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.


Part One

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!

Toothpaste

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.


Part Two

Edentulous Patient (No Teeth)

This should be the easiest individual to care for, but if they have some form of dementia it can be extremely difficult!

If the individual you are caring for wears dentures, it is up to you to remove and clean them at night, putting them safely away in a see-through glass or specified denture case. You are in charge of their dentures and heaven forbid they lose them on your time.

They are extremely expensive to replace and ridiculously difficult to re-fabricate on a dementia patient. It’s not easy for any elderly patient to get used to a new prosthetic device and almost impossible for the dementia patient.

If they do lose their dentures, their ability to eat the foods they live to enjoy has become compromised.

So never allow them (nor should you) to wrap the dentures in tissue or paper towels and never, ever lose sight of them when they are ill. I can’t tell you how many dentures I have replaced because they were flushed down the toilet after vomiting. It happens all the time.

And as hard as this subject is to broach for me- it must be said, “Take the dentures our before getting into an ambulance!” The emergency medical team and first responders have one job only – to keep the individual in crisis alive. Things happen quickly and keeping the airway clear is their top priority so they will need to remove the dentures.

Think quickly as a caregiver and remove the dentures before leaving the house! I am telling you this to be prepared. I hope it never happens but if it does you will write me a thank you note later. You can bring the dentures to them later once they are settled in a hospital room.

Another important life lesson learned the hard way…ambulances are NOT responsible for lost dentures but hospitals ARE responsible. No matter, you do not want to misplace or lose anyone’s dentures. Take them out and only give them back once it is safe.

This also applies to partial dentures. Remove them before the ambulance arrives. I know things are in disarray and teeth are the last thing on your mind, but think about it like this, would you bring your valuable diamond ring to the hospital? No, that you would remember to remove for sure. Dentures are even more important and much more difficult to replace.

Removing Dentures & Cleaning The Mouth

Complete Dentures are removed by placing your index finger between the denture and the gum line midway back on the cheek side. Pull it down quickly if it is a top denture or pull it up quickly if it is on the bottom.
The suction is broken and the denture usually drops or pops up. Sometimes the individual may need an denture adhesive making it a bit more difficult to remove. But do not dispair… quickly pull down or up and it will definitely come out.

I cannot tell you how many times caregivers are fooled and don’t realize their individual wears dentures. I usually get a call that the patient is complaining of pain and that pain is from dentures that haven’t been removed for ages!!

If you do not remove the dentures every night it is possible that the tissue in the mouth can grow around the denture causing tissue overgrowth (dentally known hyperplasia of the tissues) causing an infection and or swelling that causes a lot of pain. Sometimes the patient will be forced to stop wearing the denture(s) and this event will change their quality of life. The denture can usually be adjusted away from the the area where it is rubbing against, but you want to only adjust as a last resort.

So remember to remove the complete or partial dentures at night and let the mouth and tissues rest.

The dentures are extremely fragile (made of a special type of plastic) so be careful not to drop them. They can and might break in half. Should that occur, LISTEN CAREFULLY…

DO NOT ATTEMPT TO REPAIR THEM YOURSELF…. do not buy a self-repair kit sold online or at the local pharmacy. It won’t work and the denture(s) will instantly become unrepairable! They should only be repaired by a professional laboratory technician, so please heed my warning! Call your dentist…it’s a quick and affordable repair.

Clean the dentures by soaking the dentures using special denture cleaning effervescent tablets (unless there is a soft reline in which case soak them in cool water with the cleansing tablet for no more than 10 minutes) found in the local pharmacy. You can also use a denture brush to brush gently on the inside to keep them fresh and bacteria free. If the denture has a reline material in it brush very gently to not rip the reline material away from the denture.

Partial Dentures (Some Real Teeth Remaining & a Denture Replacing the Missing Teeth)

To clean them, brush the remaining real teeth as I instructed previously and remove the partial dentures as described above (except use your thumb or index finger under the clasp and pull down if it is an upper partial or under the clasp and pull up for a lower partial).

There are three types of partial dentures you may see as a caregiver. And again you may be fooled not knowing there was a removeable appliance in the mouth in the first place. I never knew my grandmother had a partial denture until she got sick and I saw it in a glass in her bathroom!

The first type is a denture where the base material is predominantly metal. Patients find it the most comfortable and it fits like a glove. You clean it by either brushing it everywhere with a denture brush and/or soaking it overnight with a cleansing tablet. If you do not remove it and brush the remaining teeth, food and bacteria will collect around and under the clasps (that hold it in on their real teeth), eventually leading to decay and possible tooth loss. I get the occasional call that the patient’s partial is loose and rocking. I usually go with the intention of tightening a clasp, but find the unfixable clasped tooth rotted and broken off. This can only be repaired by extracting the broken off root left in the gum and adding a new clasp on a different strong undecayed remaining tooth. It sounds difficult, but I can do it bedside.

Valplast (soft flexible partial denture) is also a very popular choice when deciding what partial is right for you. No metal is showing, sometimes the clasps are clear and it looks very natural in the mouth. It is somewhat soft and is kinder to the tissues making it easier to get used to. But this type of partial due to its material attracts a bit more food and bacteria (the material by nature is a more porous).

It must be removed at night and perhaps after also after every meal should the individual cooperate. Soak it for 10-20 minutes in cool to warm water (never hot) then leave it clean in a case or clear glass overnight.

If you step on it or put it in the washing machine by accident it is not repairable so be careful!

It is also extremely difficult should a tooth break off as you cannot add a new clasp. So this is a major con when deciding which partial is right for a patient with dementia. I always advise a metal partial or an all acrylic partial as it is easier to repair and adjust.

The third type of partial is an all acrylic (all plastic) partial with wire clasps. It is totally repairable (exactly like a complete denture) and you can easily add a new wire clasp when needed. It can also be converted easily to a full denture if all teeth are lost or unfortunately become unsalvageable in the future.

This of course also needs to be removed at night and again the clasps are food traps that eventually will cause decay. This partial (which is sometimes referred to as a flipper) can cover the palate or can replace one or more teeth that are missing clasping just to the teeth adjacent to the missing tooth (teeth) easily.

My only word of warning is to be careful when the flipper is small enough that it can be swallowed. If the patient has dementia you need to think carefully about the repercussions if you can’t find it in the mouth. This type of partial must be watched and must be removed every night or perhaps permanently removed if there is even the slightest possibility of swallowing it!

If you are reading this and the individual you are caring for is in a Nursing Care Facility, my best advice is to have the patient’s name placed in the patient’s partial or full denture. If a lost denture is found, they can easily identify the rightful owner.

I have worked in many nursing homes over the years and identifying a found denture is a lost cause. A denture lab can easily place a name into the denture. If the nursing home does not provide that service, take them to your personal dentist to get this done. Do it… I promise you will thank me. I always place the name on every denture. Some states prefer an ID number but that proves to be a waste if there isn’t a central ID system in place.

To Summarize
Brush their teeth at least twice a day. If you can only brush them once, choose nighttime. At night there is a huge buildup of collected food AND a full day’s worth of bacteria.
If a full or partial denture is worn, remove it, soak it and leave it in a clear glass or denture container. Never wrap a denture in tissue or an accident will eventually happen.
Use a mouthwash if swallowing it is not an issue. And Alllday xylitol gel if swallowing toothpaste occurs.
Use soft picks if they allow under crowns and or bridges (especially after eating anything stringy like chicken, meat, corn…) and consult with a dentist if bleeding gums persist.
Never attempt to repair a broken denture. Leave it to the professionals.
ID’s should be placed in every denture no matter where they reside.
Take out dentures before going to the hospital or in the ambulance.

I hope that this manual will help you improve the oral health of the individual that you are caring for.

Contact me using the form below if you want to be one of the first individuals to try my toothbrush.

Also please feel free to contact me for any reason whatsoever. Just remember I am located in Manhattan and chances are there is no Housecall Dentist (YET) in your area to refer you to.

I promise I am working hard on changing that!!

 

Do you have any questions? Or, are you interested in learning more about my patented toothbrush?

Feel free to reach out and connect with me!