Dental care and dementia: What you need to know

How does dementia affect dental health?

Someone living with dementia may struggle with everyday tasks – and that includes brushing their teeth. They might:

• forget to brush their teeth
• not remember how to brush their teeth
• not understand why teeth cleaning is important
• have trouble holding a toothbrush or applying toothpaste
• not be able to tell you if they have toothache, so problems get worse
• develop a sweet tooth, making tooth decay more likely
• forget or not want to go to the dentist

Over time, this can make someone with dementia more likely to experience:

• tooth decay
• gum disease
• tooth erosion
• sensitive teeth
• dry mouth (which is often a side-effect of dementia medication)

These conditions can be painful and make it difficult to eat and speak properly. Gum disease may also increase your chance of developing other health conditions, like heart disease, diabetes and dementia.

How can I spot dental problems in someone with dementia?

If you’re caring for someone with dementia, they might not be able to communicate if there’s something wrong with their dental health. But there are some signs you can look out for, including if they:

• don’t want to eat
• look uncomfortable when eating - making faces or holding their face
• wince when eating hot or cold food and drink
• have swollen or bleeding gums
• have loose teeth
• have a dry, cracked mouth or tongue
• have bad breath
• can’t get their dentures to fit
• struggle sleeping
• behave aggressively

If you spot any of these problems, make an appointment to see a dentist.

How can I help someone with dementia take care of their dental health?

Helping someone with dementia look after their teeth can be different for each person and change as the condition progresses. Here are some tips to care for dementia patients’ teeth throughout each stage of the condition.

Early-stage dementia

During the early stages of dementia, you might find that your loved one can still brush their own teeth. At this stage, encourage them to keep brushing independently for as long as they can. If they do forget, try setting reminders on their phone or smart speaker, or leaving a note somewhere. They should:

• brush their teeth twice a day for two minutes
• choose a toothbrush with a small head and soft bristles that’s easy to grip
• use a pea-sized amount of toothpaste that contains at least 1450ppm of fluoride, which you can find on the packaging
• spit instead of rinsing, so the fluoride stays on their teeth
• replace their toothbrush every three months, or sooner if the bristles look worn
• try not to keep sugary food and drinks in the house, to reduce the chance of tooth decay
• try an electric toothbrush if they’re finding it difficult to use a manual one

And if at any point you discover they have:

• trouble swallowing, ask your dentist about non-foaming toothpastes
• sensitive teeth, try using toothpaste specially made for sensitive teeth
• dry mouth, encourage them to sip water and ask their doctor about alternative medication

Middle-stage dementia

As dementia progresses, someone with dementia might need extra support taking care of their dental health. So you might need to help them with brushing and reminding them of what to do. Try the following.

• Use the ‘Tell-Show-Do’ method and break things down step-by-step. Tell them exactly what each step involves, demonstrate this on yourself and then encourage them to mirror your actions or let you do it.
• Gently guide their hand if you need to but try not to take over completely yet.
• If they really don’t want to brush their teeth, stop and try again another time. In the meantime, encourage them to use mouthwash twice a day or teeth and gum cleaning wipes temporarily.

Later-stage dementia

Towards the later stages of dementia, you might need to take a more active role in brushing your loved one’s teeth for them. To do this:

• wash your hands and put on disposable gloves
• ask them to sit on a chair and place a towel over their chest
• stand behind them looking into a mirror and gently cradle their chin in your hand
• ask them to open wide so you can reach all their teeth
• brush using circular movements and cover all surfaces of their teeth (an electric toothbrush might make this easier)
• try cleaning between their teeth using dental floss, an interdental cleaner, or water flosser if possible
• try to inspect the inside of their mouth for problems like swelling, bleeding or loose teeth if you can

How do I care for someone’s dentures?

If the person you’re caring for wears dentures (false teeth you can take out), it’s important to keep them safe and clean. To care for dentures:

• take them out at night and store them in a labelled container so they don’t dry out
• leave a note on their bedside table to remind them to remove their dentures at night
• clean dentures twice a day using a toothbrush, denture paste and cold water
• clean them over a soft surface – like a sink of water – so they don’t drop and break
• replace lost dentures as soon as possible – they might struggle to eat and speak without them

Finally, if you need any support looking after the dental health of someone with dementia, reach out to a dentist for advice. Some dentists have special training in treating people with dementia, and others can pay you a visit at home.