Combining Dementia Care and Dental Care

During late-stage dementia, people can’t communicate verbally, their mobility is affected, and they lack any independence. “Sometimes, they no longer tolerate their own dentures,” Arsenault says.

Even if someone with dementia can’t communicate how they feel, Arsenault recommends watching for key signals that their teeth or mouth need professional attention.

• Changes in eating habits. “They refuse certain foods,” Arsenault says. “They don’t want certain foods: anything hard, anything cold, anything hot.” They might change to a completely soft diet or stop eating altogether.
• Visible facial or oral changes. “You might see some external swelling,” she explains. Inflammation, bleeding, or loose teeth might be visible inside the person’s mouth.
• Bad breath, or worsening bad breath. “Once there’s an infection, bad breath gets a lot worse,” Arsenault says.
• Slapping or tugging at their face “because they want to get rid of the pain,” she explains. “They’re going to be rubbing their cheeks and mouth.”
• Irritability and restlessness.

When caretakers notice these signs, they should check in with a dental professional. “There’s really no harm or foul in picking up the phone and calling the patient’s dentist and explaining some of the changes you’ve observed,” Arseanault says. “The dentist will make a decision about having the individual come in.”

She recommends taking pictures of the person’s mouth with a cell phone and sharing them with the dentist. “There are even special devices that can be mounted to a cell phone, allowing you to open the person’s mouth and take a really good picture,” Arsenault adds. 

A Successful Dental Visit

To ensure that a trip to the dentist goes well, Arsenault recommends that caretakers:

• Vet a new dentist ahead of time, seeking a small, quiet practice. “Ask them what their experience is working with these individuals; some will be reluctant to treat them and will recommend someone else,” Arsenault says. “Others will be grateful to work with you and the patient.”
• Take a dementia patient to the dentist themselves, rather than someone unfamiliar taking to the patient.
• Streamline the process: fill out paperwork ahead of time and call the office upon arrival, such as from the parking lot, to bypass the waiting room.
• Be mindful of physical comfort: “Taking a warm blanket or a favorite sweater is very important, because dementia patients don’t like the cold,” Arsenault says.
• Consider whether music or white noise might help the person and have it on hand.

Dementia at a Distance

Not every family lives near a loved one with dementia, and can’t assess them in person or take them to the dentist. Arsenault encourages families to communicate their dental care expectations with local caregivers and ask them to keep a log.

It’s also important to understand how familiar and comfortable hired caregivers are with home dental care. If they aren’t, “bring the dentist or a member of the dental team in to work with the caregiver and provide hands-on techniques,” she says.

In all stages of dementia, Arsenault suggests knowing what medications your loved one takes and telling the dentist.

Older adults are more likely to take medications that cause dry mouth, which “makes it more difficult to speak, to swallow, to retain dentures,” she says. Dry mouth also contributes to cavities, particularly for people who need help with oral hygiene. 

In cases where individuals with dementia are no longer able to make informed dental care decisions, there are legal frameworks, such as a durable power of attorney for health care or a health care proxy, to manage how those decisions are made.

Primary-care physicians and other members of the patient’s health-care team should also be consulted as necessary.

Arsenault encourages all caregivers to cultivate a calming presence while helping a dementia patient with their routine and emergency dental care. “Always be very calm,” she says. “Always be reassuring.”