Who is this leaflet for?

This leaflet is for people with memory loss and their families or carers who help with mouth care.

It gives practical advice for helping to give mouth care.

At the end of this leaflet, you will find information about services which offer advice and support.

Helping with mouth care

A healthy mouth feels comfortable. We need a healthy mouth to eat, speak and feel happy.

A person with memory loss may need help to keep their mouth healthy.

A person with memory loss may need to be reminded to brush their teeth and clean their dentures if they wear them.

It can help to guide the person with memory loss through the steps of looking after their mouth.

Someone with memory loss may need their carer to brush their teeth and clean their dentures if they wear them.

Planning for mouth care

Discuss mouth care with family, carers and any health care workers looking after someone with memory loss.

If you are a health worker, record what is decided about mouth care in the person’s health records.

You may like to use our Personal Oral Health Plan to record how someone likes their mouth to be cared for.

The Knowing Me resource can also be used to record how someone likes to be cared for.

If you would like a Personal Oral Health Plan or a Knowing Me resource, please contact us. (Our contact details are listed on the back page of this booklet).

If someone with memory loss is not able to make a decision about their mouth care, care can still be given if it is in the best interests of that person. (Mental Capacity Act, 2005).

The person can show that they agree to mouth care by saying that they agree, or by opening their mouth and allowing care to be given.

Preparing to give mouth care

Mouth care can seem threatening to someone with memory loss.

Make sure that the person you are caring for has the communication aids that they need, such as hearing aids or glasses. This will help them to understand what is going to happen next.

Approach them from the front. A person with memory loss may be less aware of things to the side of their vision.

Use warm, calm body language.

Smile and introduce yourself each time, because the person with memory loss may not remember who you are.

Try to make mouth care as relaxed as possible.

Say what you would like to do.

Use short sentences, simple words, and speak clearly.

Ask one question at a time and give one instruction at a time.

Show the person what you would like to do.

Break down the activity into each step.

A person with memory loss may be able to brush their own teeth if their carer shows them the next step.

Placing your hand over their hand to guide them in toothbrushing may be helpful.

Give lots of praise.

The environment

Mouth care can be given with the person sitting on a chair or their wheelchair in the bathroom. This is the usual place for mouth care, and a familiar setting can help prepare for tooth brushing.

If someone can brush their own teeth, check that they can easily reach the sink.

Try to make the environment as calm, quiet and positive as you can. This can help the person you are caring for to feel more relaxed and comfortable.

Playing music which they enjoy may help them to relax during mouth care.

In the later stages of memory loss, someone may not always recognise themselves. A bathroom mirror may cause confusion, and choosing another place for mouth care may be better.

Toothbrushes

Choose a toothbrush with a small head and soft to medium texture bristles. Change your toothbrush every one to three months.

Different kinds of toothbrushes are available. Some have wider handles which may be easier to hold. Talk to your dental or oral health professional about different toothbrushes available.

An electric toothbrush may help if it is hard to use a standard toothbrush. With an electric toothbrush, clean one tooth at a time

Toothpaste

Fluoride helps to protect teeth from decay. Fluoride is not added to Oxfordshire’s water supply, but it is added to many toothpastes.

Use toothpaste containing at least 1350ppm fluoride. The fluoride level is printed on the box or tube.

The dentist may prescribe toothpaste with higher fluoride for some people (2800ppm or 5000ppm fluoride). This should be used instead of ordinary toothpaste.

Unflavoured and non-foaming toothpaste can be used for those with sensory needs.

Should I use mouthwash?

The dentist may advise some people to use a mouthwash. This can help people who are more at risk of tooth decay or gum disease.

Mouthwash should be used at a different time of day to tooth brushing, unless your dentist gives different advice.

How to give mouth care

• You may find it easier to brush someone’s teeth by standing behind them, or to the side.
• Show the person you are caring for what you would like to do, using a toothbrush. A toothbrush is needed to clean teeth effectively.
• You can give the person a toothbrush to hold. This helps to prepare them for what is going to happen next.
• Brush where the teeth meet the gums and brush all tooth surfaces.
• Clean the tongue, starting at the back of the mouth and working forward.
• If gums bleed, keep brushing. Plaque has built up and needs to be brushed away. Plaque is a coating which forms on the teeth and contains bacteria.
• Clean between teeth every day.
• If the teeth are close together, use dental floss or tape if possible.
• If there are larger spaces between teeth, use interdental brushes, or special brushes with a small head of bristles.
• Spit out toothpaste foam after brushing – don’t rinse. This leaves some fluoride on the teeth, which helps to protect them from decay.
• Let the person you are caring for finish off tooth brushing if they can. They may be more likely to accept mouth care if they can take part in their own care.
• Be careful using mouth swabs: The foam end can come off if they are not used correctly. If you work for a care organisation, please check if swabs are allowed to be used.
• If you use a mouth swab, make sure that the end of the swab is firmly attached to the stick, and follow the manufacturer’s instructions for use.
• Do not use mouth swabs if the person you are caring for bites a toothbrush.

More techniques for giving mouth care

Reminding

The person you are caring for may start to brush if you hold the toothbrush and gently place it in their mouth.

Guided brushing

If the person you are caring for can help with tooth brushing, you can give them the brush to hold. Place your hand over theirs to guide them to brush.

Distracting

Music, or giving the person something to hold, like a towel, can help to distract the person and help make mouth care less frightening.

Rescuing

If one carer is having trouble giving mouth care, another carer can come in and ‘rescue’ the person from the first carer. The person may accept the new carer and agree to mouth care.

If there is no other carer, step out of the room, wait for a minute and then go back to the person. They may then be more open to accepting mouth care.

Denture care

• Ask the person you are caring for to take out their own dentures, if they can.
• To clean dentures, hold them over a bowl of water or a folded towel. This will protect them if they are dropped.
• Brush dentures with liquid soap or denture cleaner, because toothpaste can scratch dentures. Brush all parts of the dentures.
• Rinse the dentures in cold or warm water. Do not use hot water or bleach, which can damage them.
• Brush the tongue, gums and roof of the mouth with a toothbrush to keep the mouth healthy.
• Soak dentures often with denture soaking products.
• Take dentures out at night, so that the mouth and gums have a rest from them.
• When dentures are not worn, keep them in water so that they do not dry out and change shape.

Looking after your oral health

Brushing teeth helps to prevent tooth decay.

Brush your teeth twice a day, once before bed and at one other time.

Brush for 2 minutes using a family fluoride toothpaste. Spit don’t rinse.

Use:

• 1350ppm-1500ppm fluoride toothpaste
• Dental floss and interdental brushes (which clean in between your teeth).

Visit your dentist regularly, as often as recommended.

Tooth brushing helps to prevent gum disease. Bleeding gums can be an early sign of gum disease. If your gums bleed when brushed, keep brushing them. See your dentist if your gums continue to bleed.

Treating a dry mouth helps to keep your mouth healthy. Artificial saliva and other products are available. Please ask your dentist for advice about a dry mouth.

Frequent mouth care helps to prevent mouth infections.

A regular routine for mouth care i.e. time/place can be helpful for people with memory loss.

Food and drink for healthy teeth

Tooth decay is more likely if you often have sugary foods and drinks.

Drinks without sugar like milk or water help protect your teeth.

Savoury foods like vegetables, nuts and cheese are good for your teeth.

Reduce how often you have sugary foods/drinks. Try to keep them to mealtimes only.

Watch out for hidden sugars found in fruit juices, smoothies and sauces.

Visiting the dentist

Frequent checks by a dentist help to keep your mouth healthy. It is important to visit the dentist even if you wear full dentures.

The dentist will talk to you about how to keep your mouth healthy.

The dentist can check for tooth decay, gum disease and mouth infections.

They can also check for dry mouth, mouth cancer, and how well dentures fit.

It may help to visit the same dentist, if you have one you have visited before.

Oxfordshire Community Dental Service can provide NHS dental care for people with memory loss in clinics across Oxfordshire.

To access the service, you need to be referred.

The service receives referrals from general dental practitioners, other healthcare and social care professionals and secondary care.

Referrals into the service are sent to and processed by:

Email: Dental.referrals@oxfordhealth.nhs

Phone: 01865 904040

Oxfordshire Community Dental Service

Trust Headquarters

Littlemore Mental Health Centre

Sandford Road

Oxford

OX4 4XN

This service can also provide dental care at home and can help with emergency dental care.

Dementia advisors and information

Please contact Dementia Oxfordshire Support for further information:

www.dementiaoxfordshire.org.uk/

Email: info@dementiaoxfordshire.org.uk

Phone: 01865 410 210 9am—5pm Monday to Friday

For more information about memory loss, please visit:

Alzheimer’s Society

www.alzheimers.org.uk

NHS Choices

https://www.nhs.uk/conditions/dementia/

Knowing Me resource

www.oxfordhealth.nhs.uk/memory-concerns-and-dementia/your-services/