Oral hygiene. How to get it done?

Teeth cleaning is really important all your life--and almost, even more so when you're aged.

I used to hand my clients a 'loaded' toothbrush--meaning, I'd put the toothpaste on the brush and hand it over. An electric toothbrush worked best, since many elderly don't have the hand coordination to brush and the electric toothbrush does most of the work. I'd chat with her while she was 'brushing' and make sure she did so for longer than she wanted, but needed. It didn't hurt that I had been a dental assistant previously.

I also had her rinse with fluoride mouthwash--to be on the 'safe side'. (If your LO cannot remember to spit out the mouthwash, don't use the fluoride).

Flossing was a challenge and one I never mastered. I'd give my clients a toothpick or one of those 'pre strung' flossers. (Less likely to be swallowed) and let them 'chew' on it.

Sadly, as our LO's get older, so many of the things we just take for granted--like oral hygiene, get lost in the day-to-day. It's hard.

My Mom over did it. I had to out the toothpaste on her brush and hand it to her and then she would brush and brush and brush till I told her enough.

You may have to brush his teeth for him. There are sponges with toothpaste in them that can be used.

https://www.amazon.com/ZIZNBA-Disposable-Unflavored-Sponge-Swabs%EF%BC%8CTooth/dp/B077W223MF/ref=asc_df_B077W223MF/?tag=hyprod-20&linkCode=df0&hvadid=241948599983&hvpos=&hvnetw=g&hvrand=12432992557575030064&hvpone=&hvptwo=&hvqmt=&hvdev=t&hvdvcmdl=&hvlocint=&hvlocphy=9003829&hvtargid=pla-406776595429&psc=1

As you see there are all different types.

This Teepa Snow video shows how to help using the hand under hand technique

https://www.youtube.com/watch?v=6gLrH8mioCw

Mom 86 has dementia and stubbornness. Mom will not brush or let anyone brush her teeth. For years now. She will however gargle with listerine. I tell her to swish it around for 20 seconds then spit it out. This is as far as I'm going to push. Not joining this battle I can't win.

You many find this pattern follows with many of his daily tasks.

Fully independent - verbal prompts - with or without supervision - minimal assistance (hand under hand is good) then full assistance.

If verbal reminders/prompts is no longer working, it may be time to pop into the bathroom at the end of his wash routine & use visual prompts instead. Direct his attention to toothbrushing being next - tapping the toothbrush/holder, setting the toothpaste on the sink or hand him his toothbrush all loaded up.

Use the same with other grooming, dressing, washing & toileting as you need to.

It's a very hard thing for the carer to keep focusing on what he can still do (rather on skills lost) so well done for that ☺️.

While it may be quicker for you (or another caregiver) to take over some tasks, it should help him to feel good, useful & active, doing what he can himself in his own normal day to day routine.

He’s not going to do everything you ask … that’s dementia !!!

Try a waterpick which uses pressurized water to clean the teeth.

Have you tried to stand next to him and brush your teeth at the same time?

Sadly my husband’s once very healthy teeth have deteriorated badly because of his love of sweets. He needs to be reminded to brush even to the point of putting the toothpaste on the brush and standing with him while he brushes. He does sometimes forget how to brush and so I start for him and he takes the brush and continues. I also give him water with Fluoride to rinse which he has to be reminded not to swallow. More than once he has taken the brush and toothpaste and very carefully combed it though his hair! I must confess I find this hilarious and disturbing at the same time.

My Mom's dentist took me aside and said, you have to brush her teeth. I went no no no. At the next checkup (3 months later), he said, you have to brush her teeth, I see stuff in her mouth from over 2 weeks ago. I went noooo and he said, here, let me show you how to do it. He showed me how to use the proxy brushes and showed me that I needed to get into the space between her gums and her bridge.

At the end, I told him....you need to tell my Mom that I have to brush her teeth. She will not believe me and I'm not going to force it. So he told her...and told her.

Once at home, she refused, however, I got the dentist on the phone and he reminded her.

Okay, now comes the "fun" part. A toothbrush alone isn't going to do it. Toothbrush and rinsing isn't going to do it. Because gums recede from the teeth, you will have to use proxy brushes to get food out from between the teeth. There are different sizes. Your dentist can recommend what to use.

I have a 1.5-2 quart plastic bowl and a cup. I have her rinse out her mouth into the bowl until the water doesn't have "chunks". Then I have her open her mouth and I brush her teeth and tongue with an electric toothbrush, rinse and spit it out into the bowl. Then I go between the teeth and between her bridge and gums with the proxy brushes. Rinse, spit it into the bowl. Then I use a floss and pick to gets what's left and scrape the plaque. And I got a mouth mirror with a light to help me see what I am doing. It takes me longer than than what it takes me to do my own teeth.

At first, her gums would bleed because of the lack of dental hygiene. However, after 3-4 days (I only do this once a day), her gums no longer bleed and I can tell they are healthier. The dentist says that her mouth is in better shape than most people. It's like having an amateur dental hygienist working on your mouth every day.

At 100, she still had the majority of her own teeth. I started while she was in early dementia. Now, she looks forward to her daily teeth cleaning because her mouth feels so much better. As the dementia is progressing, I notice that a lot of food is stuck on her teeth. between the the teeth and the inside above the lip area.. I call it a garden...and I am doing the weeding.

The food that you can get out between the teeth is like stuff from horror films. If I think about it too much, I get nauseated.

Please pay a visit to your dentist/hygenist and ask him how to do it. He can tell you and show you, which areas need the most attention. In the case of my Mom, it was the area between the bridge and the gums that no toothbrush could ever get to.

As a horror story, my sister's MIL did not want someone to help her brush her teeth. As a result, all of her teeth need to be pulled and her mouth is too bad of a shape to get implants. Dentures are nearly out of the question because apparently your jawbone changes shape constantly without teeth. She might have to go with a soft diet.

P.S. I do not use mouthwash or toothpaste. My dentist says that it is fine.

There’s no way I can brush my dads teeth his breath stinks. Makes his whole bedroom room smell. I’m sick just thinking about it.

SuperiorShore: Firstly, your DH (Dear Husband) should see his dentist for a cleaning to remove the plaque buildup. While there, you should speak to his dentist privately, informing him or her that your DH suffers from dementia and as a result, he is having difficulty maintaining his oral health. Any good DDS should have tips on this. Secondly, a Water Pik will be a good investment with YOU operating it for him. Thirdly, there exists sponge toothbrushes for areas that are sensitive. Additionally, change his toothpaste to an advanced type since he is not maintaining his oral health. There are many out there for such a need.

May not work for you but I'll tell you how oral hygiene gets done with my husband who was diagnosed with Alzheimer's disease in 2009.

First and most important - I'm always with him during brushing after I realized that he's not doing the job properly any more. I'd rather this than to pay big dental bills or smell bad breath.

One minute before brushing I prepare the water pik by filling the reservoir with warm water and adding a good squirt of 3% hydrogen peroxide. (Dentist said it was a good thing to do).

When it's time to brush I tell him, but not always, - "Come, it's time to brush your tooth". He laughs and replies "I only have one tooth?" (He has 31).
Or he'll say like he's Mr Control - "Okay, I'm only going to brush only one tooth and then I'm done". He has aphasia so any complete sentence is welcome.

We use soft bristle electric toothbrushes. I wet and put paste on his brush, and only recently I began to brush my teeth at the same time he does because he started to spend less time doing the job even though I'm standing beside him. With this new tactic he brushes as long as I do.

I have to tell him to spit in the sink, otherwise he may just hold it in his mouth and start to rearrange the counter or wipe it down, or look for a place to spit. He likes to spit into the toilet.

After he spits I hand him the water pik that's dialed on medium pressure. I like it on full blast. His gums can handle full blast but his mental sensitivity level is at 3 years old so I'm happy that he is rinsing at all because he would otherwise never rinse without reminding. He doesn't know how to turn off the water pik so with his free hand, or a nod, he signals to me when to turn it off. Sometime he wants to rinse some more. Great. He has a bridge btw and it been good for that too.

To shake things up for him I sometimes give him his toothbrush just before we turn off the water at the end of his shower. As I hand him his toothbrush I tell him how fun and different it is to brush teeth in a shower and that he could spit on the floor of the shower if he wants to. He showers every other day. On those days he'll rinse his mouth using the water pik after he's dried off and comfortably dressed.

He gets his teeth cleaned professionally every three months because flossing is impossible.

His mouth is always odorless. I attribute this to the diluted few drops of 3% peroxide in the rinse water and our diligence.

Oral hygiene is too important because the mouth is close to the brain.

If he will use an electric toothbrush many have timers on them and will buzz or beep when it is time to move to the next quadrant.
You will have to begin supervising him more. Maybe brush your teeth together.
(when he begins to not grasp the idea of spitting out toothpaste switch to one that has no fluoride in it, you should not swallowing that. (I also switched to an alcohol free mouth wash)
There are swabs you can use after he is done eating, use a swab and run it between teeth and cheek to make sure that he is not pocketing food.

I used to fix the toothbrush for my mom & supervise & direct her when needed. You could try a nighttime checklist for him if he's capable.