Although good oral hygiene might not be a priority in the day to day care of someone with advanced dementia, it should be. Mouth care is important for many reasons including maintaining function, preventing tooth decay and gum disease, and providing sensory stimulation. There is also a trickle down impact on nutritional intake, as someone with mouth pain or chewing dysfunction is less likely to eat well.
The face and mouth are highly sensitive to touch due to a high concentration of nerve endings that keep the head and face safe from injury. An unexpected touch on the cheek, lip, or eyelid causes us to flinch and recoil immediately, which is a protective maneuver hard-wired into our reflexes.
Someone with advancing brain disease might not be able to discern the difference between a good and bad touch, or understand the harmless intention of an approaching toothbrush.
Hence the resistance.
Furthermore, in the later stages of a neurodegenerative disease process there can be a re-emergence of primitive reflexes that are difficult to override. The stimulation of oral cavity from a utensil or toothbrush can cause the mouth to clamp shut. Abnormal muscle tone around the jaw and mouth can also cause clenching and grinding.
One of the most helpful things a caregiver can do to ease the process of oral hygiene is to give the face and mouth time to adjust to the sensations of touch and pressure. Successful desensitization and preparation for oral hygiene will minimize the body’s defense response and allow for better, less traumatic mouth care.
Here are some simple tips for getting the job done for someone with significant cognitive impairment.
- Use the proper environment and props to give context to the task- sit up straight, at a sink if possible, let him hold the toothbrush and bring it to the mouth if possible
- Massage the jaw and cheeks with slow, deep pressure, working from the ear toward the chin
- Desensitize the face by gently rubbing different textures along the jaw line and lips
- Use demonstration and one word cues to open mouth
- Use a manual soft toothbrush or mouth swab
- Use a mouthrest to prop open the mouth
- Use minimal toothpaste, enough to lather, only if they can spit
- Use alcohol-free antibacterial mouthwash and/or latherless toothpaste if cannot spit
- Gently wipe the teeth, no rigorous brushing
- Remove partials and leave them out
- Don’t put your finger into mouth- use a finger protector if needed
- Avoid stimulating the gag reflex located at back of soft palate near uvula
- If he does reflexively bite down, do not try to force the mouth open or pull the object out between the teeth. demonstrate mouth opening and let them try to initiate the movement.
- Put a smile on your face throughout the process, keeping in mind the spike in anxiety you feel when your dentist frowns!