Helping Someone Else With Their Teeth

At some point the job changes hands. A parent who has brushed their own teeth for eighty years stops managing it, and somebody else has to. Usually a son or a daughter, usually with no instructions, usually working it out alone in a bathroom at ten at night.

This page is for that person. There is a one-page version you can print at the end, and we keep copies at the front desk.

Why it matters more than it used to

The mouth you are now looking after is not the mouth that person had at fifty. Gums have receded, and the root surface underneath has no enamel on it, so it decays faster. Medications have reduced saliva, which was the mouth’s own defense. Old fillings and crowns are reaching the end of their lives.

Which is why decay arrives again late in life, and why it can move quickly once it starts. The full version of that story is here.

There is also a reason that has nothing to do with teeth. When someone is frail, or in bed, or has trouble swallowing, they aspirate what is in their mouth. A study across eleven nursing homes assigned 417 patients to receive daily mouth care or not, and pneumonia, days with fever and deaths from pneumonia all fell significantly in the group whose teeth were cleaned. It helped people with teeth and people without them.

Yoneyama T, Yoshida M, Ohrui T, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc. 2002;50(3):430-3.

That is worth saying plainly to anyone who feels like brushing someone else’s teeth is a small, undignified job. It is not a nicety. It is part of their medical care.

Setting up

• It does not have to happen in the bathroom. Set up wherever the person is most comfortable and relaxed. A chair in good light is often better than a sink.
• Find a position that works for both of you. Seated in front of them, standing behind, or off to one side all work. Comfort matters more than technique, and a position you can hold for two minutes without aching is the right one.
• Have them sit up, and put a towel across their chest.
• Gather everything before you start. Wash your hands or wear disposable gloves.

The brush

• Use a soft brush. A children’s toothbrush with soft bristles is often easier to get into a mouth and more comfortable on receded gums than an adult brush.
• Long handles and angled heads are easier to control when you are reaching into someone else’s mouth rather than your own.
• Electric brushes help some people and upset others. The vibration and noise can be distressing for someone with dementia. Try it, and do not persist if it goes badly.
• If brushing is refused entirely, gum and tooth wipes are better than nothing. Something beats nothing on every day of this.

Doing it

• Tell, show, do. Say what you are about to do, show them, then do it the same way you described it. Being surprised by a hand near your face is what most resistance is actually about.
• One short instruction at a time. “Hold your toothbrush,” then “open,” rather than “go and brush your teeth.” A single long instruction can be too many steps at once.
• Hold the brush at about 45 degrees to the gums and brush gently. Include the gums, the tongue and the roof of the mouth.
• If swallowing is difficult, skip rinsing and wipe the mouth out with wet gauze or a soft cloth instead.
• Twice a day, and make the last one count. Do it after the final meal or liquid medication of the day. Many liquid medications are sweet, and anything left on the teeth overnight sits there with no saliva to wash it away.
• If they are upset, stop. Try again in twenty minutes or at the next natural moment. Forcing it teaches them to fight you tomorrow.

Between the teeth

• Floss picks are far easier than string floss when you are doing it for somebody else. Two hands and a mirror are hard enough on your own teeth.
• Interdental brushes, the small ones that fit into the spaces, work well and are often easier again.
• A water flosser suits some people, particularly where hands are unsteady.

If they wear dentures

• Rinse them with plain water after meals.
• Brush them daily with a denture brush and denture cleaner, not regular toothpaste, which is too abrasive and scratches the surface.
• Out at night, stored in water or denture solution. Tissue needs the rest, and sleeping in dentures raises the risk of sore spots and infection.
• Brush the gums, tongue and roof of the mouth even when there are no natural teeth left.
• A denture that has gone loose, or causes a sore spot, needs looking at rather than gluing. Ridges shrink over the years, and adhesive applied to a denture that no longer fits hides the problem rather than solving it. More about dentures here.

Dry mouth

Almost everyone taking several medications has a dry mouth, and it is the single biggest driver of decay in an older person. It often does not feel like thirst, so nobody mentions it.

• Sips of water through the day, and no sugary drinks between meals. Sipping juice or soda all afternoon is worse than drinking it at once.
• A dry-mouth gel or spray at bedtime, which is when saliva is lowest.
• Avoid alcohol-based mouthwashes, which make dryness worse.
• There is a great deal that can be done about this, and the long version is here. There is also a printable dry mouth sheet.

What to call us about

Most of what you will notice can wait for the next visit. These are the ones that should not:

• A tooth that has broken or chipped.
• A sore, ulcer or white patch that has not healed within two weeks.
• Bleeding gums, which are not normal at any age.
• A loose or painful denture.
• Facial swelling, or a bad taste that will not go away.
• Any change in what they are willing to eat.

When they cannot tolerate treatment

Families often stop asking because they assume the answer is no. Somebody cannot sit through a long appointment, cannot manage the drill, cannot cope with the whole business of it, and so nothing gets done at all.

There is more available than people expect. Decay can sometimes be arrested where it is, with a medication painted onto the tooth, no anesthetic and no handpiece. Treatment can be simplified and staged. The goal shifts from ideal to durable, and from perfect to comfortable.

“He will not sit for it” is the start of a conversation, not the end of one. It is worth a phone call before deciding nothing can be done.

Print it and put it on the fridge

We made a one-page version for exactly this. Print it, or ask at the front desk and we will give you one.

And if you are caring for someone and are not sure where to start, call us at 702-734-0776. We do not make hospital or care facility visits, but we can tell you what matters most for the person you are looking after, which is usually a shorter list than you would think.

Guidance in this article is adapted in part from the Alzheimer’s Association’s caregiver dental care recommendations. General information, and not a substitute for an exam.

Common Questions