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!
In collaboration with Elizabeth Dunbar.
Updated June 20, 2016.
8 thoughts on “Tooth Brushing and Dental Care and Dementia with Lewy Bodies”
This is all well and good if you have your own teeth. My partner has dentures and because of the lack of facial muscles and all the saliva it is virtually impossible for him to keep his top teeth secure and not keep dropping down. Any suggestions would be appreciated.
I can only comment on my own experience, and that of those who have spoken to me about their own techniques. Definitely your situation is entirely different — I don’t know if it’s easier or harder, but it’d be significantly limiting on food choices even if there were no swallowing issues. Maybe someone else will have a good suggestion? Ingenuity and strength to you!
My loved one’s head goes down and doesn’t come back up easily. He also closes his mouth around the toothbrush, and lastly, won’t spit. He drinks the rinse water and the toothpaste with it.
That is a difficult situation, Rose. Using the children’s toothpaste (or less chemical-filled variety) would be important if he’s swallowing the rinse-water. The “Lewy Lean” and chin down, hunched posture makes this very difficult indeed. Doing the best you can is doing incredibly well for your loved one!
I take care of my 86-year-old stepmom. She is frozen with Lewy. The nursing home will not brush, she has all her teeth. I live 2 hours away, so I brush three times a week when I am there. I use a child’s toothbrush, and tell her every part of the mouth. She cannot spit at all, so I use a suction bulb, like for a child’s nose. I keep it very well-sanitized, and she seems to love it. I think she thinks she’s at the dentist. Afterwards, I clean the toothbrush and pour a little mouthwash on it and re-brush. Then, on good days, I floss with the stick type and still get food out. The auction bulb is the central good idea to share.
That’s genius, Aletha! What a wonderful stepdaughter you are — especially going so regularly despite the great distance. I bet she absolutely loves having you visit, and your visits and ingenuity make a terrific difference, I’ll bet. It’s too bad the care-home will not do any teeth-brushing: I’m sure it’s not easy, and the staff typically have a high ratio of clients to help, but poor dental hygiene leads to so very many other issues, infections, etc, that I think it’d be worth the extra time in exchange for the improved health.
> Thanks for the great suggestions, particularly about trying the suction bulb — that might make a huge difference for people!
> Strength to you. Timothy Hudson.
I find it very interesting the many suggestions of tricks that help keep the teeth and mouth of a person with lewy body dementia issues are, to my knowledge, rarely if ever passed on to care givers of persons living with a brain injury not related to lewy body dementia. The only time i have seen anything that comes near to the VERY HUMANE AND RESPECTFUL way of practicing dental care that you describe was contained in Moseby’s Manual for the Professional Personal Support Worker, that was published several years ago. I dont know if it is still in print but I think there will be MANY good ideas that are easily used or modified to the individual and care giver of a CTE owner which will make life easier and more comfortable for both.
In my view it is too bad O B I A has nothing to match the care practices that you have put here, obviously I am P N G around that lot.
Thanks very much for your comment and thoughts on dental work and their applicability to brain injuries in general. I was completely unfamiliar with the book you refer to, Mosby’s Canadian Textbook for the Support Worker. There are so many elements that should be applicable to many different conditions, and certainly the ones I propose for dental care could work for many situations, I expect. I was unaware of what the Ontario Brain Injury Association is doing, and appreciate your mentioning that too — I hope to have a look at their content to see if there’s anything applicable to LBD as well.
Thanks again for your thoughts.
Strength to you! Timothy Hudson