Vulnerable older people living in care homes are at higher risk of oral health problems and related conditions because of high levels of dependency and dementia.
Unfortunately as people advance with dementia they often become more resistant to mouth care. Admittedly, providing good oral care for residents that are uncooperative can be particularly challenging especially if they are aggressive.
Care staff are understandably less likely to want to approach and carry out mouth care in these cases. If regular oral care is not carried out, a vicious circle of pain, discomfort and impact to the general health leading to an increased likelihood to resistance.
Strategies and Tips you may find helpful
1. Encourage people to be as independent as possible
· Approach from in front, kneel down so that your face is at the same level or lower than theirs.
· Say what you are going to do before you do it – for each step. You may need to show them what you will do – on yourself.
· Give reasons for what you are doing.
· Give positive feedback and encouragement.
· Reflect on how good it feels to have a fresh mouth.
2. People refusing mouth care
· Try to find out why the person does not want you to carry out mouthcare. Respond to this.
· Lack of wellbeing/tiredness? – come back later when the person may be more receptive.
· Pain – check for soreness, infection, broken teeth, etc. and take appropriate action.
· Fear – provide reassurance; explain and if necessary what you are going to do on yourself.
· Develop a routine (e.g. same time/same carers).
· Try not to carry out all personal care procedures at once. Carry out mouth brushing after sitting up and washing face, but before full wash.
· Give a reason, e.g. ‘I can see some food around your teeth, I’ll clean it away so you’ll be more comfortable’.
3. If someone refuses to open
· Be patient and reassuring.
· Soften the brush by running it under warm water and soft toothbrush will help
· Say what you are going to do before you do it.
· Touch the mouth, or teeth gently with the brush to prompt opening.
· Place the back of the toothbrush against the lips and gently twist it so it opens the lips and touches the front teeth.
· Start by cleaning the outer surfaces of the front teeth. Then move to the outer surfaces of the back teeth.
· Give positive feedback and encouragement at each step.
4. Biting the toothbrush
This may be a sign that the person’s face, mouth and throat have become abnormally sensitive. In this case the biting (bite reflex) may be accompanied by gagging, withdrawing, grimacing and crying out.
1.Gently rub cheek to relax jaw muscle.
2.Start by cleaning the outer surfaces of the front teeth. Then move to the outer surfaces of the back teeth.
3.Ask the person to say ‘ah’ for cleaning the biting and inside surfaces.
4.Give positive feedback and encouragement at each step.
DO NOT PUT YOUR FINGERS IN THE BITING SURFACES AT ANY TIME
5. If someone show physical aggression
· Come back later; pick another time of day when the person is calmer and more receptive.
· Try another carer with whom the person is more familiar/relaxed.
· Explain what you are going to do and why you are going to do it.
· Be patient, take time and be reassuring. Do not talk about the person but always to the person.
· Stay calm and quiet yourself.
· Look in the mouth for any signs of soreness, infection, broken teeth etc.
· Notify nurse and refer to dentist as appropriate. Use a second carer to distract, reassure or hold the person’s hand, and for risk management.
Any lasting change in a residents’ normal response to oral care may be due to discomfort or pain this should never be ignored and should be investigated by a nurse or dental professional.
Oral Care Challenges. Tips and Techniques - Considerations for Dementia
Carers can view a daily mouth care for people with cognitive and physical impairment.
Best practices in oral hygiene with proven techniques to overcome resistance to care among persons with dementia and related conditions.
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