This Manual Includes Brushing, Dry Mouth, Lip Biting and Sucking the Lip, Ulcers, Teeth Grinding, Denture Care And Repairs.
Due to the growing geriatric population worldwide,
I decided to limit my practice of dentistry to the elderly and frail who are homebound. I have been practicing geriatric housecall dentistry for almost 35 years and have decided to share my expertise with caregivers to help provide the necessary quality care to this under-served population.
With advanced training in geriatrics, hospice care and all forms of dementia and Parkinson’s Disease, my goal is to triage the situation to ensure the patient is receiving proper nutrition for their overall health and to ensure that they are not having any pain stemming from their teeth or ill-fitting dentures.
Recently, I have solved the issue of how to treat these patients in need and revolutionized the field of home health care dentistry with my geriatric dental consulting practice. I wants to share my expertise so that caregivers are more confident in daily oral care whether it is with brushing, flossing and using picks, or removing and cleaning full or partial dentures.
Part One is for individuals with teeth.
Part Two is for the edentulous (no teeth) or partially edentulous (some teeth).
This manual will teach you everything you need to know about keeping their remaining teeth and dentures in a good, functional state for hopefully a very long time.
You will also find some do’s and don’ts that are extremely helpful knowledge for denture wear and care. Please let me know what questions you have that I did not address. I am here to advise and help you.
One of the Caregiver’s Daily Chores
You are the caregiver for your loved one or the individual you care for and have a multitude of daily chores that are necessary to keep their quality of life up to par.
You need to wash, toilet and feed them daily. You also want to keep them stimulated so that they have something to do and something to look forward to every day. That is your responsibility or job. Life needs to go on and everyone deserves to live their best lives.
One of the first things you do on your own since childhood is wake up and brush your teeth. And the last thing you do before going to bed (you should be doing this but not everyone was taught this ritual!) is to brush and (hopefully) floss your teeth. So why can’t we continue this daily routine forever?
Because that is one of the first chores we neglect when unfortunately dementia or Alzheimer’s Disease occurs. And it isn’t easy to brush when you aren’t brushing your very own teeth and perhaps the person isn’t willing to cooperate. There are other diseases such as Parkinson’s and ALS that also make it difficult for individuals to brush effectively on their own. Not to jump too far ahead of myself, but I am excited about the toothbrush that I designed and is patent-pending that will effectively answer the prayers of those who understand the importance of daily oral care but are afraid to brush for someone else.
Please sign the form at the bottom of this page with your name and email to be one of the first to purchase it, and I promise it will be affordable for all. This is my life passion and I want everyone to keep their teeth healthy and useable and not let diseases or impairments destroy the quality of life everyone deserves. Chewing solid food with healthy teeth is attainable and my toothbrush will keep their teeth intact …Stay tuned!
Ways To Brush Their Teeth
The Sponge – The sponge lollipop is a great tool (usually used in the hospital) to clean the patient’s gums who have no teeth but in no way should you think that this replaces a toothbrush with bristles. Please do not use this on teeth. Only use this to clean the soft tissues in the mouth on those who have no teeth.
Baby Toothbrush – Some caregivers believe that products used on babies are effective yet gentle enough to use on the elderly. And I say that they are absolutely right. My only criticism is that you need a bigger toothbrush head so that you can cover more teeth quicker. But a baby toothbrush may work well for you.
Adult toothbrush – Always look for a toothbrush with extremely soft bristles like the baby toothbrush. And choose one where the toothbrush head has a cushion (they call it a tongue scraper) against the hard plastic in case they accidentally bite on it. You don’t want them to bite down and crack a tooth or break a filling. Don’t let this fear stop you. You MUST brush their teeth every day, twice a day! This isn’t the ultimate answer, but it will have to do until my toothbrush comes to market (and then I will edit my recommendations ).
Scenario Where Caregiver is Nervous to Brush
They see bleeding at the gum line when they brush their individual’s teeth… so they think that they must be doing something wrong!
Listen carefully…Please do not stop brushing because you see some blood. That is the number one reason caregivers tell me they stopped brushing and resorted to “cleaning” with the sponge.
And let me repeat… the sponge does nothing… do not think you are cleaning with the sponge unless you are cleaning a table or countertop in your kitchen!
The gums/teeth are bleeding because you are not brushing properly.
How To Properly Brush Their Teeth
Position the toothbrush so that the first row of bristles are touching below the gum line. There is a small “pocket” between your tooth and gum (you can feel that area in your own mouth with a toothpick) that needs to be cleaned. This is what prevents gum disease, also referred to as gingivitis (inflammation or the redness you see at the gum line that scares you when they bleed) that eventually progresses to periodontitis (gums bleed, teeth become mobile then painful and eventually fall out).
It saddens me to hear from the caregiver or family member the same story over and over again. The individual took impeccable care of their teeth diligently brushing, flossing and 6-month visits to the hygienist and dentist. Now that they can’t do anything themselves and their mouth is FALLING APART! Please help!
What Happens to the Teeth When You Stop Brushing?
Aside from the inflammation and redness you see that causes the teeth to bleed when you brush, something even more irreversible may occur. The Food Lies On The Front Of The Teeth!
The food if not removed (ie: brushed) sticks to the teeth and eventually causes a white spot which in dental terms is called initial decay. Over the course of weeks and/or months, this white spot goes deeper and deeper probably causing pain (the individual may or may not complain) until the tooth eventually breaks off leaving the root inside of the gum.
I cannot tell you how often I get a call that teeth are falling out. I have to them deliver the bad news that the tooth did not fall out (I have to point to the stub or root left to prove it).
Crowned (or capped) teeth are especially vulnerable to tooth-rotting (decay). It is extremely important to remember to clean the crown at the gum line where it meets the real tooth (remember that a “cap” or crown is essentially the “hat” on the real tooth underneath meant to protect it). If you neglect to brush caps/crowns or bridges at the gum line, decay will easily occur and eventually the cap/crown with the real tooth attached on the inside WILL break off. THIS CROWN OR BRIDGE CANNOT BE RECEMENTED ever again, and the root will need to be extracted.
So brush at the gumline front and back and do not stop if you see a little blood. If you do see a lot of blood, call the dentist to get checked. And if a tooth is loose that needs to be checked as well.
Mouthwashes and Fluoride Rinses
If your individual can still swish and spit (If they swallow, skip this paragraph because swallowing is a huge no-no) you may want to incorporate a swish and spit with a mouthwash.
I ask my cooperative patients to do this after brushing. It aids in removing the leftover particles and bacteria that may linger. I often recommend a fluoride rinse for those who can still brush but maybe not as well as they would like, to keep them from developing decay especially on the front of their teeth where food sticks the most (the tongue and saliva help in removing food from the back of the teeth).
For most of my patients who can still swish and spit, I prescribe a chlorhexidine gluconate rinse (brand name Peridex) which helps keep the gums clean, decreases bleeding and helps from developing gingivitis/periodontitis. The side effect of Peridex is that the teeth turn a bit grey, but the benefit outweighs the risk. A dentist needs to prescribe this oral rinse, and trust me that it really works!
If the individual you are caring for cooperates and can swish and spit, then the toothpaste you choose is a personal choice. If they swallow it, you need to be more proactive.
I find it is more important to brush well twice a day. And even if you use just plain tap water to brush, it is much more effective at removing food and bacteria than the sponge or (obviously) doing nothing at all.
My solution for those who will swallow toothpaste is to use a xylitol gel. I usually do not recommend individual products but in this case, I cannot help myself. AllDay made by the Elevate Company is 44% xylitol, has a great taste, has the consistency of toothpaste and is meant to be swallowed.
Xylitol is a naturally occurring sugar found in fruits and vegetables and has been found most effective for individuals with dry mouth, and for those who cannot use traditional toothpaste.
It can be purchased on Amazon and is well worth the money. It can also be used alone (spritzed in the mouth) but brushing with it is more effective when used as a “toothpaste”.
The consistency makes it feel like toothpaste and aids in picking up food particles. Trust me on this one.
Dry Mouth and Bad Breath
Dry mouth is a result of decreased saliva levels in the mouth. A normal amount of saliva is important as it is a natural cleanser against the bacteria that may cause bad breath, gingivitis, and decay. Dry mouth can also be a result of a side effect of medications or diseases such as Parkinson’s.
My go to product that I suggest is AllDay that can be purchased on Amazon. Bad breath and decreased saliva should be checked by a dentist if the issue persists after using an over the counter product. There are prescription strength products that the dentist can prescribe.
Ulcers and Trauma on the Lip/Cheek caused by biting or sucking And Grinding of the teeth
Some caregivers feel nervous to care for the mouth when they see trauma occurring whether the individual is biting their lip (causing visual damage such as an ulceration on the lip or cheek) or they are grinding their teeth (causing obvious damage as they teeth appear to be getting smaller and shorter). The caregiver must know that THEY are not causing this to occur by performing oral care and that this may just be a targeted behavior that a dentist can eliminate.
The primary care physician should also be involved as grinding is a possible side effect of many medications that dementia patients are prescribed. Sometimes the dosage may simply be adjusted and the grinding will stop.
Grinding the teeth and listening to that awful noise (like chalk on the blackboard, enough to drive anymore crazy) is definitely damaging to the teeth (at the very least causing sensitivity) and causes caregivers to worry that nothing can be done to stop it.
Something CAN be done to prevent the grinding to stop. It’s important to find a dentist who can deal with this situation and please let me know if your dentist needs my help in treatment planning. It’s important to call a dental professional so something as simple as a grinding guard fabricated by the dentist that fits thinly against the lower teeth could eliminate he problem. But understand that this type of situation MUST to be assessed on a case by case basis.
It’s also important to know that an ulcer in the mouth lasting more than two weeks could be a bigger issue or problem. So it’s important to call a professional so something as simple as a grinding guard fabricated by the dentist that fits thinly against the lower teeth could fix the problem. But understand that this type of situation MUST to be assessed on a case by case basis.
In Summary for Individuals With Teeth
It’s important to brush even if it makes your daily chores more difficult. Not having tooth pain or gum disease gives everyone a better quality of life and keeps chewing and swallowing status quo. Eating will always be one of life’s pleasures and maybe the last great pleasure you have as you age.
Food caught between the teeth is painful and obviously we use floss or picks when it happens to us. As a caregiver you need to be extremely proactive and help with this chore if you notice they are picking at the teeth after eating a meal.
You may or may not be able to incorporate a mouthwash or fluoride rinse. Remember… the minute they swallow you MUST discontinue the products that cannot be swallowed and switch to those that can.
Don’t stop brushing if you see the gums bleeding. If the bleeding is profuse (or perhaps they are on blood thinners) you must check with your dentist.
Get a full set of X-rays taken before dementia progresses and if this already occurred get the newest ones taken from the last dentist visits. Either have them sent to you digitally or pick them up for safekeeping.
Brush their teeth twice a day and use soft picks (if they allow) for food caught between teeth or under bridges. Flossing should be done but not if they don’t allow (you don’t want to get bitten). The individual floss swords are great and I recommend them for those who allow you to help them. If they are grinding or physically hurting themselves by biting or sucking their cheek or lip, a dental evaluation is necessary so that this behavior can be modified to prevent further damages.