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toothbrushesProviding mouth care to the elderly who have dementia, brushing their teeth in particular, is often a challenging task for caregivers. Thanks to Rita Jablonoski, PhD who has 30+ years nursing home experience, we can explain a few things and offer some advice on the topic. If you have encountered someone who is resisting mouth care, even biting during it, this information should be helpful.

First, the best place to do mouth care is at a sink (bathroom is best, but even the kitchen sink will work) because the familiar setting will ease the anxiety being experienced by the person who has dementia. A mirror at eye level, whether the person is standing or sitting, is also helpful as it helps to reinforce self-care memories.

Second, smile a lot! This may sound overly simple, but the mouth care you are trying to give may seem threatening to someone with dementia. If you have a big smile on your face they may be less threatened. Also lower the pitch of your voice because this makes it easier for them to hear you (as we age, it is harder to hear the higher pitches.)

Allow them to do as much as possible. If you are afraid they aren’t doing a good enough job, however, you have a few options. You can guide their hand or pantomime the mouth care to guide them along. Try putting the toothpaste on the brush for them. It may also be helpful to just let them hold a toothbrush while you do the mouth care.

Some things to avoid include trying to reason with someone who has dementia as this will only increase the likelihood of their resistance. Instead, use simple one-step instructions, giving them time to process the request before you repeat it. Resist the urge to talk to them in a baby-talk manner using plural pronouns such as, “It’s time for us to brush our teeth.” This is called “elderspeak” and has been documented by nurse researchers as a guarantee for care resistance. It also raises dignity issues. People with dementia will forget many things, but they will not forget that they are an adult.

Try singing while performing mouth care if you meet with resistance. This will sometimes distract the person with dementia and if they sing along, you will have easier access to their teeth. Giving them something to hold on to such as a stuffed animal may provide comfort and help melt their resistance. Talking about their favorite things also serves to distract and relax someone with dementia. Sometimes getting creative works too. Rita describes an approach that worked for a lady in a wheelchair who clenched her teeth during mouth care. The staff tried sitting her in front of a mirror as they stood behind her, reaching around to do mouth care. This worked like a charm in her case as long as she could see herself in the mirror.

One more thing. Remember to use tepid water as gums recede as we age, making teeth especially sensitive to cold water. And make sure the toothbrush has soft bristles.

An alternative to brushing is flossing, but not with the typical waxed string. This flossing is done best with a small toothpick-like device called a proximal brush or interdentate stick. They can be used like toothpicks to go in between the teeth, and when dipped in mouthwash they are even better. After this type of flossing, tooth brushing may be met with less resistance. Rita recommends having the resident say “EEEEEEEEEEE” during this particular type of mouth care.
Rita admits that there is no sure way to get people with dementia to cooperate with a caregiver’s efforts to brush their teeth, but the advice she offers is to just keep trying. Her decades of experience has proven that eventually resistance will diminish with time.

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