how to wear them or even refuse the new set. According to the Alzheimer’s Society, new dentures should be permanently marked during their manufacture, and existing dentures can be temporarily marked using a simple technique that lasts 6-12 months.
  • According to the American Dental Association, your dentures might not fit correctly over time, so you may want to have a dentist check your loved one periodically to make sure the dentures fit well. Poorly fitting dentures are not only uncomfortable, but can interfere with eating – which, in turn, can affect nutrition.

How can I tell if someone with dementia is having dental problems?

Sometimes, a person with dementia may be unable to communicate pain or discomfort in his or her mouth. According to the Alzheimer’s Society, here are some signs that there is a dental care problem:

  • Refusing food, especially hot, cold, or hard foods
  • Pulling at the face or mouth
  • Refusing to wear dentures that were previously tolerated
  • Restlessness, moaning, disturbed sleep
  • Flinching while having her face washed or when being shaved if the patient is a male
  • Aggression or irritation

If you notice these symptoms, consult with your doctor to help identify the cause, or seek professional dental care with a provider familiar with dementia patients.

Are there other things I should do to help with routine dental care?

In addition to practicing good dental hygiene and getting regular professional dental care, you can take other steps at home to help promote healthy teeth and gums. According to Alzheimer’s Australia, you can monitor the person’s sugar intake, and encourage your loved one to drink plenty of water to help rinse the mouth and keep it moist. According to the American Dental Association, eating cheese may provide natural protection against the acids that cause decay and help rebuild tooth enamel.

Does Medicare cover dental care?

Original Medicare has limited dental coverage. However, if the patient has a Medicare Advantage plan, routine dental care may be covered, depending on the plan. Medicare Advantage plans are an alternative way to receive your Original Medicare benefits (except for hospice care, which Part A still provides), along with possible additional benefits, like routine vision and dental care, depending on the plan. Please remember that not all Medicare Advantage plans are the same and you should check with the patient’s particular plan coverage.