When people have Alzheimer's disease they are sometimes unable to accurately communicate their needs. Sometimes a reason for disturbed behavior can be that the person is feeling uncomfortable, is in pain or is just plain bored. So when we are giving care to someone with Alzheimer's, we should ensure that we have carried out basic nursing care first. Meeting the basic needs of the individual, such as washing, a healthy diet, toileting - including making sure they have regular bowel movements, etc., - is fundamental to having a settled day. Just as important is mouth care and oral hygiene.
Neglecting mouth care can lead to infection, poor food intake, health problems and can cause distress and discomfort that may then be exhibited in behavior changes and other psychological problems.
You have to remember that someone with Alzheimer's disease will have variable understanding of what is happening to them. The person requiring mouth care may not always be able to carry out your instructions.
As the caregiver you will need to help them:
- Get regular dental checkups.
- Help them carry out daily mouth care.
- Maintain the mouth care equipment.
- Make sure dentures are cleaned and that they fit properly.
It is important to encourage the person you are caring for to do as much as possible for themselves. Although this may be time consuming it helps maintain their skills and independence for as long as possible.
Overall the golden rules for carrying out oral hygiene are:
- Always tell the person what you are going to do.
- Keep sentences short.
- Talk in a gentle and reassuring way to help them relax.
- Never force the mouth open.
- Praise cooperation and make encouraging statements such as "That's great," "Your teeth look really clean now," "Does the toothpaste make your mouth feel fresh?"
Caregivers need to clean the person's teeth or dentures gently every morning, evening and after each meal. Use a soft toothbrush or electric toothbrush. Electric toothbrushes are great but may not be tolerated by someone who is confused or not used to the noise and vibration they produce.
Use a toothpaste the person likes the flavor of.
Mouthwashes are great for bacteria control and to leave the mouth refreshed. The problem is that you need the cooperation of the person with Alzheimer's so they do not swallow the mouthwash.
Remember some mouthwashes can cause discomfort especially if someone's mouth is sore. Try diluting the mouthwash with water, or using one teaspoon of bicarbonate of soda diluted in a cup of warm water or by changing the mouthwash brand.
Be gentle when you brush their teeth or gently move their lips to accommodate the brush or cup. Externally, the person's lips can be kept moist by using Vaseline, or a flavored lip balm.
If you are unable to examine the person's mouth or find the person is very uncooperative ask your dentist, doctor or a nursing professional for help.
Remember, someone with Alzheimer's may find it difficult to be in the position of being looked after and all that entails for his or her self image. Be gentle, be understanding. If the patient objects and is resistant when you begin their mouth-care stop and try again later.