Performing oral health tasks for those with dementia or other cognitive impairment can be challenging and stressful for all parties. These tasks are important, but it is common to get resistance that may reduce the effectiveness of the procedure or make it seem impossible.
Here are some methods that can assist to make the process easier and improve compliance and participation.
Timing – Choose a convenient time of the day when the frail or elderly person is most receptive to participating in oral health care – after breakfast and after dinner may be appropriate times. Position the elderly person in the most suitable position for oral health care – seated with some head support is best.
After washing your hands, gather all the dental aids and products required (this may include, a penlight torch, toothbrush, toothpaste, lip balm, dry mouth gel, mouth rest and paper towel) and put on your Personal Protective Equipment (PPE) as per infection prevention and control guidelines – gown or apron, mask, protective eyewear and gloves.
Permission – Ask for permission and always explain to the person what you are going to do, and what you are doing for the person throughout the procedure.
Each person needs to be encouraged to do as much as they can themselves. Depending on their capacity, you might need to remind them to brush by showing them the toothbrush and toothpaste, put the toothpaste on the toothbrush for them and ask them to start brushing (known as chaining), or by letting the person brush their own teeth and then transitioning to you finishing with a more thorough clean.
However, if you are cleaning their teeth for them, be assured that a person’s mouth is like their arm or leg – it needs to be handled and lifted with care and purpose in a similar manner. Fortunately, a person’s mouth is robust as it uses strong muscles to eat food and to speak.
Access – For greater access and better visibility, a lip can be gently and slowly lifted (for the top lip) and moved down (for the bottom lip) by placing your thumb and index finger on each side of the lip. Similarly, a cheek can also be moved out for greater access and better visibility with your index finger or a foam rest.
Mouth Rests – A foam mouth rest can support the elderly person by allowing them to keep their mouth open whilst you are cleaning their teeth; a penlight torch can assist in assessing the health status of the mouth, teeth, tongue, gums and soft tissues; and the paper towel can be used to wipe away excess toothpaste or saliva.
After explaining that you are going to clean a person’s teeth and after putting on your Personal Protective Equipment (PPE), place the toothbrush with pea-sized amount of toothpaste on the person’s lips and then into their mouth. For information on toothbrushing, click here. Whilst brushing, it is important to have a good look at the teeth, gums, tongue, and soft tissues for any signs of dental decay, gum diseases, or an ulcer or a pressure sore
from dentures.
For people who are not fully cooperative, return at another time of the day and try using different behavioural strategies. For example, attempt to distract them with singing or music (distraction), place a toothbrush in the person’s own hand (known as bridging), place your hand over the person’s hand (hand-over-hand) or ask another person to do it instead of you.
Another technique is to place your hand(s) on the dominant side of the person’s body – you can start at the hand, then their arm, elbow, shoulder, side of the face and lower jaw to assist in sending a message to the person that you will be touching their mouth and cleaning their teeth.
- Tell the person that you are about to clean their teeth and get permission.
- Place brush on lips first
- Lift lips to access
- Pull cheek to side
- Try a mouth prop to help with access
- Give person a toothbrush to hold as a means of distraction, or participation