Dental health

Appearance, eating, behaviour and general health and wellbeing can all be influenced by poor dental health. 1  This is of particular importance for people with dementia who are more susceptible to dental problems for several reasons, including the following: 2

  • Polypharmacy, long-term use of sugar based medications and medications that reduce saliva flow
  • Reduced saliva flow from other causes, as saliva prevents dental decay and other oral lesions
  • Changed eating habits, ie. More frequent meals, higher sugar intake.
  • Impaired ability to maintain own dental care 2

Because of these increased risk factors for poor dental heath, it is important that a preventative approach is established as soon as a person is diagnosed with dementia.  In addition, when a person with dementia enters permanent or long-term residential care, their oral health should be screened on admission and then regularly from then on, by a dental health professional. 2 Carers may also assess dental health using an established screening tool such as the Oral Health Assessment Tool, which allows general carers and health professionals to make an oral health assessment and determine if a visit to a dental health professional is required. 2, 3  Nevertheless, regular dental appointments are recommended regardless of presence or absence of any problems.

Oral hygiene care

It is important to brush all surfaces of the teeth and if possible, an electric toothbrush should be used. Some people with dementia have trouble brushing their teeth and can be helped by breaking the task down into smaller steps or allowing them to copy another person brushing their teeth. 1  Sometimes a person with dementia will require someone else to brush their teeth.

Denture care

The key to successful denture care is to keep them clean. Dentures should be removed and cleaned after each meal and should also be removed and soaked in water overnight with or without denture cleaning tablets.  It may be useful to place a face washer in the bottom of the sink to prevent breakage if they are dropped.  Partial dentures can increase risk of decay and can also damage tongue and oral tissue and be difficult to remove.  For these reasons, there may be a point at which these should be removed for prolonged times or not worn at all.  In the later stages of dementia, it may not be possible to wear dentures at all due to deterioration in oral muscle control. 1

Behavioural management techniques to facilitate dental care

One of the principal obstacles to achieving good dental care in people with dementia is resident behaviours such as refusing to open the mouth, not understanding directions, biting the toothbrush and aggressive responses.  There are several steps that can be taken to maximise cooperation by the person with dementia: 4

  • Develop a daily dental care routine in a quiet distraction free environment
  • Use short and simple directions, with one-step instructions
  • Also use non-verbal cues, such as facial expressions and gentle touch
  • Provide a diversion to occupy hands
  • Use dementia communication techniques

References and recommended reading

  1. Alzheimer’s Australia. (2005) Information Sheet 2.14 – Dental Care. Available online at www.alzheimers.org.au/upload/HS2.14.pdf
  2. Chalmers, J., & Pearson, A. (2005). Oral hygiene care for residents with dementia: A literature review. Journal of Advanced Nursing, 52, 410-419.
  3. Chalmers, J. M., King, P. L., Spencer, A. J., Wright, F. A. C., & Carter, K. D. (2005). The Oral Health Assessment Tool - validity and reliability. Australian Dental Journal, 50, 191-199
  4. Joanna Briggs Institute. (2004). Oral hygiene care for adults with dementia in residential aged care facilities. Joanna Briggs Institute: Best Practice Information Sheets, 8, 4.