The premise of this article is to provide information to a care partner who will be helping their loved one who has dementia. Dentures and dental appliance care is not covered here. The recommendations described here will certainly not apply to everyone, but many of the tips and techniques will be applicable — at least some of the time — and have sections for varying severities. There’s a separate article on finding a good dentist, and how to decide if dental work is warranted.

Dental hygiene is enough hard for the healthy, and borders on the impossible for some people with Lewy Body Dementia (LBD). However, there are things you can do to make the best of a very difficult situation.

Any dental care is better than none! Regular cleaning can avoid significant problems, some even life threatening — immediately, and in future.

The assistance and attention of the care partner can ensure that many health issues are avoided. And with some practice, patience, good humour and diligence, the teeth of our loved ones can likely be maintained quite effectively in most cases.

If you’re in the early stage, make sure teeth brushing and regular dental work is done. Actively. The more something is habitual, the less likely it will be abandoned, and the less unfamiliar it will be if cognitive decline begins to interfere. This goes for most things, but as ones’ health declines, dental care often goes with it because its impact is not immediately noticed, and its importance pales in comparison to other acute health issues that can develop.

Health setbacks will occur. Nothing can avoid that. Get back on the dental hygiene regimen as quickly as possible to avoid other problems developing. Tooth decay, breakage, loss of teeth, dental appliances and other issues can wreak utter havoc on a person with dementia, and the shockwaves will radiate outwards to cause a vicious circle of problems with the care partners, family, and health care professionals. Many negatives can be avoided by attention to relatively simple methods: avoiding and as many problems as possible will drastically improve the LBD journey for all involved.

Tips for Everyone

• Make a routine, and a safe place to do it where your loved one is comfortable and confident. At a table with a basin or at the sink with a chair may be best.
• Having a mirror to recognize what they’re doing is usually useful — and a movable or portable one may be better than a fixed vanity to allow different positions.
• Try a power toothbrush on a low setting — this can be very efficient, and will reduce the need for back-and-forth movement which can be difficult, frustrating and unpleasant. If the sensation of the power toothbrush makes your loved one uncomfortable, discontinue it at least temporarily, or only use the power only for very difficult to reach areas.
• Children’s toothbrushes may be helpful since they’re smaller, may be easier to manipulate in confined space, and their softer bristles may reduce unpleasant sensations.
• Toothpaste may be counterproductive and unnecessary if its taste, frothiness, volume and spitting-out requirements pose problems.
• Organic or children’s toothpaste have fewer potential issues if accidentally swallowed, and a gel form may be preferable to the grittier texture of some toothpastes.
• If possible, dilute the toothpaste to make a thinner consistency to eliminate any blobs that could potentially mix with saliva and increase the risk of choking.
• Flossing is very difficult, but things like Placker’s floss picks, Stimu-dents, and Water-Pik devices may make this easier.
• Ensure they spit out as much as possible when finished to avoid potential swallowing issues or stomach upset.
• Be careful to avoid choking, aspiration and respiratory impacts by careful attention to posture, fatigue, attention, distractions, etc.
• Some medications can be very damaging to teeth and gums, so whenever possible, do a light brushing or mouth rinse after taking medications, especially if they are taken crushed in food.
• More frequent trips to the dentist for professional cleaning may help, especially if frequent brushing and cleaning is difficult to accomplish.

Early Stage Unassisted Brushing Tips

• Encourage and facilitate oral hygiene as effectively as possible to minimize future problems and to maintain habit and comfort level.
• Make sure that the location used for tooth-brushing is safe: this could mean you’ll need a chair at the sink, or use a portable basin and brush at the table you eat at.
• Keep the implements rigorously clean, close at hand, with easy-to-grip handles and contrasting colours so they’re easy to see and use if hand-eye coordination diminishes.
• Periodically check up on the efficiency of brushing and flossing in case it is not being done but you assume it is.

Brush Together and Get Benefits from Mirroring

If self-directed brushing and flossing is not being done well, you can facilitate it and improve the results significantly by brushing your own teeth at the same time as your loved one.

• “Mirroring” is commonly used, and is simply doing the desired behaviour yourself so your loved one doesn’t have to remember, they can just see what you are doing and imitate the desired activity.
• Do your own teeth at the same time, in clear view of your loved one so they can mimic what you’re doing closely.
• Maintain a pleasant aspect and avoid annoyance or scolding. Encourage positively: your loved one may be unclear on what’s needed, use very clear, simple instructions if helpful.
• Make sure there’s time after every meal to brush, because your loved one may be too tired otherwise, and particles of food left in the mouth can cause many serious problems.
• Use an egg-timer or non-disconcerting alarm to make sure the brushing goes on long enough to be thorough.

Advanced Stage Assistance and Brushing Someone’s Teeth

If a person is too tired, confused or unable to do the brushing themselves, you will need to help them partially, or do it yourself. With ingenuity, patience and care, this can be easy to do in many cases. It brings great benefits for hygiene and drastically diminishes the likelihood of aspiration and pneumonia (from food particles dislodging and ending up in the lungs).

• Brush your own teeth just before helping them with theirs, to visually establish what’s expected and appropriate, and so they know that it is not something being done “to” them, but “for” them.
• Get al the implements you will need and keep them in sight before you start: toothbrush, towel, wash cloth, water-cup, basin, etc. If they see it in advance, it should be less worrisome when you start. And seeing the brush just went in the water in a glass or tap will provide assurance that it’s clean.
• Describe each individual step before you do it, and show them what you mean, such as “I’m going to brush your teeth now, and this is the brush I will use. I’m going to put it to your lips. When you open your mouth, I’ll be very gentle and clean your teeth.” Reassure and gently explain each step before you perform it, using the simplest language possible. Singing, humming or soft music may help.
• Use an apron, bib or towel draped over a wide area beneath their chin to catch any drops or spit. Be extra gentle. Their gums may be very sensitive. Use the smallest, softest brush you can.
• Ensure that your actions do not make them think you might obstruct their breathing.
• Be patient and comforting, and extra sensitive to how they react. Having an unpleasant experience with brushing can elicit difficult behaviours, and reduce your status as a person they trust intuitively.
• If it is creating agitation, stop for a while.
• Play quiet, favoured, calming music before and during to help reduce agitation. Avoid other seen, heard or felt distractions while brushing.
• Make it a ritual. Be as consistent with the process as possible. Keep the routine the same all the time will allow whatever memory abilities remain help you by making it less upsetting by it’s familiarity. Even if they never become calm, once you establish your own routine, you will be calmer yourself, and that will lead to less potential agitation or anxiety.
• Watch the video at the bottom of the page by Teepa Snow, which includes a her great suggestions of being at eye level, making physical contact, being in their field of vision, avoiding threatening posture or gestures, etc.

This is not an easy process, but will bring significant rewards and diminish many other problems and we’ve certainly found it well worth the trouble almost every time. Sometimes it has to be abandoned, but usually by the next meal, any difficulties have been forgotten and I am absolutely confident that aspiration problems have been significantly reduced because of this.

If you’re interested, read more about safe swallowing and avoiding aspiration.

Strength to all!
Timothy Hudson

In collaboration with Elizabeth Dunbar.

Updated January 25, 2024.