For many families, the first hint of a dental problem in someone with dementia is not a complaint of toothache. It is a parent who pushes dinner away, pulls at one cheek, or becomes agitated at the bathroom sink. As dementia progresses, people often lose the habit and the hand skills for brushing, may resist help, and can stop telling anyone that something hurts, so decay and gum disease can move quickly and quietly.
Carers cannot fix all of that, but a short, calm routine and a few changes in technique go a long way.
Pain often shows up as behaviour
When someone can no longer describe pain, watch for what they do instead. Signs worth acting on include:
- wincing or grimacing while eating, or refusing food they used to enjoy
- pulling or rubbing at the face, jaw or mouth
- new bad breath, or a swollen cheek or gum
- taking dentures out and refusing to put them back
- restlessness, poor sleep or aggression with no other obvious cause
Any of these, or a broken tooth, sore spots under a denture or a sudden change in eating, is a reason to book a dental review.
Why the mouth is harder to keep healthy
A 2018 systematic review in Clinical Oral Investigations (Delwel and colleagues, 36 studies) found that older people with dementia often had high levels of plaque, gum bleeding and gum disease, and frequent problems with the soft tissues of the mouth, such as thrush and sore patches, as well as reduced saliva flow. Much of this comes back to plaque not being cleared each day.
Medicines add to the problem. Many medicines used in later life can reduce saliva, and saliva is the mouth's main natural protection against decay. With a dry mouth, decay often starts on the roots of teeth where the gums have receded. Our article on dry mouth and Sjögren's syndrome explains why saliva matters so much.
Dentures bring their own issues. They get lost, broken or left in overnight, and a denture worn all the time can lead to soreness and fungal infection underneath. Our guide to denture stomatitis covers what to look for.
A routine that avoids a daily battle
Choose the time of day when the person is usually most relaxed, and keep it the same. Use the same room, the same few words and the same order of steps. Familiarity tends to lower resistance more than explanation does.
Approach from slightly to the side and at eye level rather than face-on, which feels less confronting. Two techniques are worth trying:
- Chaining: you start the brushing and let the person take over and finish, so they stay involved.
- Hand over hand: your hand rests over theirs and gently guides the brush.
Work in short bursts. If the person becomes distressed, stop and come back later, or try another time of day. A partial clean done calmly is better than a full clean done by force.
Tools that do more of the work
A soft brush with a small head reaches the back teeth with less effort. An electric brush can help if the person tolerates the noise and vibration; if not, a manual brush is fine. Use a fluoride toothpaste, and ask the dentist whether a higher-strength fluoride toothpaste would help, as these are often recommended when decay risk is high. If foam causes coughing or upset, a low-foaming toothpaste can be easier.
For a dry mouth, regular sips of water, sugar-free lozenges where it is safe to use them, and saliva substitute gels can make eating and wearing dentures more comfortable. Take dentures out at night, clean them, and check the gums underneath for redness or sore spots. Gums that bleed when brushed are a sign that plaque needs more attention, not that brushing should stop; see bleeding gums when brushing.
Mouth care and chest infections
You may hear that good mouth care prevents pneumonia in older people. The link is plausible, because bacteria from the mouth can be breathed into the lungs, but the evidence is less certain than it sounds. A 2022 Cochrane review (Cao and colleagues) of oral care in nursing homes found low-certainty evidence that professional oral care may reduce deaths from pneumonia, while its effect on preventing pneumonia itself remained largely unclear. Daily mouth care is still worth doing for comfort, eating and preventing dental pain, and any possible benefit for the chest is a bonus.
Plan dental care early
The most useful step is often the earliest one. While the person can still cooperate with a check-up, a dentist can find and treat small problems, remove teeth that are likely to cause trouble later, and set up a prevention plan with fluoride and regular cleans. That is far easier than treating a painful abscess in someone who can no longer sit still for treatment.
When booking, ask for short appointments at the person's best time of day, bring a familiar carer, and tell the team about the diagnosis and anything that upsets them before you arrive. How often to come back depends on the person's decay risk, and the dentist or OHT will suggest an interval. If travelling to a practice becomes too hard, ask about domiciliary or special needs dental services. People with Parkinson's disease face some similar challenges; our article on Parkinson's disease and oral care has more.
Costs to plan for
A check-up and clean in Sydney typically costs $200 to $400 at private practices. This is a general market range, not a Lumi Dental fee. Denture repairs, relines and other treatment vary with what is needed. Our dentists and oral health therapists at Lumi Dental in Melrose Park can plan care around the person's needs, and after an examination you will usually receive a written treatment plan, often by email. You can see current offers on our current deals page or read about routine care with a general dentist.
What carers ask us
My mother refuses to let me brush her teeth. What can I do?
Do not force it. Stop, try again later, change the time of day, and try chaining or hand over hand. Keep sessions short. A dentist can also suggest products such as higher-strength fluoride toothpaste that protect teeth even when brushing is not perfect.
Should dentures stay in overnight?
Generally no. Taking them out at night lets the gums rest and makes it easier to clean both the denture and the mouth. If removing them causes distress, talk to the dentist about a plan that works for the person.
Is an electric toothbrush better?
It often does more of the work, which helps, but only if the person accepts the noise and buzzing. A soft manual brush used gently is perfectly good.
This article is general information and does not replace individual dental and medical advice for the person you care for.
