The Caregiver’s Guide to Dental Health

Many older adults can care for their own mouths on a daily basis but may still benefit from your support. In these cases, here are some ways you can support their mouth care routine:

• Ask them to tell you about their daily mouth care routine.
• Talk with them about the importance of a healthy mouth. Let them know that an unhealthy mouth can make other health problems worse.
• Help them set up and maintain a schedule for brushing twice and flossing once a day. Check that they have an easy-to-handle toothbrush with no frayed bristles, as well as floss or picks they can manage. A powered toothbrush may be easier for some people to use because they can be easier to hold and do some of the work for you.
• Make sure they are using a fluoride toothpaste.
• Using fluoride or antiplaque mouth rinse daily may provide additional protection from bacteria for their teeth and gums
• Get them a two-minute timer to help them brush for the right amount of time.
• Offer to make dental appointments for the person and to drive him or her to the dentist. If the person goes alone, ask about any advice the dentist gave and help him or her act on it.

Still, keep an eye on your loved one and his ability to care for his mouth. “It really is important to get every side of every tooth,” Dr. Jones says. “If your loved one is no longer capable of taking care of his teeth then develop a routine where you can help do it for them.”

Adults who are unable or unwilling to care for their mouths may need your help. Until you get comfortable with each other, be patient. Always treat the person compassionately, as you would want to be treated.

Being efficient and effective is the name of the game. “When brushing someone else’s teeth, I recommend a soft toothbrush,” Dr. Jones says. “If somebody has three teeth it might only take 30 seconds to brush those teeth.  However, additional time will be need to brush their partials or dentures.”

For cleaning between their teeth, picks or pre-threaded flossers can help. If you find those or other interdental cleaners too difficult to use, a water flosser may help because it won’t require you putting your hands in your loved one’s mouth.

Here are a few tips to get started:

• Before you begin, prepare the work area. Make sure the lighting is good and have a flashlight in case you need it to see into the mouth.
• Have the person sit up in a straight-backed chair and drape a towel over their chest to protect their clothing.
• Make sure you and your loved one are in comfortable positions. For some, it’s easiest to have the person seated in front of a mirror with you working from behind or on the side.
• Hold their chin gently with one hand, and show them the brush, floss or toothpaste you are using with your other hand.
• Explain what you’re going to do and make it enjoyable. Play music, tell jokes or get inventive to make to make the time caring for their mouth fly by.

You may also need to be flexible if your loved one resists. Try a different time of day and point out that mouth care will help their smile look and feel better. “Sometimes the traditional times are not the best times to get it done,” she says. “If it’s difficult brushing during more traditional morning and night times, then try it after lunch but before their afternoon nap.”

If your loved one continues to resist brushing, it may be because they are experiencing pain or have a dental need. See if they can communicate the issue to you. If not, call the dentist to explain the situation and see if an appointment is needed.

Dentures, whether partial or full, need to come out every day and be cleaned morning and night. “Scrub them carefully at night and store in a cup of water or an ADA-Accepted denture cleanser,” Dr. Jones says. “Rinse the denture before putting them back in every morning.”

And make sure any dentures come out before your loved one falls asleep – even during a nap. “Dentures may dislodge and may cause choking,” Dr. Jones says. “To be safe, always take them out before bed times or nap times.”

When you’re caring for someone who is confined to bed, they may have so many health problems that it’s easy to forget about oral health. However, it’s still very important because bacteria from the mouth can be inhaled into the lungs and cause pneumonia. And it's not just elderly patients who are at risk. A study published in the American Journal of Infection Control found that younger patients made up half of hospital-acquired pneumonia cases.

Learn more about preventing hospital-acquired pneumonia in this video from the U.S. Department of Veterans Affairs.

A June 2015 study found that 1 in 4 caregivers caring for someone 50 or older is doing so because that person has Alzheimer’s, dementia or other memory disorders. This can make dental care even more challenging, but don’t give up. “Like everybody else, people with dementia need to get their teeth brushed every day, twice a day,” Dr. Jones says. “Good dental hygiene is even more important for people with dementia because they often cannot communicate when there is a problem. Engaging in daily care can help avoid trouble as well as identify potential problems early when they are easier to treat.”

If possible, take care of any potential dental needs in the early stages of the disease when the person can cooperate with dental care. “This can be a time where you and your loved one can discuss their needs with the dentist or take x-rays, if necessary,” she says. “It is also a time for the family member or caregiver to establish a relationship with the dentist who knows their loved one’s dental history and can act as a resource later on.”

Nearly 8 million people reside in long-term care facilities, according to the CDC. By law, these facilities must provide routine and emergency dental care. Still, don’t forget to ask about the dental care they provide. Find out if there’s a dentist on site, or if your loved one will have to travel to the dentist for regular checkups. Ask who provides daily dental hygiene care, if they’ve been properly trained and make sure they’re doing it twice a day.

If your loved one has any special dental needs, let the staff know – and don’t be afraid to state the obvious. If he has dentures, point it out to make sure those are also being cleaned and cared for. It may also help to make sure his case is labeled with his name.

If you’re told your loved one is having difficulty with dental care, work with the care staff to find a way to make it happen. “If your loved one is resisting or is having difficulty during tooth brushing in the advanced stages of dementia. Try different flavors of toothpaste to encourage cooperation, or use warm water to see if it makes a difference,” she says. “In denture patients the gum and mouth tissue may be sore and fragile, so wipe the mouth with a soft cloth dipped in water.”