Dementia

People with dementia can be at greater risk of poor oral health. This includes people with conditions such as Alzheimer's disease, Vascular dementia, Parkinson's disease, and Huntington's disease.

Managing oral health

People with dementia should have a plan for caring for the health of their mouth that is specific to their needs. It does not matter if a person has all their own teeth, only some of their own teeth or upper and lower full dentures, good oral hygiene is important for good health.

The dignity of a person with dementia should be respected and where possible, their normal routine should be followed. If it possible, people with dementia should continue to see their regular dentist for dental care as they are familiar with the dental practice and dentist. Dental specialists known as specialists in special needs dentistry are located in some states and territories and can provide specialised dental care to people with increased medical needs. 

 

Toothbrushing

People with dementia should continue to brush and floss their own teeth for as long as their ability to manually do so is not affected. If their ability to control a toothbrush to clean their teeth is affected, it is important for family members or carers to provide help to care for their teeth and gums. There are a range of techniques that a carer can use to brush a clients teeth. These techniques are based on a co-operative approach.

Chaining - The carer begins brushing the teeth and the person with dementia completes it.

Bridging - The person with dementia holds a toothbrush while the carer brushes the teeth with a separate brush. This aims to improve the sensory connection.

Hand over hand - The carer's hand is placed over the person with dementia's hand to guide the brush to clean the teeth together.

Yawning - Yawn facing the person with dementia and hopefully this will stimulate a yawn in return so the person will open their mouth for their teeth to be brushed.

Consider using a three-sided toothbrush when brushing, known as the Surround Three-Sided Toothbrush or the Collis Curve. An electric toothbrush should also be considered if it is able to be tolerated.

Denture care

If the person with dementia wears dentures, ensure that the dentures are removed from the mouth when brushing. Brush the dentures separately using soft hand soap and a separate toothbrush or a denture cleaning brush. If the person lives in an aged care or residential facility, write the person's name on their denture/s to ensure easy identification and store it in a safe location when not worn.

Medications effect on the mouth

Medications used to treat dementia can cause a decrease in the amount of saliva that is produced in the mouth. A decrease in saliva can cause a dry mouth. Saliva plays an important role in protecting teeth from tooth decay. Therefore, having a dry mouth can increase a person's risk of developing tooth decay. A lack of saliva can also make it difficult for dentures to stay in place and make them more uncomfortable to wear.

Diet

People with severe dementia may need to eat a soft or modified diet. Modified foods made in aged care can include a lot of refined carbohydrates, commonly sugars and processed grains. This can increase the risk of tooth decay developing especially if the person has poor oral hygiene and suffers from a dry mouth where there is a decreased amount of saliva, letting the food sit on the teeth for longer.

Choose water over other drink options throughout the day. Drinks such as fruit juice should be consumed with main meals rather than sipped on between meals. 

Aspiration pneumonia

Regular and thorough brushing and flossing of the teeth not only help to maintain good health but has also been associated with a decreased risk of elderly persons developing aspiration pneumonia. This is where bacteria from inside the mouth is breathed into the lungs causing pneumonia. This can result in severe disease or death but can be prevented with good oral hygiene daily. 

Visiting the dentist 

Where possible, people with dementia should continue to see their regular dentist for dental care as they are familiar with the dental practice and dentist.

When booking a dentist appointment:

• Request a morning appointment, especially if the person with dementia experiences sundowning.
• Ensure that the dental clinic and dentist are aware of the dementia diagnosis.
• Take a thorough medical history and list of medications to the dentist so they are fully informed of the patient's general health that may impact their oral health and dental treatment.

In some locations in Australia, specialist special needs dentists are available for persons with medical conditions that require special considerations.

Thanks to a partnership between the Australian Dental Association (ADA) and Dementia Australia, dentists are increasingly aware of the best ways to treat persons living with dementia. Education modules regarding caring for the oral health of people with dementia were created by the ADA and Dementia Australia