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My patient is 90 and stopped brushing his teeth over a year ago. Therefore I manually brush and floss his teeth. He always bites and chews on the toothbrush which makes the process very difficult and prohibits using a mechanical toothbrush. His gums have receded and a lot food gets stuck between the teeth. Sometimes he will pocket his food and I have to dig it out with a toothbrush. He cannot see a dentist because he will not cooperate and will resist any dental exam or cleaning. I thought of buying some type of teeth guard over the counter, but he would probably spit it out or choke on salvia accumulated in his mouth. Any recommendations?

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Ricky6 Dec 2020
Thank you you both for responding. My patient is in the late stages of dementia and it is disheartening that at some point there come a time when there is nothing a caregiver can do to help. So sad and hurtful for me.
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I’ve used a sports mouth guard, which stops tooth grinding, very cheaply approx $10. They are quite thick, but you can cut them down with a sharp knife so they aren’t so bulky in the mouth. I use mine to avoid leaving my dentist guard behind when I am traveling. You could use one to check how a $1000 dentist version might be accepted by your patient. Perhaps you could navigate the ‘cutting down’ procedure together.
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Ricky6 Dec 2020
I am looking at a Oralab dental guard that does not need to be molded to prevent teeth grinding, Out of curiosity I am now trying a surgical mask, upside down, so the nose metal piece does not get chewed on, just rests on his chin. It seem to quiet him down from teeth crunching if he wants to bite down on the soft part of the mask.
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At 90 and already fighting having anything put into his mouth a Brux guard is not going to work.

Why do you want to stop the teeth grinding?

Why do you think there would be accumulated saliva if he wore one?

My Dad is almost 92, about 5 years ago after his stroke his teeth started breaking, not due to grinding, just old brittle teeth. After months of encouragement, Dad went to the dentist, he has several mild abscesses and needed to have about 10 broken tooth roots removed. He took the antibiotices and had the worse of the broken teeth removed, then refused to go back to the dentist, that was 3 years ago. He has few intact teeth left, but no infections and does not care that his smile shows his few remaining snaggle teeth.

Dad does not have dementia. I have no idea if he brushes his teeth anymore.

There comes a time when we have to accept that our standards do not apply.
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Ricky6 Dec 2020
Thank you for sharing your experience with your father. I want to stop the grinding to prevent pain he might get from chipped teeth and preserve the teeth he has for eating. I wear a dental night guard and I like to chew on it at night before I fall asleep, and I accumulate some saliva while chewing in it. Therefore I am concerned that my patient might gag on his salvia. He sometimes coughs if he drinks too fast. My patient does have severe dementia. He cannot brush his teeth or floss his teeth. If I did not do it he would surely lose what he has left for eating. He used to see a dentist, but now he would not cooperate and he would resist (fight) any dental procedure. He does not seem to have any major dental problems, but if he needs dental treatment (for pain or infection) his doctor advised that my patient would need to go to dental surgeon to be anesthetized for treatment. I agree with you that there comes a time when normal things do not apply anymore. I just want to prevent a possible problem for him.
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I wouldn't be trying any kind of mouth guard on someone who is at the stage they pocket food, IMO it would be a huge choking hazard. I very much doubt that you can preserve his teeth with all the other dental problems going on, what exactly do you hope to accomplish?
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Ricky6 Dec 2020
I would not use the guard except at night. I also am trying to double check if there is some food hidden in his mouth that I cannot see yet which is causing him to grind his teeth.
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A Water Pic Sprayer may help? Dr. Jack Grenan PhD Hypnotherapy
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There may be a reason for the teeth grinding and clenching.

Mom was doing this and turned out she had a fracture. Once we addressed the issue she no longer did the teeth grinding and clenching.

Hope this helps!
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