This Smile Month, the Oral Health Foundation will raise awareness of important health issues and ready to smile on everybody’s face.

Dementia and Good Oral Health

Good oral health is important for everyone’s health and wellbeing, but for people living with dementia, the risk is not only of higher rates of tooth decay and gum disease. Poor dental hygiene can also lead to heart disease, gingivitis, stroke, osteoporosis, and respiratory disease.

This is probably because as their dementia progresses, they find it difficult to perform their normal daily activities and need support to keep up with their oral hygiene routine. For others, it may be they are not able to express that they have a toothache and leave problems untreated.

It is essential for people living with dementia to establish a dental routine as soon as possible. A good dental routine will help to maintain oral health and wellbeing. This has the added benefit of self-esteem, body image, dignity, social interactions and nutrition.

If poor oral health is allowed to prevail, it can lead to pain, tooth loss, bad breath and can negatively affect the ability to eat, smile, laugh and even talk.

Medication

Individuals living with dementia may be taking medication, such as antidepressants, antipsychotics and sedatives.  These medications have dry mouth as a side effect, and saliva acts as a lubricant and cleans the mouth and teeth. This is a problem as a lack of saliva can increase the risk of dental problems, gum disease and cause infections. A dry mouth can also affect the fit of dentures, making them loose and cause sores.

Sugar and oral health

Sugar is one of the main culprits of tooth decay. If you are caring for someone with dementia, try to avoid too many sugary foods between meals. Tooth friendly foods and snacks include:

• vegetables
• bread with sugar-free spreads
• savoury crackers and cheese
• pitta bread with hummus or guacamole
• rice cakes or oatcakes
• fresh fruit
• plain yoghurt

Drinks that are labelled sugar-free may still be damaging to health if they are acidic. Water is the best drink to consume to avoid damaging teeth. Milk and unsweetened tea, and coffee are good to have in moderation.

Caring for teeth and gums

Frequency:

We should all clean our teeth twice a day. It may be difficult for a person living with dementia to remember to do this, and they may need help. They may be unable or be reluctant to do it themselves.

You can make brushing your teeth an activity you do together so that you can prompt them and help if needed. Cleaning our teeth is a complicated process with many steps, although we do most of them automatically. If you had a memory problem, you would struggle to remember all of them.

Where:

The bathroom is not the only choice for brushing teeth; you can encourage them to brush their teeth by doing it together with a basin on a table with you sitting side by side so you can mirror eat other. Often people with dementia worry they are doing things wrong because they keep forgetting how to do something; following your lead may make them feel more confident.

When:

You don’t have to do it last thing at night before bed or the first thing in the morning; you could do it after breakfast and after dinner.  Find a time when both of you are calm and have time to devote to the task.

Top tips:

If you can use fluoride toothpaste; however, if the person is likely to swallow the fluoride toothpaste, rather than spit it out, try brushing just with water or baking soda toothpaste.

Never force their mouth open, and do not pry their lips apart. If they don’t want to brush their teeth, take a break and try again later. It may be that the bristles are too rough on your loved one’s delicate gums; ask them if there is a problem.  If dental care at home is proving to be very difficult or extremely unpleasant for you both, make an appointment to see a dentist every two months for regular dental care.

Flossing

Flossing may actually be more important than brushing. Use a floss holder, Flexi-Picks, or Stim-u-dent, or use a tiny brush that can fit between teeth to clean the gums as well as the teeth. Again, try this sitting face to face so you can show them how you do it or stand behind them and very gently floss between their teeth if you are unsure of how to talk to your dentist about this first, as it can be daunting.

Brushing teeth

Break it down into sections and talk through, perhaps use a toothbrush with a larger handle for a better grip or an electric toothbrush, whatever works best for the individual.

• Place the head of the toothbrush against the teeth, then tilt the bristle tips to a 45-degree angle against the gum line. Move the brush in small circular movements, several times, on all the surfaces of every tooth.
• Brush the outer surfaces of each tooth, upper and lower, keeping the bristles angled against the gum line.
• Do this again, but on the inside surfaces of all your teeth. To clean the inside surfaces of your front teeth, tilt the brush vertically and make several small, circular strokes with the front part of the brush.
• Brush the biting surfaces of your teeth.
• Spit out after brushing and do not rinse so that the fluoride stays on the teeth longer.

For information about dentures and advice on finding a dentist, please contact admiral nurses at dementia UK here.