Dr. Alisa Kaufman, a dentist specializing in geriatric care, shares her expertise to help caregivers become more confident in providing daily oral care to seniors — whether by brushing, flossing and using picks, or removing and cleaning full or partial dentures. Below is first in a two-part series of a caregivers guide to oral care.

Part One: A How-To Guide for Brushing Teeth of an Elderly Person

by Dr. Alisa Kaufman – Geriatric House Call Dentistry, an ALCA Corporate Partner

Due to the growing geriatric population worldwide, I decided to limit my practice of dentistry to the elderly and frail who are homebound. I have been practicing geriatric house call dentistry for almost 35 years and have decided to share my expertise with caregivers to help provide the necessary quality care to this under-served population.

With advanced training in geriatrics, hospice care, and all forms of dementia and Parkinson’s Disease, my goal is to triage the situation to ensure the patient is receiving proper nutrition for their overall health and to ensure that they are not having any pain stemming from their teeth or ill-fitting dentures.

Recently, I have solved the issue of how to treat these patients and revolutionized the field of home health care dentistry with my geriatric dental consulting practice. I want to share my expertise so that caregivers are more confident in daily oral care whether it is with brushing, flossing and using picks, or removing and cleaning full or partial dentures.

Individuals with Teeth

If you are the caregiver for your aging loved one or the other individual, you have a multitude of daily chores that are necessary to keep their quality of life up to par. You need to wash, toilet, and feed them daily. You also want to keep them stimulated so that they have something to do and something to look forward to every day. That is your responsibility. Life needs to continue, and everyone deserves to live their best lives.

One thing you do on your own since childhood is wake up and brush your teeth. And the last thing you do before going to bed (you should be doing this but not everyone was taught this ritual!) is to brush and, hopefully, floss your teeth. So why can’t we continue this daily routine forever?

Because this is one of the first chores neglected when, unfortunately, dementia or Alzheimer’s Disease occurs. And it isn’t easy to brush when you aren’t brushing your very own teeth and perhaps the person isn’t willing to cooperate. There are other diseases such as Parkinson’s and ALS that also make it difficult for individuals to brush effectively on their own.

Tools to Brush Their Teeth

• The Sponge – The sponge lollipop tool (usually used in the hospital) to clean the patient’s gums who have no teeth. Note: Only use this to clean the soft tissues in the mouth of those who have no teeth.
• Baby Toothbrush –The same toothbrush used on babies is effective yet gentle enough to use on the elderly.
• Adult Toothbrush – Always look for a toothbrush with extremely soft bristles like the baby toothbrush. And choose one where the toothbrush head has a cushion – called a tongue scraper – against the hard plastic in case they accidentally bite on it. You don’t want them to bite down and crack a tooth or break a filling.

How To Properly Brush Their Teeth

• You MUST brush their teeth every day, twice a day.
• Position the toothbrush so that the first row of bristles are touching below the gum line. There is a small “pocket” between your tooth and gum (you can feel that area in your own mouth with a toothpick) that needs to be cleaned. This is what prevents gum disease, also referred to as gingivitis (inflammation or the redness you see at the gum line that scares you when they bleed) that eventually progresses to periodontitis (gums bleed, teeth become mobile then painful and eventually fall out).
• Brush their teeth twice a day and use soft picks (if they allow) for food caught between teeth or under bridges. Flossing should be done but not if they don’t allow (you don’t want to get bitten). The individual floss swords are great, and I recommend them for those who allow you to help them. If they are grinding or physically hurting themselves by biting or sucking their cheek or lip, a dental evaluation is necessary so that this behavior can be modified to prevent further damage.
• You may or may not be able to incorporate a mouthwash or fluoride rinse. Remember: as soon as they start to swallow these, you MUST discontinue the products that cannot be swallowed and switch to those that can.
• Don’t stop brushing if you see the gums bleeding. If the bleeding is profuse (or perhaps they are on blood thinners), you must check with a dentist.
• Get a full set of X-rays taken before dementia progresses and if this already occurred get the newest ones taken from the last dentist visits. Either have them sent to you digitally or pick them up for safekeeping.

It’s important to brush even when it is difficult. Freedom from tooth pain or gum disease improves quality of life and keeps chewing and swallowing status quo. Food caught between the teeth is painful, and we use floss or picks when it happens to us. As a caregiver you need to be extremely proactive and help with this chore if you notice the individual picking at their teeth after a meal.

It saddens me to hear from the caregiver or family member the same story over and over again… the individual took impeccable care of their teeth diligently brushing, flossing, and six-month visits to the hygienist and dentist. Now they can’t do anything themselves and their mouth is FALLING APART! Please help! I hope this guide to oral care will help you in caring for the oral health of your aging loved one or client.

About the author: Dr. Kauffman limited her practice in 1995 to Geriatrics and is currently the Director of Geriatric Dental Care at three nursing homes. She also lectures in Geriatrics at Penn Dental Medicine and is the founder of the Dental LIFE program at the University of Pennsylvania School of Nursing.  Geriatric House Call Dentistry is  proud to be an ALCA Corporate Partner. Visit our website to learn more about our team, our dentists, and our resources: www.geriatrichousecalldentistry.com

Disclaimer: This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.