A guide to some of the common issues experienced
when providing oral care as a carer
Why oral care is important – Beating bacteria
When people are unable to manage their own oral care, they are reliant upon carers to implement effective dental hygiene routines for
them. Good oral health is critical to everyone’s overall well-being. The mouth is vital for eating, drinking, breathing and communication.
Poor oral health can lead to infections which left untreated can cause pain. Bacteria from gum disease can enter the bloodstream
causing blood poisoning and may also be related to other diseases such as heart disease, diabetes and pneumonia.
Taste
Smell
Touch
Sound
People with sensory processing issues can be overly sensitive to certain tastes, from cooking spices to minty toothpastes.
People may develop sensitivities during their life, possibly due to chronic conditions such as dementia or medication. Carers may therefore find that someone suddenly rejects a toothpaste they’ve used for years as they now find the taste too strong.
In circumstances where someone refuses to accept oral care, it can be extremely difficult to provide it, causing frustration and worry for the carer and a downward spiral for oral care provision and overall health. Finding a toothpaste that tastes good can be the key to them accepting oral care
People with sensory processing issues can be overly sensitive to certain smells, from minty toothpastes to scented shampoos. Taste and smell are closely connected. Your taste buds can identify basics such as salty, sweet, sour and bitter. But your sense of smell provides the rest of the input to notice flavour. That’s why smell can make a difference to people with taste sensitivities.
People may develop sensitivities during their life, possibly due to chronic conditions such as dementia or medication.
Carers may therefore find that someone suddenly rejects a toothpaste they’ve used for years as they now find the smell turns them off. In circumstances where someone refuses to accept oral care, it can be extremely difficult to provide it, causing frustration and worry for the carer. Finding a toothpaste that smells good can be the key to them accepting oral care
When providing oral care for others, its invasive nature may be a real problem for some. The size of brush head used can make a real difference as to whether a carer is able to persuade someone to allow a toothbrush in to their mouth. Then once in, it is easier to manoeuvre a small brush to clean effectively.
The texture of toothpaste used and the firmness of toothbrush bristles will also need to be considered.
A very firm toothpaste is likely to fall off the brush, limiting the effectiveness of the protective fluoride it contains. A low foaming toothpaste is easier for carers to use and probably means the paste won’t contain SLS (Sodium Lauryl Sulphate) which can cause dry mouth.
A manual toothbrush with compact soft to medium bristles is suitable for most people, but super soft bristles are kinder for those who:
- Are frail or suffering from dementia and reject or refuse oral care
- Have sensitive areas in their mouth due to gum disease or other infections
- Are suffering from dry mouth
- Have loose teeth
- Have sensitive teeth
- Where possible, making any oral care experience as pleasant as possible for a person is the best way to ensure they are happy to repeat it. As a carer, offering choice is key.
The noises associated with provision of oral care can be particularly distressing for someone with aural sensitivity. Of course this is most often linked to the sound of the dentist’s drill, but even the noise of bristles brushing against teeth may be a source of discomfort and stress to some.
Most electric toothbrushes are noisy to use and it can be difficult to find one suitable for these situations.
Ageing and the elderly
Elderly people may have problems managing their own dental
hygiene due to issues with dexterity. Long-term conditions such
as arthritis and Parkinson’s disease can make it harder to hold
and use a toothbrush and to go for dental treatment.
People now keep their natural teeth for longer, but this can
mean they need more complex dental care than people without
dentures. On the other hand, denture wearers are at increased
risk of chronic denture stomatitis, a common condition where
mild inflammation and redness of the oral mucous membrane
occurs beneath a denture.
Dry mouth (xerostomia) is a common complaint found often among
older adults, affecting approximately 20 percent of the elderly.
However, xerostomia does not appear to be related to age itself as
much as to the potential for elderly to be taking medications that
cause xerostomia as a side effect.
Saliva has many important functions including antimicrobial
activity, mechanical cleansing action, control of pH, removal of
food debris, lubrication of the oral cavity and remineralisation.
Dementia and Alzheimer’s
People living with dementia have a high rate of tooth decay and gum disease possibly because they find it difficult to perform their daily activities. Others may not be able to express that they have a toothache and leave problems untreated.
It is common for people with dementia to lose their sense of taste, so they tend to like strong tasting food, especially sweet food and drink, even if they haven’t liked it in earlier life. It’s important that people living with dementia receive the help they need to keep their teeth and gums clean and free of debris so that they can maintain their self-esteem and avoid pain and infections
