Teeth and Mouth

Sadly, not all care homes can be relied upon to clean teeth, especially if there are genuine difficulties in doing so (see below). If they say your loved one refuses to have their teeth brushed but you find no such difficulty, then it may be that your loved one trusts you more but it may be that a poor care home isn't bothering to do it. Old folk generally welcome having their teeth brushed, because they know how important it is.

Your loved one may be able to brush their own teeth if you put the toothpaste on - in which case it's a good idea for them to do this even if they miss bits (such as the back of the teeth or one side of their mouth). You can then remind them to do the missed bits or offer to help finish off. It's important to keep up skills they have, and will also make it seem less intrusive than you doing the whole thing from the start. Hold up a mirror if it helps them see where they're going. You may be able to remind them how to brush their teeth by miming the brushing action for them to copy.

If someone with dementia brushes their own teeth at home and keeps their toothbrush in the bathroom then it's best not to move it elsewhere as that will confuse them and remove the trigger for them to brush. Other than that, toothbrushes etc shouldn't be kept in a room with a toilet, as when the toilet is flushed invisible aerosol droplets could reach the brush. Especially in times of something infectious going round it's in any case best to put the lid down before flushing and wait a minute after flushing before lifting it again (but don't forget to lift it!).

Biting down on the toothbrush can be a problem when brushing someone's teeth when they have dementia. If this is the case then the first thing to consider is whether they also bite down on a spoon when being fed - it may be that they don't understand what to do and they treat it as food. In this case you could try asking them to say 'aah' and keep their mouth open wide like they're at a dentist, or say you need to see their teeth so you can brush them and keep them healthy.

Alternatively it may be that they're trying to stop the brush moving because they don't like the feel, there's too much toothpaste froth or taste, they're worried about how far in it's going, or there's a particular spot that's hurting or sensitive.

Whilst an electric toothbrush cleans better than a manual one, if they don't like the vibration or noise then it may be best to switch to a small, soft manual brush, such as one designed for 0-3 year olds.

You could also try OraNurse Unflavoured non-foaming toothpaste if they don't bite the brush when it doesn't have toothpaste on (available online but use a reputable supplier).

Use a finger guard

It's very important to avoid anything hard and with a small width such as a toothbrush handle being bitten on, as old teeth may break. To keep teeth open enough to brush the top and the back of the teeth we highly recommend a finger guard such as the Bedi Shield or Dent-O-Care Dental Shield. These can be a little hard to find, but the Bedi Shield is available on the AlzProducts website, or you may be able to get one from a dentist. (We don't receive any money for mentioning this shop.) Note that many different items also get called dental shields, so make sure you get this finger guard design. Place it on one side of the mouth, not on the thin front teeth, and switch sides when necessary.

Whilst these are hard plastic in order to be cleanable and last a long time, they're not solid and are wider than a toothbrush handle, and being taller are less likely to prompt hard biting on them. It goes on your finger on one hand to hold the teeth open while you use a toothbrush with the other hand, and as they're slightly tapered they can be removed without difficulty even if the person is biting on them (but make sure they won't bite their tongue as it's removed).

In terms of other products, it's worth noting that the Dent-O-Care Mouth Rest is a single-use item intended for dentists, as the stiff foam isn't cleanable for reuse - so it's too expensive for daily use.

Special brushes

If you need to minimise the time spent brushing in order to avoid problems, then consider a Dr. Barman's Superbrush, which has two brushes angled together with the aim of cleaning all round the tooth at once (available online but use a reputable supplier).

Note that a baby's chewable tooth brush (such as 'brush-baby') doesn't work, because they're not deep enough to reach an adult's gums.

Your dentist may wish to prescribe a special very high fluoride toothpaste. There's also an unflavoured non-foaming toothpaste with high fluoride called OraNurse Unflavoured (available online but use a reputable supplier).

Flossers can be useful if flossing someone else's teeth, as can TePe brushes which are like little pipe cleaners and are available in different widths for different size gaps between teeth. These are both widely available, including at supermarkets. Be very careful not to hurt the gums, though.

To treat an extremely dry mouth, lips or tongue, such as with dehydration in end of life palliative care when the person no longer recognises thirst and can't drink, there's BioXtra Long Lasting Moisturising Gel (not to be confused with BioXtra Dry Mouth Toothpaste). As it's approved for use within the mouth (and is prescribable on the NHS although a prescription isn't necessary) a care or nursing home shouldn't have problems with it being used, and in our view it's far more appropriate than petroleum-based Vaseline. It's available online but use a reputable supplier.