Family Caregiving: How Do You Brush Someone Else’s Teeth?

correct_tooth_brushing_technique

Two recent articles brought to my attention the importance of oral hygiene for the people we care for. The first is major exposé in The New York Times (08/06/13) entitled “Nursing Homes Neglect Teeth,” and the second is a new research report from Medical News Today (07/31/2013), “Alzheimer’s Disease Linked to Poor Dental Health.”

I’ve been aware for a long time that keeping care of your teeth and gums is essential to good health, in fact, gum disease is a contributing factor to heart disease. But, I’ve only thought of this in terms of myself.

I began to wonder just how would you brush someone else’s teeth if they couldn’t do it for themselves? I found an answer to this problem at a booklet for professional caregivers published by The National Institute of Dental and Craniofacial Research. I’ve adapted it for family caregivers below:

A Family Caregiver’s Guide to Brushing Your Loved One’s Teeth

As a family caregiver, you play an important role in maintaining the oral health of your family member.  Helping someone with brushing and flossing, however, isn’t always easy.  But there are steps you can take to make daily dental care a good experience.

The key ingredients are patience and preparation:  pick a place in the house where the person is comfortable; allow time for him or her to adjust to the dental care; have a set routine; and reward cooperation.

Remember, a healthy mouth can make a big difference in the quality of life for the person in your care.

Getting Started

Location. The bathroom isn’t the only place to brush someone’s teeth. For example, the kitchen or dining room may be more comfortable. Instead of standing next to a bathroom sink, allow the person to sit at a table. Place the toothbrush, toothpaste, floss, and a bowl and glass of water on the table within easy reach.

No matter what location you choose, make sure you have good light. You can’t help someone brush unless you can see inside that person’s mouth. 

Behavior. Problem behavior can make dental care difficult. Try these ideas and see what works for you.

  • At first, dental care can be frightening to some people. Try the “tell-show-do” approach to deal with this natural reaction. Tell your care recipient about each step before you do it. For example, explain how you’ll help him or her brush and what it feels like. Show how you’re going to do each step before you do it. Also, it might help to let your client hold and feel the toothbrush and floss. Do the steps in the same way that you’ve explained them.
  • Give your family member time to adjust to dental care. Be patient as that person learns to trust you working in and around his or her mouth.
  • Use your voice and body to communicate that you care. Give positive feedback often to reinforce good behavior.
  • Have a routine for dental care. Use the same technique at the same time and place every day. Many people with developmental disabilities accept dental care when it’s familiar. A routine might soothe fears or help eliminate problem behavior.
  • Be creative. Some caregivers allow their care recipient to hold a favorite toy or special item for comfort. Others make dental care a game or play a person’s favorite music.

Positioning Your Body

Keeping people safe when you clean their mouth is important. Experts in providing dental care for people with developmental disabilities recommend the following positions for caregivers:

sitbehindMale2

If the person you’re helping is in a wheelchair, sit behind it. Lock the wheels, then tilt the chair into your lap.

standbehindFemale2

Stand behind the person or lean against a wall for additional support. Use your arm to hold the person’s head gently against your body.

Bush Every Day

Angle the brush at the gumline and brush gently.

Angle the brush at the gumline and brush gently.

  • First, wash your hands and put on disposable gloves. Sit or stand where you can see all of the surfaces of the teeth.
  • Be sure to use a regular or power toothbrush with soft bristles.
  • Use a pea-size amount of toothpaste with fluoride, or none at all. Toothpaste bothers people who have swallowing problems. If this is the case for the person you care for, brush with water instead.
  • Brush the front, back, and top of each tooth. Gently brush back and forth in short strokes.
  • Gently brush the tongue after you brush the teeth.
  • Help the person rinse with plain water. Give people who can’t rinse a drink of water or consider sweeping the mouth with a finger wrapped in gauze.

Floss Every Day

Flossing cleans between the teeth where a toothbrush can’t reach. Many people with disabilities need a caregiver to help them floss. Flossing is a tough job that takes a lot of practice. Waxed, unwaxed, flavored, or plain floss all do the same thing. The person you care for might like one more than another, or a certain type might be easier to use.

Use a string of floss 18 inches long. Wrap that piece around the middle finger of each hand.

Use a string of floss 18 inches long. Wrap that piece around the middle finger of each hand.

Grip the floss between the thumb and index finger of each hand.

Grip the floss between the thumb and index finger of each hand.

Start with the lower front teeth, then floss the upper front teeth. Next, work your way around to all the other teeth.

Start with the lower front teeth, then floss the upper front teeth. 

Next, work your way around to all the other teeth. Work the floss gently between the teeth until it reaches the gumline. Curve the floss around each tooth and slip it under the gum.
Slide the floss up and down.

Do this for both sides of every tooth, one side at a time. Adjust the floss a little as you move from tooth to tooth so the floss is clean for each one.

If you have trouble flossing, try using a floss holder instead of holding the floss with your fingers.

If you have trouble flossing, try using a floss holder instead of holding the floss with your fingers.

Regular Dentist Visits

Your family member should have regular dental appointments. Professional cleanings are just as important as brushing and flossing every day. Regular examinations can identify problems before they cause unnecessary pain.

As is the case with dental care at home, it may take time for the person you care for to become comfortable at the dental office. A “get acquainted” visit with no treatment provided might help: The person can meet the dental team, sit in the dental chair if he or she wishes, and receive instructions on how to brush and floss. Such a visit can go a long way toward making dental appointments easier.

Prepare for Every Dentist Visit

Be prepared for every appointment. You’re an important source of information for the dentist. If you have questions about what the dentist will need to know, call the office before the appointment.

  • Know the person’s dental history. Keep a record of what happens at each visit. Talk to the dentist about what occurred at the last appointment. Remind the dental team of what worked and what didn’t.
  • Bring a complete medical history. The dentist needs each patient’s medical history before treatment can begin. Bring a list of all the medications the person you care for is taking and all known allergies.
  • Bring all insurance, billing, and legal information. Know who is responsible for payment. The dentist may need permission, or legal consent, before treatment can begin. Know who can legally give consent.
  • Be on time.

Brushing and flossing every day and seeing the dentist regularly can make a big difference in the quality of life of the person you care for. If you have questions or need more information, talk to a dentist.

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