Having helped to care for my own Mum for over 6 years, living with Vascular Dementia I experienced, first-hand, some of the challenges of delivering effective oral care to someone living with dementia. It is proven that they are more likely to resist tooth brushing and that this is often a response to fear or a previous bad experience.
Dementia UK have also recently published research supporting the fact that that people living with dementia have a higher rate of tooth decay and gum disease, and this can be because they find it difficult to perform normal daily activities, or are unable to express that they have a toothache.
I am sharing a blog which includes some of the strategies that helped me with my Mum, and also to answer the question that many care home customers asked me, how can I improve oral care for my residents with dementia? I hope this is helpful and will be useful to others too.
Our top 10 coping strategies to help you to improve oral care for your residents with a Dementia
One of the biggest challenges we know you face, because it is one of the most frequently asked questions we get asked regarding oral care is:
How Can I Deliver More Effective Oral Care For My Residents With A Dementia?
It is fact that your residents with a Dementia are most likely to present your care staff with the greatest challenges regarding delivering effective oral care, as they are more likely to resist tooth brushing. This is often a response to fear or a previous bad experience.
And with the number of people with a Dementia who have their own teeth expected to rise significantly, if oral care is not carried out, a vicious circle of pain and discomfort, leading to increased resistance becomes likely.
Those people who have advanced Dementia may not be able to verbally communicate pain and discomfort in their mouths, and this may manifest itself in other ways such as crying, pulling or hitting their faces, hitting out at care staff or being very passive.
To compound this, many carers have little or no experience of training in delivering good oral care and there is a lack of good quality, safe and fit for propose oral care product solutions available on the market.
The Important Thing To Remember Is That As With All Other Aspects Of Care, There Is No Standard One Size Fits All Solution.
A good oral health plan, in 3 stages, should be created for each resident which is specific to their own individual needs.
On admission a risk assessment should be completed to ascertain the oral health needs of your resident.
A care plan should be created from the findings of the risk assessment.
The care plan should be followed and documented at regular intervals dependant on the findings of the risk assessment, and both should be reviewed at least every 12 months.
Always Encourage Independent Brushing Where Possible
Always try to encourage your residents to brush their teeth for themselves for as long as they are able to do so, to promote their independence and dignity for as long as possible.
Sometimes, residents will forget that they need to brush their teeth, and a reminder to brush is all that is needed.
Some residents may be able to brush their teeth, when prompted, with some assistance. Try using the Chaining or the Bridging methods to help support your resident to brush their teeth themselves.
The Chaining Method – Place your hand over your resident’s hand and guide them as they brush.
The Bridging Method – Standing in front of the resident, brush your own teeth so that they can copy and follow your actions.
For Residents Who Are Non-Compliant With Tooth Brushing.
If you have residents who refuse to brush or have their teeth brushed, try to understand this behaviour as a sign of distress rather than thinking that the resident is choosing to be aggressive and uncooperative. Remember, this is often a response to fear or a previous bad experience.
We do need to respect peoples’ decision should they decline from wanting their teeth brushed, however, it is important to remember that oral hygiene is part of personal care and that brushing is not just dismissed because your resident has declined to have their teeth brushed at that time and in that place.
Think About How You Would Feel If You Weren’t Able Brush Your Teeth For 2 Weeks
If you clean your teeth twice a day with a brush and paste, then that’s the minimum attention you should give your resident.
Then Think About How You Would Feel If You Were Reliant Upon Someone Else To Brush Your Teeth For You
- Be flexible - try prompting oral care at different times of the day and in a place where your resident feels comfortable, it doesn’t have to be in the bathroom!
- Review the tools and products being used, are they appropriate for your resident? Look at the size of toothbrush head and strength of bristles, too big? Too hard? Small, soft headed toothbrushes are recommended, such as our Tepe Special Compact Toothbrush.
- Use an SLS free (non-foaming) toothpaste,this has a tremendous benefit to your residents who have to have mouth care delivered by a carer as it will greatly reduce the risk and fear of aspiration and also take away any potential choking and gagging risk. It also allows carers to see if there are any problems in the mouth.
- It is important NOT to wet the tooth brush as this will avoid unnecessary liquid in the mouth, and only use a pea size amount of paste, as, again, this will greatly reduce the risk and fear of aspiration and also take away any potential choking and gagging risk.
- Always approach your resident to assist them with their oral care either from the side or at the front of them and always at their level. Try using the Chaining or the Bridging methods to help support your resident to brush their teeth them selves
- Talk to your resident calmly and kindly, and tell them what you are doing throughout the care to help build their trust and confidence.
- Consider also, carer preference, if there is a particular carer that your resident enjoys a good rapport with, there will most likely be able to achieve a more positive outcome.
- Think about introducing a system of brushing, eg always start brushing from left to right so that you can monitor which teeth have been brushed if you have to split mouth care into short bursts.
- Record oral care in care plans including refusal, so that it is documented that you have attempted to deliver that care, but it is your residents’ choice not to have it.
- Remember that any changes in oral care that are currently being delivered need to be managed in small steps to allow your resident to get used to new ways. Small introductions of change will enable you to gauge how well things are working and how well your resident is responding to and is compliant with new introductions, workings and tools.
And finally, and above all, always remember that you are dealing with one of the most intimate areas of your resident’s body which is used for lots of lovely things, eating, talking and kissing.
When delivering oral care - ‘Look beyond the illness and reach out to the person who needs to feel secure, respected and cherished’.