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Mom tends to forget to brush her teeth and also not wash her hands after using the bathroom. Occasionally I get a whiff of bad breath and I also worry abut her careless hand wishing. But at 82, she is generally in good physical health (initial stages of dementia). So I have been handing her Listerine cups and hovering around her to make sure she uses it. She has all original teeth but they are all gappy and yellow.


I also squirt hand sanitizer if she will let me.


How important are these things as she goes farther into her dementia journey? Will her teeth be affected in the long run????


Thanks so much

Thank you, everyone.
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Reply to wren9184
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Listerine contains alcohol. Alcohol is known to contribute to dry mouth. Most elderly people have dry mouth to a degree.

Dry mouth also is known to contribute to cavity formation. Saliva contains lactoferrin and other substances that prevent cavities,

There are mouth washed that do not contain alcohol and actually are made to keep the mouth moist.

Perhaps those will be a better choice.

Brushing is best, but if she refuses, rinsing is certainly the best second choice.
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Harpcat Sep 5, 2018
You are right on all of the above. But also wanted to point out that Listerine does have an alcohol free version too. Biotene mouthwash is excellent for xerostomia (dry mouth) and contains helpful enzymes too
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My niece recently told me that the call of 'puss & paws' was what she remembered most about coming to my home when she was little - that meant everyone wash their face & hands before eating - if I couldn't smell the soap it was too long since they had washed up & this stopped those who said 'I just did it' [2 to 3 hours before] -

Try it for all so she washes those hands - start when others are there & are on board so she will see it is the usual [FYI my 2 & 3 YO grandchildren wash their hand & come for the sniff test] - it's worth the try & if it works then that is 1 worry off you - I hope this works for you

If you need her teeth to last 30 years then worry about it - if less make a call - maybe group listerine swishing which is better than nothing - what was her prior teeth issues? this can be a contributing factor - I had a bad problem after a wisdom tooth extraction so doing teeth is an issue for me as I generally gag every time I brush my teeth - maybe settle for 3 times a week rather than force the issue
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Reply to moecam
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An elder should have a routine, but they should brush their teeth ~ absolutely. Also, as part of their routine, they could have hand sanitizer and lotion. To avoid them swallowing hand sanitizer, have that next to their bebside along with the lotion. To avoid confusion, take away the Listerine.
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Reply to Llamalover47
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Try Gold Bond or other brand lotion hand sanitizer. She is more likely to use lotion, especially in winter!
Sugar free gum helps. Floride mouth since is good!
If her mouth gets dry, skip stuff NH uses. Bioteen gel lasts far longer, tastes great. Dry mouth is very bad for gums and teeth. With Dementia, avoid Bioteem mouthwash. If she swallow it, it will make her sick to the stomach. Gel can be swallowed, no problem.
Personal Experience!
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Reply to GraceLPC
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The lack of good oral hygiene as well as hand washing after using the toilet are two signs of the dementia progressing and signals to you that you'll need to up her level of assistance with these ADLs in particular.

My mom experienced this too. It started with the lack of hand washing then a refusal to wash. Bear in mind when the hand washing refusal started, I had already been assisting her during bathroom trips because I first noticed 'accidents' in her underwear when I did her laundry--clearly she wasn't wiping appropriately and needed help. So, look out for this and other signs, and perhaps start accompanying her to assist in toileting. The hand washing problem evolved to her being downright agitated and aggressive when I tried to intervene and assist with this. I tried remaining calm and not escalating things, speaking to her in a pleasant voice and making sure the water was an inviting warm temperature. I added hand massages and fragrant smelling soaps to the routine as well as had various alternatives like hand sanitizer, wipes, or a wet soapy washcloth to offer if she just wasn't willing with soap and running water. It was really a painstaking process, but I did whatever it took because I am a hygiene freak.

As the illness progressed she became incontinent and now has us caregivers handling toileting; her hands became very contracted and in fist configurations, so it has been even harder to manage, but I still find appropriate methods to keep her hands clean, like soaking them in warm soapy water.

Not long after the hand washing issue came her disinterest in her oral hygiene. This one totally shocked and really depressed me because my mom was a dentist assistant married to my dad--a dentist--and SHE used to brush and floss multiple times a day! Her teeth were in great shape going into the dementia, but suddenly, no more flossing, and then she would not even open her mouth to let me brush them. Again, I tried different tactics, for example, switching to an electric brush (Oral B), and that helped some with the process. I couldn't floss her because she too would bite me, so I started using Go-Betweens (Proxabrushes) which helped.

Next, she would not spit out the water after rinsing either holding it in for long periods or just swallowing it, so I started using an aspirator to suction her mouth. I add alcohol free Listerine to her rinsing water, and sometimes she swallows this but that's okay. I still use a paste with flouride because she was getting bad decay from baby toothpaste or the flouride-free ones.

In terms of cleanings, I now use dentists that make home visits because she is now homebound (confined to a wheelchair). Sadly two of her teeth recently broke off and one chipped due to severe grinding and accumulation of plaque, as the aides I have had were not as diligent about her oral care. The dentists emphasized using flouride toothpastes and proxa brushes as well as raising up/pulling down her lips while brushing to really get into those hard to reach areas. I also have my mom rinse out her mouth after every meal (super helpful) and I brush her morning and before bed. It is more work, but I will do what's needed to help her retain her teeth.

So please don't give up. Just be sure to modify your approach with new tactics and tools and more vigilance and assistance of your loved one. And check with your local Alz. Association chapter &/or MD for referrals of visiting dentists, particularly those who work with dementia clients because they will have experience dealing with these issues.

Last tip that I've been using for myself & my mom is one recommended by a periodontist that involves brushing with baking soda, leaving on a coating of the soda and then rinsing with a teaspoon of apple cider vinegar for fighting and repelling plaque. (For more details on this, search YouTube for 'Simple, but Powerful Gum Treatment Strategy - with Nadine Artemis'.) It works!
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Reply to Dsucks4321
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Grandma1954 you are correct that every dementia person is not the same and not all principles can be applied. I gave the information above for best case scenario and then people have to fit it into their own scenario. Gdaughter, a salt water rinse should only be used when trying to soothe irritated tissues. Not long term. Also some people need to avoid salt. No rinse reaches under the gums and no rinse removes plaque. The studies that showed Listerine helped with gingivitis had the patient rinse with it for 30 seconds twice a day. Try it...not easy! Otherwise it’s like putting on make up.
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Reply to Harpcat
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That is the English way as Listerine is an antiseptic and many wash lettuce in Listerine then rinse. I suggest your dentist might be able to put you straight and at this point she can gargle which is fine but later on will be the problem.
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Reply to normandy
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We brush mom's teeth and use Tom's Natural Children's Toothpaste - Strawberry flavor - fluoride free.  Since it's made for children it's not going to harm her if she occasionally swallows it.  We don't spend a lot of time but try to brush every tooth and have her spit in a bowl, since she's in a wheelchair.
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Reply to Jessica40
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Good oral hygiene is important for many other reasons then just your mouth. Your heart for one thing!!!! And if I was around your mom I’d hate to pickup fecal matter germs. YUCK
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Reply to Cmthatcher
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Dementia patients are as different as night and day. Some will still love to have their teeth brushed and their hair combed and be bathed. Others will bite you if you try (and everything in between). All anyone can do is see what their dementia patient will tolerate, then do that and no more. You are dealing with a broken brain that may not understand society norms any longer. To them, the toothbrush may be trying to choke them, the bath may be trying to drown them, etc. All we can do is be gentle and kind to them, since they are in such unfamiliar territory.
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Reply to BeckyT
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My husband and I cared for his mother, and as she entered into the last stages of Alzheimer's she then forgot how to brush her teeth. The day I caught her scraping her toothbrush across a bar of soap was when we had to take over! Going forward we stored her toothbrush where she couldn't get to it, and took over brushing her teeth.

Although she wouldn't allow us to floss her teeth she did allow me to brush her teeth, and then she rinsed with a glass of water. Otherwise, she would not have been able to brush her teeth any longer. The dentist / hygienist were unable to help her because they said she would become combative in the chair. At that point something was better than nothing, so at least we were able to brush her teeth for her!

God bless you for taking care of your loved one!
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Reply to Caring2Love
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When I noticed my mom's nails had dirt under them I was appalled and wondered about that. So now when she gets her hair done (which she tolerates at least once there, every couple weeks) every other visit she goes to the stall next door and gets her nails filed which I have no patience for as we have an antagonistic sort of relationship. At least it keeps the nails short.
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Reply to gdaughter
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My mom (96) with dementia that crept in is still somewhat functional. I've had to pick the battles. I worry about the same issues but there is only so much one can do short of having a 1/1 person with her which is impossible for many reasons not the least of which would be her tolerance (not). So, for the moment, she has not bathed /showered in many months. The DDS has noticed less attention to her teeth brushing but I am not the one to stand over her and have my hands full dealing with a demanding father (age 101/deaf) and doing cleaning, cooking, laundry and holding a part time job so I can retire less poor than I will be. But yes, I'd say the teeth will be impacted, and you know how bad...from dirty, to decay to gum issues, and removals and bridges or more...so if you can do anything towards the goal it is great. I'm sure others here will give you better guidance and I will be following along with you:-)
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Reply to gdaughter
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Some power toothbrushes can be pretty abrasive to teeth. Oral B comes to mind as one example.
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gdaughter Aug 28, 2018
Are you a dental professional? I don't find that to be the case; the brushes on electrics tend to be softer and with mine if you put too much pressure on the teeth/gums it will stop.
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I found a reasonable solution for brushing teeth with disposable toothbrushes. Colgate Optic White Wisp Mini White is available from Amazon. It has a built in sugar free bead that dissolves to help clean the teeth. No water needed, everything can be swallowed. The mini brush has a dental pick on the other end. My mom loves it. It doesn’t replace a good brushing with real toothpaste, but it’s way better than nothing.
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Reply to daybyday27
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I’m a dental hygienist (retired now after 37 years of practice and teaching). Mouthwashes do nothing to remove daily plaque accumulation which is full of bacteria. You may know it causes both decay and bone loss around teeth and gingivitis. So the answer is no the mouthwash is not substitute as it will not remove the sticky adherent biofilm on the teeth. I would suggest you get a powered toothbrush such as Oral B or Sonicare and you brush them. Ideally she should use floss but I doubt she would. But you can buy interdental picks called Soft Pics by Butler. They will go between her teeth to remove food. The smell of her breath is caused by bacteria releasing sulfur compounds. This is indicative of gum disease. The bacteria can get into the blood stream as well. They are implicated in heart, lung, issues as well as strokes. Some studies have found the bacteria associated with gum disease in the brains of Alzheimer’s victims. I suggest you supervise or you brush her teeth. Take her to a dentist for an exam and a good periodontal cleaning by a hygienist.
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Reply to Harpcat
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Grandma1954 Aug 28, 2018
The use of a toothbrush, and I did use an Oral-B UNTIL he started biting on it and broke one of the brush heads. Try getting that out of the mouth without loosing a finger.
The other problem is a lot of people with dementia become non compliant with allowing oral care.
The chance of aspiration increases as well and there is a lot of water used when cleaning the teeth. Not to mention getting someone to rinse and spit out the abrasive cleaning paste.
It all has to be judged on the individual person.
I gave my Husband a mild sedative the dentist prescribed before his appointment. I did not like what sedation did to him, it took a long time for him to recover from any type of sedative. Even with the sedative he was non compliant and the dentist said he could refer him to another dentist that would use a stronger medication but I did not like what the mild sedative did to him. It took a while for him to recover from it. Not to mention it was dangerous and difficult for me to get him back home as he was very unsteady on his feet.
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You need to supervise her oral care. My mom has end-stage Alzheimer's and still brushes her teeth AND uses a water pic because I watch and supervise her every step..it's one of the few activities she can do because it's a twice a day routine. If you do not manage her teeth cleanliness the *bacteria can build up and cause pneumonia*. Further, periodontal disease can contribute to diabetes, heart disease and strokes. Do NOT depend on her to brush her teeth--YOU have to make sure she does it.
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Reply to cetude
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Thank you all
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Reply to wren9184
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The problems with most mouthwashes is they contain alcohol and some contain fluoride. These she should not drink.
There are oral swabs that are a firm foam, some have a toothpaste like product embedded in them so when you moisten it it can be used as a brush or you can use it to swab the roof of of the mouth as well as the gums and tongue.
If you can not find the swabs use a brush but use a toothpaste and or a mouth wash that does not contain alcohol or fluoride.
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robinr Aug 28, 2018
You know, it never ceases to amaze me, though it shouldn't, how so often the "professionals" fail to take into account what dealing with dementia is like...from beyond the patient (i.e. medication effects  on someone with dementia) to the hassles for a loved one dealing with the after effects when you try to get him home without a fall that could result in so many worse issues...dental care is so overlooked in spite of our now knowing as others have pointed out, the correlation between dental health and physical.  And the expenses of it not being covered by insurance is dreadful as well.  We really need to fix that, for all of us.
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If you can hover with a cup of Listerine, can you not hand her a toothbrush and help her brush? Can you not supervise toileting and hand washing afterwards?

One of the reasons that we placed mom in a NH is that was assistance with these essential ADLs.
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Reply to BarbBrooklyn
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I have some piece of mind by taking my mom to the dentist for regular cleanings.
my mom thinks she brushes well. but the hygienist always removes a bunch of crud.(plaque etc)

maybe buy a large bottle with pump of hand sanitizer. but with supervision
or check her hands during the day. and pay attention to under the nails. 
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