Dementia and Oral Health: How to Help Sufferers Care for Their Teeth
Dental care and oral health can be hard for dementia patients. These tips are designed to help caregivers deliver efficient and successful oral care.
Image by Vinoth Chandar on Flickr.
We are currently living through the most sophisticated and advanced medical age in existence. Our doctors and scientists have eradicated diseases and developed treatments which allow sick people to live for much longer than was ever thought possible. Yet, there is still much work to be done. Every year, millions of people die from cancer, AIDS, diabetes, coronary disease, and respiratory infection. And millions more are diagnosed with dementia.
This simple unassuming word continues to destroy families all across America and all across the world. At present, there are more than one hundred known varieties of dementia. The most common and widely discussed is Alzheimer’s disease, but there is also vascular dementia (resulting from a stroke), fronto-temporal lobe dementia, Korsakoff’s syndrome, DLB (dementia with Lewy bodies), and many more.
While some truly huge scientific breakthroughs have been made in recent years, we are yet to find a cure for dementia. It is a serious degenerative illness which affects the function of the brain and, particularly, the memory. It may start and progress slowly, but eventually, the condition begins to degrade identity and erase even the most basic motor skills. It is a quietly devastating disease and it puts a huge strain on family members and caregivers.
The Importance of Physical Health
While dementia is in its early stages, it is possible for a spouse, child, or other relative to independently care for the sufferer. This usually involves moving in to the same house and remaining close by to help with everyday tasks. A range of different support options can be sought and most carers choose to alleviate the strain on their own lives by relying on nurses and domestic assistants.
As the condition progresses, the sufferer will find it increasingly difficult to not just physically perform everyday duties, but also to understand why they are necessary. At this point, it is very important for the caregiver to step in and provide sustained support. Without help, physical health deteriorates very quickly. The person with dementia will find it hard to remember basic tasks like eating, showering, dressing, and brushing their teeth.
They are likely to get confused if you ask them to perform these tasks, because they no longer relate them to their own health or physical wellbeing. Wherever possible, a caregiver must take steps to make sure that essential duties are carried out. This is particularly important when it comes to oral health, because dental problems can lead to serious illness if left untreated. It can be very tricky to persuade dementia sufferers to brush their teeth, but a suitable routine or method must be found.
The Emotional Trauma of Dementia
Ultimately, every case of dementia is unique. Each patient or sufferer presents symptoms in their own way and struggles with different aspects of life. For some, the condition progresses very slowly and it may take a long time for the brain to degenerate to a point at which tasks become difficult. For others, the rate of cognitive deterioration is much faster. During the final stages of dementia, most sufferers do require round the clock care.
This is usually provided by a dedicated nursing team, in a specially designed ward or respite centre. If you know or care for somebody who has dementia and are finding it hard to cope, do not hesitate to seek help from the many support services available. There is no shame or failure in needing help from an outside source, especially when caring for a person with late stage dementia. You need to be healthy and emotionally fit if you are to provide care, so do not neglect your own wellbeing.
It is difficult to adequately describe the strain of care, because it is not easy for anybody to imagine the loss of a spouse, friend, or relative while their physical presence is still here. Late stage dementia is characterised by verbal and physical aggression. This can be extremely shocking, because the sufferer will be unable to recognise or identify the true source of their anger. This means that physical and verbal attacks may be directed at you, the caregiver, even if you have always had a very good relationship with the patient.
Putting Together an Oral Health Strategy
As aforementioned, oral health and hygiene is one of the most important aspects of physical wellbeing for dementia sufferers. It also happens to be one of the most easily disregarded. For a caregiver, the physical and emotional strain of trying to persuade a person that they need to brush their teeth is tough. It is natural to want to avoid it completely or to eventually give up, in exchange for cooperation with another task.
However, dental health must be maintained. If you cannot achieve this, it is important to seek the help of a qualified medical nurse. If you do feel comfortable attempting to implement an oral health routine, make sure that it is consistent and as stress free as possible. Sometimes, this simply will not happen, but the best course of action is to avoid shouting, keep movements relaxed and slow, and defuse aggression with gentle responses.
Try to carry out brushing routines at the same time every day. Even if the person struggles with telling the time or keeping to a schedule, a consistent routine is likely to put them at ease. Where possible, avoid raising your voice or giving orders which are too aggressive or overly firm. As aforementioned, the goal is to keep the situation as relaxed as possible. If the atmosphere is negative, the dementia sufferer will pick up on it and start to worry.
The next section will offer some handy hints and tips for encouraging a dementia sufferer to brush their teeth.
Always Brush at the Same Sink
If it is easier for you both to stand around the kitchen sink and brush, there is nothing wrong with taking the routine outside of the bathroom. However, you are advised to maintain this method. Try to avoid switching from sink to sink. If you brush in the kitchen, stay in the kitchen. You must keep as much of the routine consistent as possible.
Use a Mirror to Stimulate Recognition
Even in the later stages of dementia, patients will have days when they recognise their carer, their environment, and themselves. Do not shy away from the visual triggers and clues which could help to stimulate these memories. There will be times when confusion and frustration lead to anger, but the responses are valuable. When brushing, stand or sit the person in front of a mirror so that they can see their own face. This will help them find their mouth, keep the toothbrush in place, and associate their movements with their body.
Smile as Often as Possible
This might feel unnatural, but it will go a long way towards keeping a dementia sufferer feeling comfortable and relaxed. As the brain functions deteriorate, it becomes harder for patients to distinguish between the different facial expressions. Even a neutral expression can be mistaken for a frown and the person may respond with stress or anger. To avoid this, keep your facial expressions relaxed, speak gently, and smile to put them at ease.
Allow the Patient to Brush Independently
This piece of advice will be difficult to follow at first. If you are not a medical caregiver, it will take lots of practice, patience, and experience to find the right balance between direct assistance and essential independence. It is vital, even for late stage dementia sufferers, to be given the opportunity to function as normally as they can. While this will clearly be difficult most of the time, forcing a person to accept help if they are keen to try something for themselves will only cause more stress. Before stepping in and brushing their teeth for them, try giving basic instructions or performing a simple demonstration to jog the memory.
Use Tepid Water for Rinsing
As the gums age, they recede and the teeth are left vulnerable to extreme changes in temperature. To prevent nasty shocks, use tepid water to rinse teeth after brushing. If the water is too cold and causes pain, the dementia sufferer may resistant or become upset. Also, make sure that the toothbrush you use is not too firm. It is best to steer clear of electric brushes as the noise can be confusing.
Try a Little Distraction
If you have tried all of the above techniques and are still struggling to convince a patient to clean their teeth, a little distraction may be in order. Once again, the key is to keep things relaxed and casual. You do not have to make them entirely forget that they are brushing their teeth, but introduce something which makes the process fun or more interesting. Over the years, studies have demonstrated the remarkable impact of music on dementia. Even in the late stages of the illness, many sufferers remember their favourite tunes and light up when they are played. This technique is definitely worth a try if you keep encountering resistance when it comes time to brush.
Forget the Baby Talk
One thing which medical professionals are keen to remind caregivers of is the fact that their charges still recognise themselves as adults. The brain may be functioning erratically, but it is rare for a person to revert back to childhood. In fact, dementia is so frightening precisely because sufferers are adults trapped in a disordered world. They know that they are adults and it is hard for them to be talked to in simple, babyish tones. To avoid conflict and aggression, try not to confuse basic instructions with baby talk. When brushing, be direct and use easy to understand language, but do not revert to a ‘sing song’ tone.
Keep an Eye on Oral Health
You might find it tricky to keep tabs on the oral health of a dementia sufferer. Even if you watch them closely whilst they brush their teeth, it may be hard to spot problems quickly. The best way to approach this is with vigilance. If you can recognise the early signs of a dental problem, you are more likely to catch and treat it before it becomes a serious issue. For instance, keep a weather eye out for unusual habits like lopsided eating. If the person is consistently eating with only one side of their mouth, they may be in pain or struggling with sensitivity. If they start to pick, play, or pull at the insides of their mouth, there could be an ache.
Investigate Problems Gently
If you do suspect that there might be a dental problem, approach the situation gently. Do not try to open their mouth or manipulate their face without permission, as this will only cause anger and aggression. Once you do have permission, perform a visual inspection. Ask the dementia sufferer to describe the type of pain and its location. In the event that you cannot persuade them to let you look, go ahead and book a dental appoint anyway. It is always better to be safe than sorry.
Later Stage Brushing and Care
If you continue to handle primary care duties by yourself, even once the dementia has progressed to its later stages, you may eventually need to take full responsibility for brushing. The best way to do this is to sit the person in a comfortable chair and wait until they are relaxed and feeling safe. Then, stand behind them (make it clear that you are going to do this first) and cradle their head with one hand. Brush their teeth with the other hand. It is okay to do this with a dry brush if it prevents mess and fuss.
How to Handle Trips to the Dentist
Like most people, you probably dread having to visit the dentist. However, this strain is bound to be amplified if you are accompanying somebody with dementia. The duty is tough at the best of times, so you must prepare for potential resistance and even aggression. Nevertheless, regular dental appointments are essential for the maintenance of good oral health.
The relationship between caregiver and dentist can make a huge difference in this situation. If the dental specialist is aware of the unique needs of the patient before a check-up takes place, they can implement suitable measures and strategies. It may even be possible, with a little pre-planning, to arrange for an appointment to take place outside of regular hours.
This is useful because there would be no other people around, less noise, less movement, and less pressure on the dentist to rush through the appointment and on to the next patient. You must, however, discuss this with the surgery and the dental specialist first. It is likely to require a special agreement from the dentist to work a longer shift, so always be polite and appreciative if it does not work out.
It is also a good idea to sign up to a reliable dental membership plan. That way, you do not have to worry about running up huge expenses. You can focus your attention on the appointments and treatments themselves, rather than being unnecessarily concerned about dental rates and prices. In some cases, it is possible to take out a family scheme. This saves money, keeps payments simple, and makes sure that there will no unexpected surprises.
Tips for Dentists and Dental Hygienists
Now, it is time to look at the situation from the perspective of a dentist or a dental hygienist. If this is your everyday life and career, and you are asked to treat a patient with dementia, what is the best way to approach dental care? How do you make sure that essential checks are carried out with the minimum of fuss and stress? Well, as already described, the best possible course of action is not reaction but preparation.
This does, of course, depend on the reliability of the caregiver and their willingness to discuss the needs of their charge with you before a scheduled appointment. If a caregiver does come to you to talk about potential options for care, ask as many questions as you can about the patient. If you need to, make notes on what they prefer to be called, any topics to be avoided, how best to physically approach them, and any techniques or strategies which might help them to relax and cooperate.
You must do your best to avoid growing visibly frustrated or annoyed with the patient, no matter how stubbornly they may behave. You will only end up making the situation tenser. If you grow worried or unsure about how to treat the dementia sufferer, turn to the caregiver for advice. Keep your voice relaxed, avoid shouting, and remain calm whatever happens. The environment should feel safe and not cause unnecessary stress.
You can use some or all of the following techniques to improve the efficiency of dental care for patient with dementia.
Check for Aspiration Issues
Before you begin with procedures, make sure that the patient does not have any kind of special aspiration requirements. If there are issues, avoid the use of standard toothpastes. The caregiver should also be advised to steer clear of conventional varieties. Instead, an alcohol free CHX is a good alternative. For older patients, however, CHX can be too strong for prolonged use, so after 6-8 months, recommend switching to an OTC mouth rinse.
Use an Interdental Brush Head
If the standard brushing motion is intensely disliked by the patient, or the teeth are a little too sensitive for it, it is worth trying an interdental brush head. These devices are much thinner than regular toothbrushes, so they can be used to eliminate debris and bits of food without the need for vigorous or aggressive movements. They can offer dentists and caregivers a way to bush more delicately.
Describe Movements Out Loud
One of the easiest ways to make sure that a dementia sufferer is not given an unintentional shock or scare is to make a habit of describing physical movements out loud as you make them. This is especially important when you start to get close to their mouth. Talk them through the process, by explaining what you are doing and why. It does not matter if they do not fully understand you, because the aim is simply to avoid surprises.
Treat Sedation as a Final Resort
You can, of course, consider sedation for patients who put up too much resistance for dental care to be delivered safely. However, this should always be treated as a final resort. The vast majority of dementia sufferers will already be taking medication to regulate or control their symptoms. As their physical and mental condition may be very complex, sedation should only be considered once you have seen a full rundown of every prescribed medication.
Always Remember to Smile
The power of a smile can work wonders, but if anybody knows this, it is a dentist. If there is one thing dental specialists are used to doing, it is smiling to put nervous patients at ease. The same rules apply to patients with dementia, so maintain the cheer and diffuse the tension with a positive mental attitude. Always remember that your job is to provide care; you are there to provide an essential service and the vast majority of people will be happy with your approach.