Helping a person with dementia to clean their teeth is complex with lots of steps involved
To get the best cooperation possible you need to think about every step with the unique needs if your client in mind
If you make them feel safe and secure then you're sure to get a better result
So, let's break down the steps
The six steps to oral care are
choosing when to brush
choosing where to brush
setting up the room
brushing
rinsing
and
cleaning up
As the assistant to the person
you need to decide how many of these tasks you need to assist with
For instance
it's quite possible that once you set up then the person might be quite independent
or
you may need to direct the person through some of the steps or perform some of the tasks with them
try to establish a daily routine to reinforce patterns of behavior
patterns make it happen
but
oral care does not have to be after a meal or before going to bed
the best time it when the person is relaxed
and agreeable
as dementia progresses the person's understanding changes
places can become unfamiliar and can be confronting
the person may not recognise you
and spatial perception changes
so a white basin over a white floor will be hard for them to distinguish
so the place to brush needs to be familiar and comfortable
and that may not be always be the bathroom
sometimes the kitchen table can be a better choice if the bathroom is problematic
ask some simple questions to make this decision
can the person stand or sit comfortably in the bathroom at the basin
can they easily reach to pick things up
and can they spit into the basin
do they seem lost, unsure or worried when they're in the bathroom
if you're assisting can you fit in the room at the same time
and when in the room can the person see your face
if the bathroom satisfies all of these needs then make the bathroom setting one that makes them feel safe and comfortable
because bathrooms are generally cooler than the other areas
it's often important to warm them up
and to have good lighting
you may even suggest installing a heated light source or sensor light that goes on when they enter the bathroom
points of reference and familiar items can help orientate the person so consider items of interest such as indoor plants and colorful towels
Stale or offensive odours can make the bathroom unpleasant to be in so think about air freshners
bathrooms have many hard surfaces that can cause sounds to echo making it difficult to hear and concentrate
consider reducing noise level such as turning off the noisy extractor fan
or use of background music
you may need to contrast the color the hand basin with the surrounding bench and floor
this can be done with a non-slip mat on the floor
if the bathroom floor is cold then the non- slip mat with also make it cozier
the occupational therapist may have input to design grab rails
a non-slip surface for the whole bathroom or a call bell
make sure the mirror is at a good height but keep in mind that for some people mirrors can be confusing
they may not recognise themselves in the mirror which can be confronting
you may choose the kitchen table for brushing where there's no mirror
make sure you have all that you need for the job
choose a toothbrush that's colorful and a different colour to the hand basin or table
you may need a handle adaptor to make it easy for the client to hold the brush
and you may have a second brush to help protract the cheek
if you've chosen in the kitchen table you'll need a basin that the person can spit into and a box of tissues to wipe their lips clean
it's preferable for your clients to spit and not rinse out the toothpaste but some will insist on rinsing
use a plastic cup of water preferably a coloured one so they can easily see it
if the client likes to wear there glasses make sure they are on as well as hearing aids if necessary
if they're seated you might find a chair with arm rests gives them a bit more security and stability
you'll need toothpaste of course and then your're ready for action
a person with dementia is often sensitive to non verbal forms of communication
such as facial expressions and posture
they usually have increased sensitivity to the emotions of others
and progressively increase their use and nonverbal communication
so how does that help us with brushing teeth
well the key worker and needs to engage the client to start with
you can achieve this by using the preferred name at the start of your sentences
position yourself where they can easily see you
and give them a big smile so they make a good emotional connection with you
gentle touching is also a good way of engaging the client but make sure they are the type of person that doesn't mind being touched
now you only want to assist where assistance is needed
it may be enough to just set everything up
if not stop by finding out if they are right-handed or left-handed
and make sure they have the toothbrush in the correct hand
if they're struggling to use the brush
you may just need to sit opposite them and brush your own teeth
they can mimic you as you move around your mouth
once again the kitchen table may be easier than the bathroom if they need you to model for them
you can also try a hand over hand technique where the client has some control
and you're guiding them to make sure they clean effectively
if your client needs full assistance and resists you go back and think about how you set up the kitchen table or bathroom
with closer attention to the setting the client is more likely to feel secure and safe
if there is abrupt resistance to your help
stop
ease off and give the client time to relax
rethink how you can engage them
make them feel safe and able to accept your help
try mimicking toothbrushing using gestures
and encourage them to try again
if resistance persists
think about how you can approach oral care in a different way next time
you now have lots of ideas about how to make the setting an easier place to achieve oral care
not rinsing and just spitting out the toothpaste
maybe be a bit odd for some of your clients to accept
it's a good practice because the chemicals in the toothpaste are great for your mouth
and it's a bit of a waste washing it down the sink
if a client just can't get used to that
try and get them to wipe a little toothpaste on their front teeth after they rinse
you may also want a tissue handy if they spit without rinsing to wipe there lips and chin clean
that toothbrush is now full of bacteria so make sure it is thoroughly rinsed
and stored in an open container to dry
remember we're not just aiming to keep teeth clean
we're helping the person to have fresh breath improve self esteem and keep the person socially acceptable
a well informed enthusiastic care worker can empower their client to achieve this goal