FACT SHEET – Dental Services
Oral Health Care for people with Dementia
Information for Carers/HCA/Nurses
Warning: People with Dementia will be more at risk of dental pain
and less able to relay this to others.
We hope you will find some useful information in this
leaflet to help you provide good oral hygiene, as one of
the many aspects of caring within your nursing role.
Bad Oral Health could cause
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Behaviour problems
Medical complications (Aspiration Pneumonia)
Inability to eat
Speech and swallowing difficulties
Diet, nutrition and hydration problems
Weight changes
Social interaction
Mouthcare is an essential part of overall personal care as required by the Care
Quality Commission, and it needs your time and assistance.
Assess the level of oral hygiene and care required for the person
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Think of all the steps involved in brushing the teeth or cleaning a denture.
Ask to see them brush their own teeth or clean their own denture to assess
ability.
See where they require assistance and write their ability in detail in their care
plan. This could include: Independent: needs reminding and prompting/Needs
some assistance/Needs full assistance.
Break down the oral hygiene process to promote independence. This
assessment could lead to you encouraging independent toothbrushing/denture
cleaning but helping with the parts they are unable to perform adequately.
If full assistance is needed this may mean 2 people providing toothbrushing or
denture cleaning.
Ask relatives and friends about previous oral hygiene care and routines at home.
Communication
Verbal and non verbal communication may be the key in delivering oral health care
to others, especially when there may be problems with understanding.
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Approach from the front and move calmly while identifying yourself. Always
explain what you are going to do and expect the person to understand more than
they may be able to express. Have eye contact and bring yourself to the same
level as them. Move yourself slowly and calmly with the person if they move
away. Smile and use a gentle touch and try to avoid any stimulation in the
environment. Above all be patient, positive and reassuring and try to get them to
participate.
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To achieve the above use their sight and touch to help them to understand what
you are trying to do. Place the toothbrush in their hands (do not attempt this if
they have aggressive or inappropriate behavior.) Give them a few minutes
holding the brush which may prompt them to start brushing their own teeth. If not
then distract them by placing something familiar (a towel or photo) in their hands
while you brush the teeth. Familiar music played while oral hygiene is carried
out can also distract and relax the person. To help improve sensory awareness
place your hand over theirs and start to brush their teeth with them.
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If your attempts fail walk away and ask someone else to attempt the oral
hygiene. They may feel more cooperative with someone else brushing their
teeth. If no one else is available try again later at a different time and in a
different location.
Oral Health Care instructions
Bleeding Gums
This is caused by the daily build up of plaque which is not being
removed by brushing. Gums get inflamed, red, sore, and painful
and lead to the gums bleeding.
Action - The teeth should be brushed twice a day with a medium, small headed
toothbrush. When brushing, get right down on the gums to remove the plaque build
up and cover all areas of the teeth. If the gums bleed don’t be put off and gently
carry on removing the plaque which is causing the irritation.
Plaque
Plaque contains bacteria that cause tooth decay and gum disease.
In people with dementia this can lead to eating problems,
behavioural problems and medical complications including
aspiration pneumonia.
Action - Plaque is soft and sticky so when brushing remember this is what you are
removing. If not removed it will calcify and you will be unable to remove with
brushing.
Tooth Decay on roots of teeth
Due to the lack of oral hygiene and reduced production of saliva,
the exposed roots of teeth are more sustainable to decay.
Receding gums cause the enamel exposed to come under attack.
Action - When brushing use fluoride toothpaste which will toughen up the enamel.
The amount of fluoride in the toothpaste should be 1,450ppm fluoride. The amount
can be found on all toothpaste tubes. The dentist can prescribe toothpaste with
extra fluoride. Do not attempt to rinse the mouth after brushing. “Spit Don’t Rinse”
as this will keep the fluoride on the teeth.
Dry Mouth Xerostomia
This can be caused by medication, physical disability, mouth
breathing, dehydration, depression and radio therapy. It causes
the mouth to be very uncomfortable and makes it difficult to eat
and wear dentures.
Action - Talk to the doctor about the type of medication causing this. Give frequent
sips of cold water to moisten the mouth. Talk to the dentist/pharmacist about artificial
saliva/stimulants which will help ease the symptoms.
Lesions in the soft tissues of the mouth
This could be due to many causes including ulcers, ill fitting
dentures or cancer. The patient may have pain, and difficulty in
eating and wearing dentures.
Action - Any changes in the mouth must be noted down and any worries should be
reported to the doctor or dentist. A mouth ulcer that has been there for longer than 2
weeks should be certainly be reported to the dentist.
Monthly Oral Health Workshops for Nurses/HCA/Carers
For further information please contact:
Oral Health Promotion Team, Somerset Primary Care Dental Service
[email protected]
Tel: 01278 773180
Fax: 01278 772681
Dental Advice Line Tel: 03001237691
Dental Access Centres for the Somerset Primary Care Dental Service
www.sompar.nhs.uk/dental
If you would like to contact our Patient Advice and Liaison Service (PALS) please telephone 01278
432022 or email [email protected]
Headquarters:
Somerset Partnership NHS Foundation Trust
2nd Floor, Mallard Court, Express Park,
Bristol Road, Bridgwater TA6 4RN
Tel: 01278 432 000 Fax: 01278 432 099
Email: [email protected]
Web: www.sompar.nhs.uk
Date Issued: January 2016
Review Date: January 2018
Author: Somerset Primary Care Dental
Service
Ref: SS DENT FS005 v2