Recommendations for Carers - Caring for the oral health of Alzheimer's patients

Routines may need to change as Alzheimer's disease symptoms become more severe.

The patient may become more forgetful, confused or anxious when it comes to brushing their teeth. At this stage, the Old Grammar School Dental Surgery's guidance is given below:

• Guide the patient to the bathroom – it’s common for people with more advanced Alzheimer's disease to lose their way or become confused about where they need to go.

• A carer should always assist the patient with brushing their teeth twice daily

• If possible, we recommend rinsing Corsodyl mouthwash for 60 seconds before brushing – rinsing with mouthwash can help clear food particles from their mouth. Mouthwash isn’t a replacement for brushing but can be helpful at difficult times.

Twice daily oral hygiene routine for the health carer assistance of patient.

• Make sure your hands are clean. Wash your hands thoroughly first and wear disposable gloves to avoid risk of infection.

• Apply a pea-sized amount of fluoride toothpaste to a toothbrush. Press it well into the bristles so it doesn’t fall off – particularly if using an electric toothbrush.

• Stand to the side of the patient and hold the toothbrush. Preferably use an electric toothbrush.

• Use your fingers on one hand, that is not holding the toothbrush, to gently lift the resident's cheek away from their teeth and gums. This should make it easier for you to see inside the whole of their mouth as you brush.

• When a patient's teeth are brushed, there may be a lot of blood in their saliva and bleeding. NB This is a normal consequence of severe gingivitis and this should not stop a carer from brushing the patient's teeth.

• Brush the teeth and gums in a circular, ‘round-and-round’ motion not backwards and forwards.

• Make sure you brush the teeth from these different angles:

  • behind the teeth (the ‘inside’), with the toothbrush facing diagonally towards the gum

  • on the top (biting surface) of the teeth, with the toothbrush facing horizontally up or down

  • in front of the teeth (the ‘outside’), with the toothbrush facing diagonally towards the gum.

• Brush the top set of teeth for one minute (spend 30 seconds on each side of the mouth). Repeat this on the bottom set of teeth.

• Use the recommended interdental brush to clean in between teeth, if you are able to do this.

• Encourage the patient to spit out the toothpaste after brushing. They should not rinse with water or use mouthwash straightaway. This helps to keep fluoride on the surface of the teeth to protect them from decay.

Why are my teeth so sensitive?

Sensitive teeth are usually triggered with cold food (ice-cream) or drinks, or touch (toothbrush or fingernail) or sweet foods (chocolate). The pain is severe but only lasts for a few seconds. If you get pain that lasts longer than this and is triggered with hot things more than cold you have toothache not sensitivity! Sensitivity can be caused by exposing the more sensitive dentine on your teeth either by brushing too hard or drinking /eating too many acidic foods, fizzy drinks, white wine, fruit juice. The solution is to limit or exposing your teeth to acid attack, cleaning with an electric tooth brush and using toothpaste for sensitive teeth. Use the toothpaste as an ointment…rub it into the sensitive areas and leave it there.

If you find no improvement come and see us!

Dental floss is the Boss!

How to use dental floss

Dental floss is a thin, soft thread used to help eliminate any additional foodstuff in-between your teeth following brushing. If you find it difficult to use floss you can use dental tape which is thicker, but the main action of flossing is a firm but gentle stroking of the tooth from the top down. Try not to be too aggressive with the floss as this may harm your gums.

For the best result, break off about 45 centimetres of floss, and wind some around one finger of each hand. Hold the floss tightly between your thumbs and forefingers, with about an inch of floss between them, leaving no slack. Use a gentle ‘rocking' motion to guide the floss between your teeth, trying not to snap the floss into the gums.

When the floss reaches your gumline, curve it into a C-shape against one tooth until you feel resistance. Hold the floss against the tooth, gently stroking the side of the tooth, moving the floss away from the gum. Repeat on the other side of the gap, along the side of the next tooth.

When flossing, it’s always best to keep to a regular pattern. Start at the top and work from left to right, then move to the bottom and again work from the left to right. This way you're less likely to miss any teeth.

If you find flossing very tricky or don’t have nimble fingers then you may find the floss holders are useful and easier, although they are not as thorough as normal floss.

Similarly, to when you first use interdental brushes, when you first floss your gums may be tender and bleed a little, but this is all completely normal in moderation. Carry on flossing and your gums should become healthier after a few days and stop bleeding. If your gums are still regularly bleeding after a few days, contact your dental team and they can check if you’re flossing correctly.

Good dental health begins with you, by following these tips on how to brush in-between your teeth, and following our guide on how to brush your teeth properly, you can keep your mouth clean and healthy, reducing plaque build-up and gum disease. For any other questions at all, contact your local practice on reception@togsdental.co.uk and we’ll be happy to help.