Why People with Dementia Resist Mouth Care

• Resistance is usually fear-based, not intentional aggression.

• Brain changes affect fear responses, making low-threat situations feel threatening.

• Reflexive behaviours include clenching, biting, moving the head, or closing lips.

• Early dementia: may need only reminders.

• Mid-late dementia: may communicate pain or distress through crying, hitting, or passivity.

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General Approaches

• Know the person: adapt techniques to their needs, fears, and pain.

• Use visual cues and demonstration; limit talking.

• Build trust gradually; break brushing into small steps.

• Positive feedback, simple language, and reassurance.

• Approach side-on, at eye level, with gentle touch.

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Encouraging Independence

• Let residents brush themselves where possible (sense of control).

• Techniques:

  • Bridging: mimic brushing, let resident follow.

  • Chaining: guide hand to mouth and let resident continue.

  • Hand-over-hand: assist directly if needed.

  • Distraction: singing, familiar objects, music.

• Timing: choose calmer times; break brushing into sections.

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Dealing with Resistance or Aggression

• If mouth care is refused, come back later; try a familiar carer.

• Stroke cheek/jaw, explain each step, and start with front teeth.

• If biting or sucking toothbrush: have a spare, rub jaw to relax.

• If physically aggressive: remain calm, patient, reassuring; check for pain or infection.

• Grabbing hands or anxious residents: use hand-over-hand, gentle guidance, distraction, and reassurance.

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Practical Tips

• Unable to spit: use non-foaming toothpaste, dampened brush, cup or gauze, ensure upright position.

• Denture removal: encourage resident to do it; use hand-over-hand guidance if needed.

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When to Escalate

• Repeated refusal should be reported to senior nurse, dentist, or mental health team.

• Follow Mental Capacity Act 2005 principles: care must be in the resident’s best interests and least restrictive.

 

 

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What to do if someone continually refuses mouth care

 If a resident refuses mouth care on several consecutive attempts, this should be escalated to a senior nurse or their medical team

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Who should consult with one of the following:

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• dementia Liaison or Community Mental Health teams

• the resident’s dentist if they have one or healthcare professional

• your local NHS Dental Helpline for advice and information on which dentists in your area can help.

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Mental Capacity Act 2005.

Acting in the best interests of someone lacking capacity to make a decision for themselves

People who work with or care for others who lack capacity to make decisions have a legal duty to consider the Code of Practice. Any care provided should be in the patient’s best interests and be the least restrictive on the individual’s rights and freedom of action. It is important to make every attempt to support a patient with mouth care, a failure to do means neglecting them of care.

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If issued with a certificate of Incapacity

All regular personal healthcare (oral care is included) is to be given despite resistance – but the principles of the Incapacity Act must still be upheld. Consideration should also be given to local policies and the resident’s care plan.

One of the key principles of the Act is that any act done for, or any decision made on behalf of a person who lacks capacity must be done, or made, in that person’s best interests.

As long as these acts or decisions are in the best interests of the person who lacks capacity to make the decision for themselves, or to consent to acts concerned with their care or treatment, then the decision-maker or carer will be protected from liability.

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Transforming Mouth Care Challenges into Success  Download presentation HERE

[1] No More Fighting and Biting During Mouth Care: Applying the Theoretical Constructs of Threat Perception to Clinical Practice,   Rits  A Jablonski et al. PMC 2012 HERE

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