Cleaning teeth

[PJS]

Hi all. My son is currently training to be a dentist and so i brought this feed to his attention. He has an interest is oral hygiene (or the lack of ) provided to those with dementia (his father has early onset and his grandma is in a CH). He is, frankly, quite horrified with some of the advice being given on this feed. He writes:
Whilst it can be accepted that the cleaning of teeth is incredibly difficult to do on someone else, especially someone uncooperative, the only way you will be allowed to do it is to persevere. Accepted, a soft brush may be better received, but a medium brush will give better results. Furthermore, a tooth paste with a high fluoride content (1450ppm) is essential to help prevent decay, and if you wish to use a mouthwash, get one with fluoride too (sage mouthwash will provide absolutely no benefit). The most efficient way of cleaning someone else's teeth is from behind. That way, motions are the same as for when you brush your own teeth.
It is very easy to shun this subject but an unhealthy mouth can lead to greater complications later on and can have a negative effect on well being.

 

[garnuft]

What advice is he 'horrified' about PJS?

It would be interesting to know what stance the Dental Association takes on treatment and their legal stance if it's invasive.

 

[DozyDoris]

How on gods earth can you force someone's mouth open who is refusing to cooperate???? Even if this was allowed it would be impossible and not everyone with a form of dementia would be persuaded.
I'm lucky with my Dad in that he is pretty chilled about accepting help, and he has dentures! I help him use mouthwash every morning and if the time comes we can't put them in then I won't and will work around that one

 

[Witzend]

Hi all. My son is currently training to be a dentist and so i brought this feed to his attention. He has an interest is oral hygiene (or the lack of ) provided to those with dementia (his father has early onset and his grandma is in a CH). He is, frankly, quite horrified with some of the advice being given on this feed. He writes:
Whilst it can be accepted that the cleaning of teeth is incredibly difficult to do on someone else, especially someone uncooperative, the only way you will be allowed to do it is to persevere. Accepted, a soft brush may be better received, but a medium brush will give better results. Furthermore, a tooth paste with a high fluoride content (1450ppm) is essential to help prevent decay, and if you wish to use a mouthwash, get one with fluoride too (sage mouthwash will provide absolutely no benefit). The most efficient way of cleaning someone else's teeth is from behind. That way, motions are the same as for when you brush your own teeth.
It is very easy to shun this subject but an unhealthy mouth can lead to greater complications later on and can have a negative effect on well being.

Well, I invite your son to kindly try persevering with anyone like my mother. How long has he got, every single day? It's one thing to give this sort of advice, quite another trying to do it on a daily basis when they just get incredibly cross and irritated, and the more you try, the more cross and irritated they are apt to get.

I do appreciate that it's important, and in a perfect world everyone with dementia would have perfect oral hygiene, but professionals need to understand the practical realities of living with dementia. All too often there is far too little understanding, not that I really blame anyone since I don't suppose many of us understood until we found ourselves living at the sharp end.

 

[grey bunker]

Hi

My wife age 59 will allow me to clean the front faces of her teeth but will not open her mouth wide enough for me to put the brush through the teeth and clean the rear faces.

I have thought about trying to use mouthwash but they all, including those for children, say avoid swallowing. How much is swallowing a health issue?

This has been going on for at least 2 years but no evidence of any mouth or teeth problems.

We have not been to the dentist in this time because I know that my wife will not agree to lying flat and tilting backwards let alone open her mouth as required.

What I find most frustrating is that for both teeth and eyes checking the only advice the AS provides is to talk to the professionals and in my experience this is a waste of time. Surely, the AS should speak to the professional bodies for dentists and opticians about these issues and designing procedures for people with dementia. Perhaps talking to the manufacturers of toothbrushes and paste etc would also be useful.

I had thought about finding out about what happens in the USA and will follow up on the suggestion made.

 

[rajahh]

I smiled at the prospective dentists horror!!!!

As others have posted he should come visit, and see just what is entailed.

Agression is the worst part of trying to get my husband to clean his teeth, and I have joined the ranks of those who just do not bother.

There are enough hassles every day, and at least he allows me to wash him when changing his pads and for this I am grateful.

Enough is enough

 

[garnuft]

I don't think it matters what happens in the USA grey bunker, unless you live there and even then each state has it's own rules.

Here in the UK we subscribe, quite rightly IMO, to the Human Rights Act.
And to forcibly hold someone's mouth open to brush their teeth is a step too far.

A step too far.
Notwithstanding the health implications, a step too far.

And happily the Law agrees with me.

p.s 'degradingly treated'.

 

[webcat]

..... and if you wish to use a mouthwash, get one with fluoride too (sage mouthwash will provide absolutely no benefit). ...

With all due respect I have to respond here, in fact sage has an enormous variety of health benefits which can easily be Google'd so I will say no more other than to quote:

"In Germany today, Sage is state licensed as a standardized tea to treat gastrointestinal complaints and night sweats. The tea is also approved as a topical rinse or gargle for inflammations. Sage is used in prepared German medicines for mouth and throat problems as well. Germany is the strictest country in the world regarding herb use. Herb use is regulated by drug companies and the German government."

Unfortunately all UK orthodox medical practitioners they have little or no training in any treatments or medicines other than that provided by the pharmaceutical industry and are woefully uneducated in many important areas of health. The important thing for me was that sage can safely be swallowed unlike all the high street chemical mouthwashes - especially those with very high fluoride content, when you look after a dementia sufferer you cant go pouring anything toxic into their mouths hoping they wont swallow it!

 

[tp18]

How bizarre!

Last week, I bought from ebay, a girls annual from my childhood (Dianna Annual 1976 - I was ten).

It has a doublepage spread (which I remembered instantly when I read it again for the first time in 37 years)....concerning the health and beauty attributes of certain herbs. It says, "Sage can bve powdered by placing the dried leaves under a sheet of paper and rolling with a rolling pin. The powder can be used as a teeth cleaner, placed on a dry tooth brush. A fresh sgae leaf rubbed on teeth leaves them feeling free of film, and often makes teeth a shade or two whiter"

 

[Saffie]

Accepted, a soft brush may be better received,

It was an experienced dentist who prescribed a soft brush as my husband's gums are sore and sensitive. Incidentally, I I've been given to understand form my own dentist that a softer brush is better for gums than a harder one and, with sensitive gums of my own, was advised to use one too.

I also think the sage mouth wash would be a good thing though I can't see the nursing home bothering wth it unfortunately. Many herbs have good medicinal properties, often overlooked by more orthodox practitioners. The fact that it can be swallowed has to make it preferable to other mouthwashes on sale for somebody with dementia.

I think that a in perfect world good oral hygiene is to be applauded, however a person with dementia lives in an imperfect world and all anyone can do is their best.

 

[Porscha]

You have to try your best to clean a Dementia patient's mouth/teeth, especially if they are in advanced/late stage of Dementia like my mom.

If you don't, then you are not only causing them to have serious dental health issues, but they may well be in pain and suffering even more as a result of tooth decay, and gum degeneration.

We been having many difficulties in cleaning my mother's teeth/mouth every night. But she is kind of accepting it now - though gentle force/pressure is needed!

Use:

Toothbrush: Sensodyne "Ultra Soft".

Toothpaste: Arm&Hammer Enamel Care, Sensitive. Or others by A&H. As they contain Baking Soda. Little on the brush goes along way in dissolving stains, deep cleaning teeth.

Hope this helps!

 

[garnuft]

You try cleaning my teeth when I don't want it.
I'll bite you.

We ALL know what's 'right' there's a difference.

Life has a habit of getting in the middle.

No, Dentist...NO carer....has a right to force the jaw open of a person....

EVEN if they die (?) of the consequences....

NO BODY.

Persuasion, yes.

Force? No.

Human rights, that everybody hates....well, I LOVE it.

It's what keeps you safe.

 

[My Mum's Carer]

My Mum's health recently took a turn for the worse so none of this really applies now but up until recently, my Mum didn't resist having her teeth cleaned but she didn't like opening her mouth properly so it was difficult to clean the back of her teeth. Last time we went to my Mum's NHS dentist, the dentist said she wasn't cleaning her teeth properly and prescribed some special toothpaste with extra fluoride. We have been using that since so hopefully that will help to keep her teeth cleaner and stop the build-up of plaque.

We have also always used mouth wash and I have always bought the non-alcohol ones so it wouldn't be a problem if she swallowed it instead of spitting it out.

I am not a dentist but I recently finished a nutrition course and part of it covered the effect of sugar on teeth. I wouldn't recommend pineapple or any other juice to clean teeth - in fact the sugar in all fruit juices (although natural fruit sugars) can cause tooth decay so could make the problem worse rather than helping. One thing we were told on my nutrition course was that if you had a lot of sweet food, say during a meal at a restaurant and you are unable to clean your teeth, a piece of cheese is good to eat. Eating cheese makes your mouth produce lots of saliva and the saliva contains things which stop the sugar depositing on your teeth and building up plaque (which is what leads to tooth decay) so that might be an alternative to cleaning someone's teeth or to give to someone after they've eaten lots of sweet food.

I agree completely that it is impossible to force someone to open their mouth so you can clean their teeth. If you fight with my Mum or try to get her to do something she doesn't want to do, it puts her in a bad mood for hours and that's no way to start or finish every day.

 

[Porscha]

You try cleaning my teeth when I don't want it.
I'll bite you.

We ALL know what's 'right' there's a difference.

Life has a habit of getting in the middle.

No, Dentist...NO carer....has a right to force the jaw open of a person....

EVEN if they die (?) of the consequences....

NO BODY.

Persuasion, yes.

Force? No.

Human rights, that everybody hates....well, I LOVE it.

It's what keeps you safe.

In our case, how can we persuade a patient in a state of severe dementia that cleaning her mouth is good hygiene! Or better, that opening her mouth for a rinse is good thing!

Communication is almost nil at this stage, so better to use a little force, than leave them as they are to suffer the consequences of not just bad breath, but serious teeth and gum disease

BTW, the carers we got, have their way of opening mother's mouth without much effort. You just have to learn the technique... my dear!

 

[garnuft]

I know the technique my dear.
I've been doing it for 20 years.

 

[webcat]

BTW, the carers we got, have their way of opening mother's mouth without much effort. You just have to learn the technique... my dear!

I don't know the technique, could you explain?

 

[DozyDoris]

This is an interesting debate!

Regardless of the HR Act using force on someone in this way could (please note I say could) constitute Common Assault. There is a very fine line that could be crossed here.

A human bite can be a very nasty thing. I guess physical prompting could be used to help open the mount but once met with any great degree of resistance then that has to be it.

Someone asked about swallowing mouthwash. It contains a small amount of alcohol, maybe this is why they say it should not be swallowed, and it probably wouldn't be great to drink a bottle If my Dad swallowed his I don't think I'd be too worried though.

One last thing (honest!) someone mentioned chewing gum. Apart from the mess I'd not want to give this to Dad in case of choking.

 

[susieq5000]

False teeth can be lost

Hi Can anyone give me any advise on how to clean my husbands teeth please? Since his diagnoses of dementia teeth cleaning has been a battle ground, he does not want to do it. His dentist has spoken to him and now he has been referred to the hospital dentist for some extractions. The dentist there said I should clean his teeth for him using an electric brush, but he wont cooperate. Says I hurt him, but I cant see what I am doing as he hardly opens his mouth.
I am finding things diffcult enough without this. We did ask if they would remove all his teeth whilst he was there (they are taking 6 out) but he still has some good front ones so they said no.

My mother had her teeth out when I was 4 - I am now 60. She now has Altzeimer's and my father has been coping with the war of the missing teeth for 4 years! Mum refuses to put her teeth in as they "hurt". Gums recede as we get older so the teeth can become ill-fitting but the major problem was Mum taking them out (sometimes in a restaurant). She would sit holding them or place them on the table to Dad's extreme embarassment. Twice the teeth went walkabout & after ordering a new pair (£100 +)Mum refused to put them in anyway!! Now all food has to be soft & takes on average 45minutes for her to eat. (Needs to be reheated in microwave) Weight loss has been a worrying problem for my 86 year father. Any advice on this?
I'd say keep whatever teeth the sufferer has for as long as possible!

 

[gardengirl]

cleaning teeth!

Have the same problem, looks as though you are not alone! The love of my life tightens his lips around his teeth, but I manage to prise his mouth open with two fingers and juggle the electric toothbrush inside with the other hand. The dentist/hygenist recommended duraphat 5000 which has a high concentrate of flouride - only given on prescription. It is a trick, but keep on, you will find a way - my voice suggesting he'll lose the award winning smile if I don't clean his teeth usually works. Hygenist also suggested placing a child's toothbrush inbetween top and bottom teeth giving him something to bite on to keep the mouth open, giving the opportunity to clean teeth with your electric toothbrush! All advice is welcome - give it a go!!

 

[Porscha]

I don't know the technique, could you explain?

Sorry if I cannot explain the exact way they do it. But as I see it, wearing proper gloves - of course - the nurse would insert her index finger at one end of the mouth (lips), slowly, with soothing/calming words (to avoid panic reaction). Once about half the finger, no more than that, is in, mouth half opens.

Brush with paste on hand, ready to be inserted instantly. While mother may show some resistance, like biting on the brush (not the handle!!), combination of kind/comforting words - as I say - along with slow, no force, move of the brush along the teeth surface, then gum line.

Cleaning of back (inner side) of teeth is not possible, far as I see it. Unless one is willing to use force on the patient, which is neither acceptable nor tolerated, by us, the carers of my mother.

Hope this is of some help!