What happens to a dementia patient who refuses to brush their teeth?

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What happens to a dementia patient who refuses to brush their teeth?

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Mom stopped brushing her teeth on her own a year ago. Her gums look horrific. When I manage to brush what little she allows, there is a lot of blood. After a few seconds of brushing, she freaks out and refuses to open her mouth. She will not let me brush her teeth properly and they will continue to rot. What will happen to her? infection = sepsis? dentures? A dentist would have to put her under to clean her teeth, do they do that?

Thanks for sharing your experience

Alzheimer's & Dementia Dental Care Family Caregiver Poor Hygiene

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Sadly there are some battles not worth fighting.

Dad does not have dementia, yet his teeth are rotting out of his head. He brushes his teeth to some degree. He refuses to go to the dentist, last time was about 5 years ago, he had multiple minor abscesses and had the remains of several teeth removed. The procedure was painful, of course, so now he just lets them rot.

He was warned by his dentist that bacteria is getting into his system due to the poor condition of his gums and teeth. It may have contributed to an infection after the removal of a skin cancer.

But at 93 there is no point in arguing with him.

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thanks for sharing

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These are sponge toothbrushes. I think they have toothpaste in them. May be gentler than a toothbrush.

You Mom probably has gum desease if her gums are bleeding that much and they are hurting. I have been thru the process but it was 40 yrs ago. With regular cleanings I have kept it at bay. You can brush all you want but flossing and regular cleanings help to prevent gum desease. I know, not an easy task. I had to actually have my gums cut open to graphed the bone, scraping off the damage bacteria made. Your Mom will not be able to go thru this process but I would ask the dentist if putting her under would be OK. Just long enough to give her a good cleaning. As said, the poison given off by the bacteria causing the problem can make her sick. If her breath smells like rotten eggs/sulfur, she has gum desease.

https://www.walmart.com/ip/100-Pcs-Suction-Oral-Swabs-Disposable-Sponge-Swabs-Cavity-Cleaning-Tooth-Shape-Unflavoured-Swabs-Disposable-Care-Swab-Mouth-Pink/989663676?wmlspartner=wlpa&selectedSellerId=18988&&adid=22222222227989663676_18988_142769376613_18354731446&wl0=&wl1=g&wl2=t&wl3=631649406389&wl4=aud-1651068664746:pla-1877571100265&wl5=9003829&wl6=&wl7=&wl8=&wl9=pla&wl10=125210027&wl11=online&wl12=989663676_18988&veh=sem&gclid=Cj0KCQiA-JacBhC0ARIsAIxybyNlRnnBTLEOWzgwk5yyTdkeGW3UZ9BGCfez19nuDNQtMkwssC5jUjcaAt8wEALw_wcB&gclsrc=aw.ds

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Your mom has periodontal disease, it sounds like, from the gum bleeding she's experiencing. When periodontal disease goes untreated, there is bone loss in the mouth which leads to tooth loss. When your mom starts expressing great pain in her mouth, you will need to take her to a dentist that offers sedation; she can be sedated (knocked out) while her mouth is examined, and then treated for whatever is going on at the time. If a tooth or teeth need to be extracted, they will be. That's about all that can be done for a dementia patient, really.

My mother had a few teeth that needed to be extracted while she lived in Memory Care AL. I had the visiting/traveling dentists come in to treat her in her recliner in her room. Surgery had to be performed to remove 2 molars, which was done under Novocaine, and she was stitched up right there. Her PCP ordered a Xanax to be given to her beforehand to keep her calm throughout the ordeal. If I could have had her sedated, I would have, but that wasn't an option. I also chose not to take her out of the MC to the dentist's office b/c she was wheelchair bound and 190 lbs, so I felt it was easier to deal with the matter in her room at the MC.

There's no easy way to handle dental issues when dementia is present. And I wouldn't fight your mother about brushing her teeth; it's too late anyway; the majority of the damage has already been done. Just treat her pain as it crops up, that's my suggestion.

Best of luck with a difficult situation.

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My mother had dementia and became afraid of her toothbrush. She no longer knew what it was, and when her caregiver brought it close, she'd become very frightened. Caregiver did the best she could in cleaning her teeth. No dentist appointments were possible because she was bed-bound for years and we kept expecting her to die. But she didn't until after 5 years from the time we were sure she had dementia. She was 95 at death. She'd taken good care of her teeth all her life and hadn't lost any, but by the time she died, her teeth had turned brown. I never knew the cause for this, but it didn't matter. They seemed intact and neither teeth nor gums appeared to cause pain. She could no longer communicate in any meaningful way and it was impossible to know.

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There is this page:

https://www.alz.org/help-support/caregiving/daily-care/dental-care

Much of it (not all) won't apply until the current issue is brought under control. You might find the "watch me" technique worth trying, perhaps, especially with a soft toothbrush.

Meanwhile track down a sympathetic dentist and ask for suggestions. If your mother can be trusted not to swallow, a mouthwash might help to calm the inflammation that's currently there and causing the bleeding (and probably tenderness and discomfort), but take professional advice.

What happens if she continues to refuse is that her mouth will get more and more sore, it will affect her ability to eat and possibly her enjoyment of food, and she'll be at risk of local and systemic infections :(

But for her, these possibilities don't outweigh the fear and discomfort of having her teeth brushed at the moment - and as you say there's a lot of blood then I really can't blame her.

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My mom wants to brush but can’t find her mouth with the brush, it’s too weak etc. so I let her chew on a foam lollipop (as I call them) with either a bit of toothpaste or mouthwash. She won’t let me brush but the hospice nurses aide is magnificent and does it vigorously! Good luck!

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There are even lemon flavored "foam lollipops" and possibly other flavors. Please check afterwards to be sure she has not bitten off a small piece.

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Depending on her overall health, a dentist can put her to sleep and do a thorough cleaning. The mouth can be an entryway for bacteria which can lead to infections of all types. If swallowing is an issue, leading to aspiration pneumonia. Infection in the blood stream can lead to heart issues... especially if that is already a concern. It is possible that it can be done without general anesthesia much like other procedures with sedatives along with numbing so when it is over it is not remembered.

In this line of thinking here is something else to consider. When my husband was in cardiac rehab after a quadruple bypass we had classes teaching us about the new life we were facing. We were cautioned to always let the dentist know after any kind of cardiac procedure (even simple cleanings) and appointments may need to be postponed.

We were also cautioned in the classes to be sure foot care is not neglected as well. This is another entryway for bacteria to enter the blood stream leading to infections including the heart. Always wash and dry their feet thoroughly.

When looking for foot care, especially geriatric foot care, it is important not to have pedicures at places like in the mall without asking about their credentials and sterilization techniques. They may not properly sterilize their instruments properly or use other cautions. We are very blessed to have a highly trained foot specialist in our area. You can check out her Facebook page to see the type issues she cares for and high standards she holds.

https://www.facebook.com/MrsGoodFoot

My husband and I go to her on a regular basis. She has certifications above a typical pedicurist and there may be professionals like her in your area. She is not considered a medical professional but a lot of the podiatrists refer patients to her when their needs are not covered by Medicare. If you can't find someone in your area, if you private message her on Facebook, she might can provide a resource to locate someone in your area because she also does training nationally. She even does home visits as I am sure others will as well.

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We are struggling with this as well. Mom doesn't remember to brush her teeth of course and I have asked her memory care facility to help her and I know they aren't doing that because she has been at this new place for 3 months and still had toothpaste. :-( I dread if mom loses her teeth because she can't keep up with dentures. They will get lost, not cleaned, etc... We are waiting to get approved for a Medicaid Waiver. I am hoping to be able to hire some help to come in and get her dressed, teeth brushed, a shower 2-3 times a week, etc.

I took mom to a dentist for a "deep" cleaning and held her hand the entire time they were cleaning her teeth. There were frequent stops. Not sure I would do it again. Can you get your mom to swish with warm salt water? That might help calm her gums down. Maybe try a baby toothbrush that is super soft.

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my loved one has alzheimers dementia. i try my best to clean his teeth every day when i visit - the carers also brush his teeth. some days he will comply other days not. i use a children's toothbrush and also children's toothpaste as he doesn't understand now about rinsing and so if he does swallow the toothpaste it's not so bad. i keep a wet paper towel on hand also to wipe his mouth out as best i can. he used to say it 'burnt' when i cleaned his teeth before - i think this is because of the fluoride in regular toothpaste - since i've used the children's one he doesn't complain. they come in nice flavors such as strawberry. he also seems to like the toothbrushes which are brightly colored. at this stage i will do anything i can to help maintain his dental hygiene. there are also toothpaste 'bits' which are readily available online. they are small, tablet sized - once popped in the mouth they dissolve and if you can get a toothbrush in there to clean, may also help. we have a mobile dentist who comes out to clean his teeth also. i hope this is helpful.

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I use the safe to swallow children toothpaste too. It works out well. Hubby can’t spit very well at all. Our dentist days are over. Sad because I know he needs dental care. I can see the teeth deteriorating. I can just see myself getting pliers and pulling. Joking on the pliers. Lol

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My missus was like that. I would lovingly fight her about it. I would take her to the dentist who would clean her teeth, if she let them, and yes, bad things will happen if you don’t - eventually. Keep trying to brush her teeth and making those dentist appointments until she does open her mouth. lots of good advice being given by others here. Good luck.

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A good question! what to do? My wife has both dementia and is bed bound. I am not sure I could even get her into a dentist chair. It is a big event to get her to the doctor and the ride usually wipes her out and she sleeps for a day after. I will ask her care givers for suggestions. She saw the dentist a little over year ago but she was more mobile then.

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toothetes a sponge looking thing with mouthwash. She doesn’t understand so maybe making it like a game. My mother refuses to wear her dentures and has implants which could get infected from food particles getting trapped. My husband the same way. He had to have surgery. It’s so mentally draining to deal with this type of thing. Do the best you can.

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To fight against the negatives, Misty, remember to smile for yourself as well as her. Control your thoughts with a single positive phrase when a negative thought arises. Any positive thought that applies: "It's all right. My mom's gonna make it." or 1000 others. "We'll get through this. One step at a time" "This will pass." My used to sundown. After I discovered how to fight inflammation of the brain by switching her to Tylenol and CBD, then maintaiining her daily supply of nootropics like Phosphatidyl Choline/Serine/Inositol, and many others, mama quit sundowning, quit badgering me for water impatiently while I was relieving myself in the bathroom. Never say never. If you want to find out how to turn AD around, you are welcome to send me private messages. I graduated from Trinity University in 1998 and that year I got three degrees, more than anybody, one in Psychology, one in Spanish and one in French... all the same day. I specialized in Alzheimer's and Schizophrenia, but gave all my practice to my mom and Alzheimer's. Dr. Calle, the imminent Southeast Side practioner in Gerontology advised me in 2004 that mom and 100 other geriatric patients with Alzheimer's had reached the "5 year point" whereby they would not live past five years, and to get all our things in order for that event. In 2009 he called mom and I in and there informed me all hundred had passed away as he said. This happened every year like clockwork. Dr. Calle had over 3000 patients, most of them from the Southeast Side of SATX. He said he called us in to tell me all those had died, as had 100 the year before, and the year before that, going all the way back twenty years, since before 1995. But mom was the only one to break that chain. So he said, Gee, you broke the record. It was you that did it. We checked all the records of your mama's class, all 100 patients, and there was no difference in how we treated them. All the same. So we examined your private life: Bill Millers, Shangrila, Snoga's, La Chinita's, El Tipico Goliad and Rigsby, Little Red Barn, her church every Sunday, Chaba Thai, every day you took your mother out and socialized her, got her moving. You took her shopping every week to HEB and Walmart and let her drive the electric carts (I was scared but I had to try and she was wonderful at it always stopping at each intersection and waving people by; she had so much fun and never knocked a stack of things over with it; those are very intutive and I suggest to let AD patients drive those and have that fun experience. That maintains certain areas of the brain, even strengthens them, and places them in control they so much need. My mom was 87 in 2009, driving carts with advanced AD. All the patients in this area that he saw told him about us. I did not mind because he did it for the good of AD research. I continued doing all these things, like answering all her questions all of them every time she asked, because if you know about the mice experiments in enriched v. disenriched environments, you know that the brain is elastic, that you can create physical lines of memory in it. The mice made to do things to eat and drink had thousands of lines in their brains; the others had none, the fat lazy do nothing mice. So answering questions keeps laying lines in their brains and reinforcing those lines. Do be frustrated when you repeat a thing to them, but realize you are adding one more line upon that line, helping to embed it physically in their brain.

Alzheimer's patients have serious inflammation in the brain. Tylenol is the only pain reliever off the shlef (OTC) that goes into the brain. Not advil, not aspirin, not ibuprofen, not exedrin. ONLY TYLENOL. Note that Tylenol is indicated in liver issues. But the trick is to just give about 330mg a day TOTAL in two doses, not one huge dose. The huge dose, even food, causes spikes. So just give 100mg 3x daily. You will see a change for the better and the body won't be overloaded.

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Hi Nandulal,
You ask a good question. It depends on the level of her condition, it can depend on the day, and it can depend on who is speaking with her and how/what they are speaking. Some persons have quite the rapport with her and some likely don't. Some nurses are able to manage it, and others aren't. In a cluster of nurses in a hospital or nursing home, their skillsets are not the same across the board. Maybe only one can get her to see how to do it or the need to do it. Here, you are at your home setting. I commend you. I stayed with my mom for 24 years after my dad died, continued my education in Psychology and Languages and the Law.
I recommend you keep trying to use your knowledge of her to make her comfortable at these times she doesn't want to brush. Her mindset can often be everything. If you know how to break through her perspective to change her attitude, get her in the right attitude, and begin to broach the subject. Maybe she needs to "own" the brush so it's not a foreign object. Depending how her memory is, if you set the toothbrush where she will touch it in bed, you can tell her "That's your toothbrush." Then you can talk about if it is soft, medium or hard bristles, which type does she like. Then how does this one feel. Let her be holding it, owning it. Don't be telling her she needs to brush, directly, while you are getting her to own it. The talk around it will set her at ease about it.

Depending on the person and stage, an AD patient can remember that someone hurt them while they can't remember what day it is or where they are. The apprehension she has expressed about brushing her teeth is a type of fear, if you will, the same as can also be tied to when someone causes them pain, hurts them, even my mom's chiropractor qualified for that after he popped her lower back and she said it hurt her, told all the clients on the way out what he did, then the next week asked him point blank are you going to hurt me like you did last week. She was considered late stage at the time, in 2013. Her meds were not totally maxed out but past the 50% point.

So keep her happy, let her own the toothbrush, and if you can set a pattern by getting her to test that toothbrush if it's too hard, she just might begin to get over that problem. Toothbrushes hurt my mouth. She's probably older than I am so they will hurt hers even more. When you do all this, get the softest toothbrush you can get and have her try that for softness. Your real goal will be for her to own that toothbrush, to say she likes that one the best. When she does, she just said she LIKES a toothbrush. Capitalize on that and reinforce that pleasant experience.

Maybe teach her to brush non-traditionally. Just getting it in there and moving it around on the teeth, not perfectly up and down like a kid does. Note how she does it when she does it. Talk in comfortable ways while she does it. And do some humming around her because humming is something she most likely associates with good times in her life when her own mom and grandma hummed while they worked. To me, there's nothing like a woman humming, but I hummed for my mom all the time. She was raised around polkas, so I hummed polkas I made up or knew, didn't matter. I'd set the pace with it, know what I mean.

Most of all, the best advice is don't give up. They can stop and start something back up. By keeping vigilant and diligent, you will likely find a way. I'm sure she likes good, old fashioned water. That's one of the best ways to clean a person's mouth and teeth. Let her use her fingers, even. Rinse with water and repeat.

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Had the same problem with my husband. He was in memory care and now in skilled nursing. I got these and the attendants love them. No water or spitting out. They are regular sized and you can’t even tell there is toothpaste on them until you start using them. These are on Amazon.

36 Prepasted Disposable Toothbrushes | Pre-Pasted Soft Bristle Tooth Brush Set for Dental Care & Oral Hygiene | Individually Wrapped Toothbrush Pack Airbnb Gifts | No Water Needed (36 Pack) https://a.co/d/7UvkdZT

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I agree with the person that said pick the right time. You know your mother best and when she is more calm. My father, who had Alz, would respond to "I love you" when he would get upset with something we were doing to help him. I would just repeat it over and over again and it calmed him. He was also more will to do things first thing in the morning right when he woke. So that was when we would bathe him so he would not get irritated. Maybe brushing your moms teeth does not need to be after meals like most people do. As long as you get her teeth brushed maybe twice a day...anytime of the day. Kind words and a soothing voice always calmed my father....maybe even a distraction story or music will help. It is all trial and error. My husband is bedridden so I choose the best times to get the job done. Try not to get frustrated and always try to put yourself in her shoes.

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The teeth and gums will end up hurting even more and will rot my suggestion:

Finger toothbushes... from Walmart

20pcs Disposable Finger Stalls Toothbrush Gauze Dental Finger Brush Oral Hygiene Cleaning Wipes Teeth Cleaning Accessory for Outdoor (White)

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My father is 92 with frontal lobe dementia and can no longer brush his teeth. I hired a mobile dentist to come clean his teeth every 90 days. Dad is able to sit in the chair and let them clean his teeth for about 30 min. Sometimes we have to do 2 sessions to get both sides cleaned, which is 2 appointments. A lot of memory care and assisted living facilities have access to mobile dentist, who come in a handicapped RV that is fully equipped to perform dental work, including cleanings, fillings, root canals and crowns. You might want to see if a mobile dentist is available to come to the facility where you mom resides. My father is in the Houston, TX area.

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Try giving her a toothbrush all set up to brush for herself, and say nonchalantly, Here you go Mom, for a quick little brushing, like its routine. Positive, positive, positive. Always. They really would rather do things themselves, but it can be too much effort. Physically but also mentally, from us ordering them around like they are our kids.

The technical... Make sure it's a soft and small child's brush. Maybe in the comfort of her chair. Have on the ready a couple cups for rinsing and for the waste. Or even a little tub for waste. And something to dry her mouth or catch stuff as she goes (make that 2 dry cloths). That is much easier. Even just a large yogurt container. If that is just not doable, some child's mouthwash to swish around in lieu of brushing. Don't in any way criticize the brushing. Just be glad it is taking place. Try once a week, then work up 2x, etc. You can add in assists later, such as "Oh did you get the back?" Have a great tasting kids SWEET mouthwash for after. Say something like here's the good part! You will probably have to tell her not to drink it but swish and spit. If its a kids, it will be ok if she does accidently drink it. Reinforce with Don't you love that fresh clean feeling?? Or "I always love that fresh clean feeling". Be genuine with that. Dementia is all about sensing. If she refuses all, try again the next day. Sometime she may. Or you might even say want me to do it for you? :) Just a quick brushing, so you don't get infection. If she agrees, then truly make it a quick brushing! Don't try to get it all. You can get some one dsumy, some another. The key is to make it a positive moment and build routine.

Another idea to start is (in her chair). "Let me see that smile again". When she smiles, say domething like " Yup yup looks like you got something in your teeth there. Let me grab you a tooth brush. And then go through the above.

And then after, Ok let me so pearly whites!! Beautiful. I love that smile of yours. Hollywood smile, Hollywood smile. Whatever makes sense to you. Humor, loving, all that good stuff. Best of luck and God bless!!

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Love your approach. It’s all in “selling” the idea. Multiple approaches and negotiation.

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Can your Mom rinse out her mouth (e.g. take in water and spit it out)? I agree with the others, your Mom has periodontal disease which will eventually hurt enough that will affect her eating.

Just making sure she rinses her mouth a lot (and possibly many times a day) to get the extra food particles out will help a lot. Plain water is good enough. One can get a cheapie plastic bowl to spit out the water into so that it is very easy for her to rinse her mouth. I do tap water so that if she accidentally drinks any of it, no harm is done. In addition, my Mom doesn't like the taste of toothpaste.

Once you are able to establish to take water in and spit it out, then try a brush (no toothpaste). Have her continually rinse her mouth while you are doing this (then it isn't as easy to see the blood). Don't brush hard. Don't try to be complete. The key here is that it is difficult for them to hold their mouth open or keep their tongue away from the brush while you are doing this and the toothbrush does hurt those sensitive gums. Maybe you brush 4 times a day (it doesn't matter if it is after meals or not), a quarter of her mouth at a time.

Don't worry about complete teeth cleaning, gum massage, toothpaste, mouthwash, or floss. At this point, anything is better than no dental hygiene at all, which is what happens to a lot of older folks.

P.S. Also, certain foods will help clean one's teeth and encourage saliva production. You could use those foods in-between meals or as a desert along with rinsing out her mouth.

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Bottom line. She needs dental work.

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Nandulal: Your mother needs to be seen by her dentist stat. It is IMPERATIVE that she be seen immediately before dental carries lead to pain due to teeth that still have the nerve/no root canal. That said, root canals sometimes fail. Do not wait for a middle of the night dental emergency!

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My dad was more tolerant of a water pik (with warm salt water) than a toothbrush and he would rinse some mouth wash a couple of times a day. It's not as good as real brushing but it's a lot better than nothing or big arguments.

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If there is blood, it might be hurting her or scaring her. Professional advice would be best. Strawberries clean teeth. So does cheese. Personally I am of the opinion that rice also cleans teeth. There are new things that clean teeth that are not toothbrushes, but this dental-shaped thing you put in your mouth and it vibrates. A soft cloth rubbing over teeth is better than nothing. Will she floss with one of those pick things? If so, be sure she uses antiseptic rinse before and after, to prevent flossing from causing temporary (or worse) inflammation.

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Also "non-aromatic" toothpastes like for children (watermelon, strawberry) are a lot less jarring than the typical menthol ones. Xylitol supposedly cleans the mouth and is available as a crystal powder as well as in Theramint breath freshening mints, which melt in the mouth. Xylitol is sweet - love it. Calorie free.

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Don't forget about children's flouride rinses to help keep teeth strong.

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Go to a medical supply and buy these small sponge mouth cleaners. They have listerine in them and I also add children’s toothpaste in fruit punch. They are soft and comfortable to clean inside of mouth. My husband has end stage dementia and that is what I use with no pain or bleeding for him. He has all his teeth so it is good for teeth and gums. And he can swallow the toothpaste. It is made by Oragel and comes in a few flavors. Hope this helps.

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I would talk to my doctor , and perhaps an occupational therapist. They can help with problems of doing ADL’S. Ps. Fluoride rinses should never be swallowed..

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What happens to a dementia patient who refuses to brush their teeth?

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